Health systems facing financial penalties for hospital readmissions are examining new ways to impact patient outcomes once they leave the hospital. One area that is showing promise is intervening with patients who have food insecurities.
In an Oct. 28 webinar presentation sponsored by America’s Essential Hospitals and the Social Interventions Research and Evaluation Network (SIREN), Larry Altier, system director for food and nutrition services at Lee Health System in Fort Myers, Fla., described his health system’s journey in helping meet the nutritional needs of patients.
Altier first spoke about demographics, noting that 48 percent of the health system’s patient population is 65 or older. And that age group has a higher propensity to be malnourished. In Florida more generally, 23 percent of the population is over the age of 60 and up to 50 percent of older adults are at risk for malnutrition. “Malnutrition is a key health indicator for older adults in Florida,” he said.
People with food insecurity have higher rates of diabetes and hypertension, he noted. They are two to three times more likely to have surgical-site infections, and their hospital stays average 12.6 days in hospital vs. 4.4. for other patients.
Lee’s journey began in 2013, Altier said. “We recognized we had a patient who could not attain food. Meals on Wheels in our area has a 1,500-person waiting list, so he couldn’t turn there. We began to prepare meals for him for four to five weeks,” he explained. “The experience with that patient made us realize this is a bigger issue than a single patient. We began taking a proactive approach to addressing malnutrition in the elderly. So we are helping get them from acute care to self-care while at home recovering from an ailment.”
The formalized program, Flavor Harvest@Home, is sponsored by AARP, and is a clinical nutrition therapy program designed to counter the adverse impacts of malnutrition through improved identification, clinical care and post-discharge nutrition support.
The program involved several process changes. Staff members are educated to identify malnutrition indicators. Registered dietitians do screening/assessment protocols. Lee created best-practice alerts in the Epic EHR that warn the physician that the patient in front of them is at risk.
Once a patient qualifies and the clinicians order the service, post-discharge they receive nutrient-dense meals delivered to their homes for up to 28 days free of charge. The program features on-demand consultation with a registered dietician any time. A 30-day post-discharge evaluation assesses the program’s impact on outcomes.
Altier shared some clinical outcomes for fiscal 2017-2018. There were 28,879 patients screened. Of those, 19 percent or 5,495, were identified as malnourished. Of those, 2,689 patients signed participation agreements.
Of those, 1,352 received four weeks of meals. The health system analytics team found that patients who are malnourished and receive four weeks of Flavor Harvest@Home meals are 30 percent less likely to be readmitted compared to patients who are malnourished and did not receive any meals from FHH or did not complete the program.
Based on the clear return on investment both in terms of patient outcomes and finances, Lee is planning to expand the program to the ambulatory setting, Altier said.
During the same webinar, Emilia De Marchis, M.D., an assistant professor in the University of California, San Francisco’s Department of Family and Community Medicine, discussed a paper she co-authored offering a systematic review on 30 research studies on healthcare-based food insecurity interventions. While some showed early evidence of positive impact, many of the studies involved small sample sizes and had no control groups. “There is a need for more high-quality studies about which interventions work,” she said, adding that there also needs to be work done to develop common language to describe program elements and consistent measures across studies.
