I came across a very interesting article in Reuters titled: ‘Medically-tailored meal delivery tied to lower health spending’. It had analysed a great study in JAMA Internal Medicine by Seth Berkowitz MD et al.
As an Internal Medicine Hospitalist, I have encountered many patients with Congestive Heart Failure (CHF) and of course those with multiple readmissions for a CHF exacerbation. I recall treating an elderly obese Hawaiian woman who had impressive 3 plus pitting edema and tree trunk style legs. She was being cared for at a large hospital in Oahu, Hawaii.
What is the link between CHF exacerbation and highly processed and canned food?
On review of her medical records, I noted that she had multiple readmissions, and it was always toward the end of each month. I felt this was a rather interesting phenomenon! On further questioning, during my initial interview with her, she told me that food was expensive. I would have to agree with her as most meat and fresh vegetables had to be imported in on a ship.
Poverty and dietary indiscretions:
She stated that by the middle of the month, she had run out of her social security check and she would then start to use her food stamps. She would buy items that were non-perishable like canned vegetables, spam (highly processed pork) and rice. One can of spam would be ⅓ of a ‘normal persons’ daily allowance of salt. The average person in USA per JACC (Journal of American College of Cardiology) eats around 3,400 – 3,700 mg of sodium per day. Daily recommendation is around 2000 mg per day. Per AHA a heart failure patient should preferably eat around 1500 mg- 2,000 mg sodium per day.
The Hospital sees a payment reduction due to the 30 day hospital readmission:
Poor lady! Due to her poverty, she was binging on salt towards the end of the month. She could not afford fresh meat and vegetables. She would then find herself short of breath with worsening leg swelling and come to the hospital for her usual IV lasix and intensive diuresis. Due to her dietary indiscretions exacerbated by her poverty, she was becoming a burden to the hospital (the hospital will be dinged for her readmission if it was before the 30 days and would get a lower payment for her admission) and her health insurance.
The costs of healthcare were lowered by 16%:
This retrospective analysis over a 3 year period in JAMA highlights the importance that food is medicine. Monitoring and managing one’s diet is essential in the control of one’s medical issues. It uses this study to highlight that eating food that is tailored to your medical needs will lower your readmission rates to a hospital and skilled nursing facility. The most fascinating part of the study is that the costs of healthcare were lowered by 16%. The health insurance (medicaid 54%, medicare 20%, private 12% and other 12%) paid for the medically tailored meals and were still able to save money! This is not rocket science, it makes sense, but it is wonderful to see a study that shows the evidence.Tweet