Department of Medicine, Division of Geriatrics, Hospice and Palliative Care, University of California, Davis, California, USA.
Institute for Health Research, Kaiser Permanente of Colorado, Aurora, Colorado, USA.
J Hosp Med. 2023 Jul;18(7):576-587. doi: 10.1002/jhm.13084. Epub 2023 Mar 28.
Medically tailored meals (MTM) may be beneficial to patients after hospital discharge.
To determine if 2 versus 4 weeks of MTM posthospitalization will improve patient outcomes.
Randomized unblinded trial.
Six hundred and fifty patients pending hospital discharge with at least one chronic condition.
One MTM a day for 2 versus 4 weeks.
The primary outcome was a change from baseline to 60 days in the Hospital Anxiety Depression Scale (HADS). Secondary outcomes measured change in the Katz activities of daily living (ADLs), DETERMINE nutritional risk, and all-cause emergency department (ED) visits and rehospitalizations.
From baseline to 60 days the HADS anxiety subscale changed 5.4-4.9 in the 2-week group (p = .03) and 5.4-5.3 in the 4-week group (p = .49); the difference in change between groups 0.4 (p = .25). HADS changed 5.4-4.8 in the 2-week group (p = .005) and 5.3-5.1 in the 4-week group (p = .34); the difference in change between groups 0.4 (p = .18). ADL score changed from 5.3 to 5.6 in the 2-week group (p ≤ .0001) and 5.2-5.5 in the 4-week group (p ≤ .0001); the difference in change between groups -0.01 (p = .90). The DETERMINE changed in the 2-week group from 7.2 to 6.4 (p = .0006) and from 7 to 6.7 in the 4-week group (p = .19); the difference in change between groups 0.5 (p = .13). There was no difference in ED visits and rehospitalizations between groups or time to rehospitalization.
Different durations of short-term MTM did not affect patient-centered or utilization outcomes.
医疗定制膳食（MTM）可能有益于出院后的患者。
确定住院后接受 2 周或 4 周 MTM 是否会改善患者的预后。
随机非盲试验。
650 名即将出院且至少有一种慢性病的患者。
每天接受 1 份 MTM，持续 2 周或 4 周。
主要结局是从基线到 60 天，采用医院焦虑抑郁量表（HADS）评估的变化。次要结局包括 Katz 日常生活活动（ADL）、DETERMINE 营养风险以及全因急诊就诊和再入院的变化。
从基线到 60 天，2 周组 HADS 焦虑分量表的变化为 5.4-4.9（p = .03），4 周组的变化为 5.4-5.3（p = .49）；两组间的变化差异为 0.4（p = .25）。2 周组 HADS 的变化为 5.4-4.8（p = .005），4 周组的变化为 5.3-5.1（p = .34）；两组间的变化差异为 0.4（p = .18）。ADL 评分在 2 周组从 5.3 变为 5.6（p ≤ .0001），在 4 周组从 5.2 变为 5.5（p ≤ .0001）；两组间的变化差异为-0.01（p = .90）。2 周组的 DETERMINE 从 7.2 变为 6.4（p = .0006），4 周组从 7 变为 6.7（p = .19）；两组间的变化差异为 0.5（p = .13）。两组之间的急诊就诊和再入院率或再入院时间无差异。
MTM 短期持续时间不同并不影响以患者为中心的结局或利用情况。
