Reducing Hospital Readmissions: Addressing the Impact of Food Security and Nutrition

2017 ◽  
Vol 45 (S1) ◽  
pp. 86-89 ◽  
Author(s):  
Mathew Swinburne ◽  
Katie Garfield ◽  
Aliza R. Wasserman
Keyword(s):  
Food Insecurity ◽  
Hospital Readmissions ◽  
Economic Incentive ◽  
The United States ◽  
Nutrition Interventions ◽  
Vulnerable Patients ◽  
Nutritional Needs ◽  
Public Health Challenge ◽  
Food Security And Nutrition ◽  
The Impact

Food insecurity in the United States is a profound public health challenge that hospitals are uniquely situated to address. Through the enactment of the Hospital Readmission Reduction Program, the Affordable Care Act provides a strong economic incentive for hospitals to actively confront food insecurity within the communities they serve. While there is a spectrum of nutrition interventions that hospitals can look to when engaging in these efforts, healthy food prescriptions and medically tailored meals are two particularly innovative and promising approaches that could help hospitals reduce readmissions by addressing the nutritional needs of vulnerable patients.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

scholarly journals Food Insecurity in the United States: Identification, Treatment, and Implications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 772-773
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Connie Bales ◽  
Julie Locher
Keyword(s):  
United States ◽  
Older Adults ◽  
At Risk ◽  
Food Insecurity ◽  
Well Being ◽  
The United States ◽  
Health Clinic ◽  
High Risk Population ◽  
Geriatric Syndrome ◽  
The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

scholarly journals High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Milagro Escobar ◽  
Andrea DeCastro Mendez ◽  
Maria Romero Encinas ◽  
Sofia Villagomez ◽  
Janet M. Wojcicki
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
San Francisco ◽  
Employment Status ◽  
The United States ◽  
Household Food Security ◽  
Bay Area ◽  
Household Food ◽  
History Of ◽  
The Impact

Abstract Background Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. Methods We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. Results We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5–14.3%); 7.2% (95%CI, 3.6–13.9%) and 3.5% (95%CI, 1.7–7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). Conclusions Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.

Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study

2020 ◽  
pp. 152483992094592 ◽  
Author(s):  
Srikanta Banerjee ◽  
Tim Radak ◽  
Jagdish Khubchandani ◽  
Patrick Dunn
Keyword(s):  
Health Risk ◽  
Food Insecurity ◽  
Public Health Problem ◽  
The United States ◽  
Mortality Data ◽  
Long Term Outcomes ◽  
Interdisciplinary Approaches ◽  
The Impact

Food insecurity is a significant public health problem in the United States leading to substantial social, economic, and health care–related burdens. While studies continue to estimate the prevalence of food insecurity, the long-term outcomes are not extensively explored. The purpose of this study was to assess the impact of food insecurity on mortality. We analyzed data on adults (≥ 20 years) from the 1999–2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. Among the total study participants (n = 25,247), 17.6% reported food insecurity. Food-insecure individuals were more likely to be younger in age, minorities, poorer, with lesser education, obese, smokers, and with diabetes compared to food-secure counterparts. During a 10.2-year follow-up, among the food insecure, 821 individuals died (11%). The hazard ratio (HR) for mortality among the food insecure compared with the food secure, with adjustment for age and gender only, was 1.58; 95% confidence interval [CI: 1.25, 2.01]. The adjusted HRs for all-cause mortality, HR = 1.46, CI [1.23, 1.72], p < .001, and cardiovascular mortality, HR = 1.75, CI [1.19, 2.57], p < .01, were statistically significantly higher among food-insecure individuals, after adjustment for multiple demographic and health risk factors. Individuals who are food-insecure have a significantly higher probability of death from any cause or cardiovascular disease in long-term follow-up. Comprehensive and interdisciplinary approaches to reducing food insecurity–related disparities and health risks should be implemented. Including food insecurity in health risk assessments and addressing food insecurity as a determinant of long-term outcomes may contribute to lower premature death rates.

scholarly journals Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic

2021 ◽  
Vol 111 (3) ◽  
pp. 494-497
Author(s):  
Tamara Dubowitz ◽  
Madhumita Ghosh Dastidar ◽  
Wendy M. Troxel ◽  
Robin Beckman ◽  
Alvin Nugroho ◽  
...  
Keyword(s):  
African American ◽  
Food Insecurity ◽  
Low Income ◽  
The United States ◽  
Supplemental Nutrition Assistance Program ◽  
Food Bank ◽  
Assistance Program ◽  
Nutrition Assistance ◽  
National Trends ◽  
The Impact

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020. Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic. Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.

scholarly journals Why Are Hungry College Students Not Seeking Help? Predictors of and Barriers to Using an On-Campus Food Pantry

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1163 ◽  
Author(s):  
Aseel El Zein ◽  
Anne Mathews ◽  
Lisa House ◽  
Karla Shelnutt
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Social Stigma ◽  
The United States ◽  
Student Loan ◽  
United States Department ◽  
Limited Information ◽  
Cross Sectional ◽  
Food Pantry ◽  
The Impact

Background: The number of food pantries on U.S. college campuses has increased in response to students’ food insecurity, but limited information is available to describe the impact of this resource. The objective of this cross-sectional investigation was to examine the relationship between food insecurity and food pantry awareness, use, and perceived barriers to use. Methods: Students attending the University of Florida in fall 2017 (n = 899) completed the United States Department of Agriculture (USDA) Adult Food Security Survey and responded to questions about food pantry awareness and use. Sociodemographic data were also collected and included in multivariate logistic regression models. Results: While most students (70%) were aware of the existing food pantry, nearly a third of respondents were classified as being food insecure. After adjusting for sociodemographic correlates, factors such as identifying as being food insecure, international status, and receiving a student loan or a need-based federal financial aid (Pell grant) increased the likelihood of utilizing the campus food pantry. Despite these predictors, only 38% of food insecure students reported food pantry use. Among students who provided qualitative insights, four main barriers to using the on-campus food pantry were identified: social stigma, insufficient information on pantry use policies, self-identity, and inconvenient hours. Conclusions: Food security interventions and administrative policy should consider a new model of the traditional campus food pantry that reduces concerns of social stigma and is supported by clear and ongoing communications of operational procedures tailored for the college student population.

scholarly journals Impact of COVID-19 on vulnerable patients with rheumatic disease: results of a worldwide survey

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001378
Author(s):  
Bella Mehta ◽  
Deanna Jannat-Khah ◽  
Mark Alan Fontana ◽  
Carine J Moezinia ◽  
Carol A Mancuso ◽  
...  
Keyword(s):  
Health Literacy ◽  
Rheumatic Disease ◽  
Food Insecurity ◽  
Ethnic Minority ◽  
Online Survey ◽  
Low Ses ◽  
Convenience Sample ◽  
Vulnerable Patients ◽  
The Impact ◽  
Racial Ethnic

ObjectiveThere is emerging evidence that COVID-19 disproportionately affects people from racial/ethnic minority and low socioeconomic status (SES) groups. Many physicians across the globe are changing practice patterns in response to the COVID-19 pandemic. We sought to examine the practice changes among rheumatologists and what they perceive the impact to be on their most vulnerable patients.MethodsWe administered an online survey to a convenience sample of rheumatologists worldwide during the initial height of the pandemic (between 8 April and 4 May 2020) via social media and group emails. We surveyed rheumatologists about their opinions regarding patients from low SES and racial/ethnic minority groups in the context of the COVID-19 pandemic. Mainly, what their specific concerns were, including the challenges of medication access; and about specific social factors (health literacy, poverty, food insecurity, access to telehealth video) that may be complicating the management of rheumatologic conditions during this time.Results548 rheumatologists responded from 64 countries and shared concerns of food insecurity, low health literacy, poverty and factors that preclude social distancing such as working and dense housing conditions among their patients. Although 82% of rheumatologists had switched to telehealth video, 17% of respondents estimated that about a quarter of their patients did not have access to telehealth video, especially those from below the poverty line. The majority of respondents believed these vulnerable patients, from racial/ethnic minorities and from low SES groups, would do worse, in terms of morbidity and mortality, during the pandemic.ConclusionIn this sample of rheumatologists from 64 countries, there is a clear shift in practice to telehealth video consultations and widespread concern for socially and economically vulnerable patients with rheumatic disease.

scholarly journals Spatial heterogeneity of quality, use and spending on medicare for the elderly

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Felipa De Mello-Sampayo
Keyword(s):  
Quality Indicators ◽  
Spatial Regression ◽  
Hospital Readmissions ◽  
The Elderly ◽  
The United States ◽  
Poor Quality ◽  
Spatial Effects ◽  
Aggregate Level ◽  
Service Type ◽  
The Impact

The spatial variation of the relations between Medicare spending (MS), use and quality in the United States was investigated employing spatial regression. A focus of the study was whether, and to what extent, MS and use vary by service type. Employing different spatial regression designs based on Medicare regional data, the impact of the heterogeneous spatial effects of hospital readmissions on MS for the elderly at the aggregate level was examined. The results were followed up by investigation whether the effects of hospital readmissions are heterogeneous with regard to service type. It was found that poor quality indicators lead to increased MS at the aggregate level and thus higher costs per beneficiary, and that the quality effects are heterogeneous with variable impacts, both spatially and by type of medical service. The results shed new light on the relationship between quality and MS highlighting the pitfalls of global averaging models that hide the reality of a highly diversified and spatially stratified country. Reducing payments to high-spending areas and increasing payments to low-spending areas should reduce spending variability but the quality indicators of care become ambiguous and not easy to interpret.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

Namaste Care™: A Person-Centered Care Approach for Alzheimer’s and Advanced Dementia

2016 ◽  
Vol 40 (1) ◽  
pp. 37-51 ◽  
Author(s):  
Paula McNiel ◽  
Judith Westphal
Keyword(s):  
Long Term Care ◽  
Hospital Readmissions ◽  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Staff Members ◽  
People With Dementia ◽  
The Impact

New methods of care are required to meet the needs of people with dementia and their caregivers. The Namaste Care™ program provides a person-centered approach through meaningful activities and loving touch. The purpose of this qualitative study was to explore the experiences of residents, staff, and family involved in the Namaste Care™ program at a long-term care facility in the United States. A descriptive approach was used to interview 14 staff members. The findings revealed six themes: peaceful sanctuary, relating their way, transforming experiences, connections and community, positive moments, and awakened to the possibilities. Results suggest that Namaste Care™ may be useful for individuals no longer able to participate in traditional long-term care setting activities. Further studies are indicated to confirm the impact on hospital readmissions, therapy enhancement, and medication use in relationship to Namaste Care™ program participation.

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