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April 15, 2019

Can Meals on Wheels Close the Gap?

Can Meals on Wheels Close the Gap for Social Determinants of Health?

Meals on Wheels delivery drivers referred nearly 150 patients to social services to address the social determinants of health.

Meals on Wheels delivery drivers are in a good position for detecting any alarming changes in senior patient health, and have been effective at alerting care coordinators when a senior may need help addressing the social determinants of health, according to a new study published in the Journal of the American Geriatrics Society.

The medical industry is largely in agreement that health is what happens outside of the four walls of the hospital. The social determinants of health are key factors that can shape patients’ abilities to achieve health or wellness.

But this knowledge introduces a new set of challenges for medical providers, who know that they cannot be with patients at all times and therefore do not always know when a patient is experiencing a social barrier or a decline in health. Community partners who see patients on a more regular basis are in a better position for detecting concerning changes in health or lifestyle, industry experts have posited.

In partnership with Meals on Wheels America, researchers from Brown University and West Health Institute put that theory to the test, asking Meals on Wheels delivery drivers to take part in an alert program. when they notice a recipient who have undergone extreme changes in health and wellness.

Drivers would be equipped with a smartphone app that allowed them to detail any concerns they may have about a patient who has undergone extreme changes in health or wellness. Those alerts were pushed out to care coordinators, who would intervene and refer patients to appropriate health or social services where applicable.

The team piloted the project in two sites, San Diego, California, and Guernsey County, Ohio. And although the study only spanned those two areas, it had tremendous impacts, the researchers found.

During the 12 months during which delivery workers tested the app, they reported a total of 429 alerts for 189 different senior patients. Fifty-six percent of those alerts related to concerns about changes in patient health, while 12 percent regarded patient self-care and 11 percent pertained to patient mobility.

Those alerts turned into a total of 132 referrals from care coordinators. Thirty-three percent of those referrals were for self-care services, while 17 percent were for health services and 17 percent were for care management services.

What’s more, the process was easy, drivers said. The app was easy and intuitive to use and did not take up much time in their otherwise stated delivery jobs, they reported.

This innovative approach could be one of many strategies for the community to participate in patient care.

As noted above, the medical industry has nearly unanimously agreed on the importance of health at home and in the community, but has no effective way for addressing patient needs outside of the clinic or hospital, said Michael L. Malone, MD, a section editor in models of geriatric care, quality of improvement, and program dissemination with the Journal of the American Geriatrics Society.

“As healthcare systems struggle to address the social determinants of health, this innovative Meals on Wheels model may provide part of the solution,” Malone said in a statement. “As leaders in geriatric medicine, we should champion social programs (such as Meals on Wheels) that meet the needs of vulnerable individuals in our communities. In retrospect, our core business is to help the whole person, whose healthcare needs are intertwined with his/her social needs.”

There is great potential in this program, the researchers agreed. The pilot study was only conducted in two test sites, but was still able to refer over 100 patients to services to fill their social needs. If implemented nationwide to all 30 Meals on Wheels programs, this model could address social needs for nearly 40,000 senior patients.

“By collaborating with Meals on Wheels America, we’ve developed a safe, cost-effective and scalable program to preemptively identify and address concerns that too often result in deterioration of a senior’s medical condition or pose a major safety risk,” said Zia Agha, MD, chief medical officer at West Health. “We’re excited learnings from this research program are now being implemented across the country within Meals on Wheels America’s expanded program that will positively impact as many seniors as possible.”