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Providing medically tailored meals (MTMs) to individuals with complex medical conditions and food insecurity can improve downstream health outcomes, ultimately reducing rates of admission to inpatient care or skilled nursing facilities in this population, new data suggest.
The findings support the argument for better integration of nutrition into healthcare delivery and payment systems, Seth A. Berkowitz, MD, University of North Carolina at Chapel Hill School of Medicine, and colleagues report in an article published online today in JAMA Internal Medicine.
It has been suggested that MTMs, which are meals prepared under the supervision of registered dietitian nutritionists to meet patients' specific nutritional needs, may improve health and lower healthcare use and cost by improving recipients' nutrition, but the association has previously only been examined in small studies with restricted sample sizes.
To test the hypothesis more broadly, Berkowitz and colleagues linked data from the Massachusetts All-Payer Claims Database for 2011–2015 with service delivery records from Community Servings, a not-for-profit food and nutrition organization that delivers MTMs in Massachusetts to individuals with serious medical illness. They identified individuals with complex medical conditions (such as HIV, cancer, end-stage renal disease, or congestive heart failure) who participated in the MTM program and a matched population (based on individual sociodemographics, comorbidities, and neighborhood characteristics, and preintervention healthcare use) of individuals who did not receive the meals.
The primary outcome of interest was inpatient admissions, which, under the researchers' conceptual framework, were likely to be reduced with the meal program. Secondary outcomes included admission to a skilled nursing facility and total healthcare costs.
The MTM intervention consists of 10 meals per week, with program eligibility based on certification of nutritional and social risk.
After matching and adjustment, the study sample included 499 MTM recipients and 521 nonrecipients; the median duration of MTMs was 9 months.
Compared with nonrecipients, MTM participation was associated with approximately 49% fewer inpatient admissions (95% confidence interval [CI], 20% - 78%) and 72% fewer skilled nursing facility admissions (95% CI, 40% - 99%) over nearly 2 years of follow-up. The savings in total healthcare costs, including the cost of program participation, was calculated to be approximately $753 per person per month.
"This difference represents approximately 16% lower health care costs," the authors write.
Although the findings support those of previous, smaller studies linking MTM and healthcare costs and outcomes, the authors stress the importance of understanding them in context. "[I]ntervention recipients were those with clinical, nutritional, and social risk factors that interacted to produce a high short-term risk of clinical deterioration if they did not receive nutritional intervention," they write. "Although these risk factors are a common combination, they caution against overgeneralizing the results of this study to other contexts."
According to the authors of an invited commentary, "MTMs may represent the tip of the spear for a national evolution toward such food-is-medicine approaches," Dariush Mozaffarian, MD, DrPH, and colleagues from the Friedman School of Nutrition Science and Policy, Tufts University, Boston, write.
Based on the estimated advantages, MTMs and other food-based healthcare interventions "warrant expanded evaluation, at scale," to understand the true health and economic benefits of MTMs, the commenters write. They note that this work has started in some areas, including California, where the state is testing the health and use effects of MTMs in a $6 million intervention across 6 counties. In addition, various nonprofit organizations are supporting MTM programs and other initiatives.
"For full scale implementation and effect, such interventions will need to be integrated into large private and public insurance programs," the editorialists stress.
"As health care professionals move toward accountable care, risk-sharing payment models should invest in nutrition for meaningful cost savings and improved patient outcomes. All of these programs should include special focus on vulnerable and sensitive groups and address social determinants of health."
According to the study authors, the findings have implications for health policy. "Medicaid programs in several states have piloted MTM delivery in various settings, and Medicare Advantage recently made changes that could allow coverage for some meal delivery programs," they write.
Further research, through large-scale clinical trials, is needed to clearly assess the benefits of MTM participation, the authors note. Also, programs should target populations with the greatest need as these individuals will be most likely to benefit. "A rigorous evidence base that elucidates when MTM programs are needed will be necessary for efficient use of health care resources," they write. "Ultimately, a range of options that vary in cost and level of service provided may be needed."
Two of the study authors are employees of Community Servings, the MTM service provider in Massachusetts. Coauthor John Hsu reports financial relationships with Community Servings, Delta Health Alliance, DaVita Health Care, the University of California, and the American Association for the Advancement of Science.
The authors of the invited commentary report financial relationships with the Bill and Melinda Gates Foundation, GOED, DSM, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, America's Test Kitchen, Omada Health, Elysium Health, DayTwo, UpToDate, the National Institutes of Health, Unilever R&D, Nestle, Danone, and World Bank.
JAMA Intern Med. Published online April 22, 2019. Full text, Editorial
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Los Angeles, CA, March 16, 2019 --(PR.com)-- QualityWorks Consulting Group is set to become the first "International Software Testing Qualifications Board" (ISTQB) accredited training provider in the English-speaking Caribbean as of August 2019.
As a pioneer in quality-driven development and test innovation throughout the Caribbean and the United States and top software testing (Clutch Awards, 2018), QualityWorks' decision to partner with the CTB – Caribbean Testing Board (regional ISTQB board for the English-speaking Caribbean) was a natural progression. Since expanding from Los Angeles to Kingston, Jamaica, QualityWorks has remained committed to empowering clients and the tech community in the region.
The company's emphasis on quality and innovation in software development has been marked by the use of leading DevSecOps technologies in penetration testing, serverless architecture, and agile methodologies to drive digital transformation. This alignment with ISTQB will serve to further this mission by strengthening the representation and competitiveness of Caribbean testers on a global scale while providing clients with the guarantee that their projects receive the quality and consistent testing practices the market demands.
Caribbean Testing Board President, Chantelle Jones shared, "We at CTB are looking forward to serving the Caribbean community together with QualityWorks to ensure that their local testers have the knowledge and expertise to compete in the global market."
ISTQB is globally recognized as the de facto standard in software testing certification, with over 600,000 certified professionals across 120 countries and regional representation in more than 80 countries. Becoming the first ISTQB accredited local training provider in the CTB region has implications that transcend the company's mission. QualityWorks will be able to tackle the "access barrier" to opportunities for skill development and career growth in software testing and development. ISTQB certified testers not only receive international recognition but over 80% of those certified have experienced a marked improvement in their testing skills and competencies that affect career growth (2017 ISTQB Quality Survey).
Over the next few weeks, the company will undergo the first training course, to be held in Jamaica with the support of the Caribbean Testing Board (CTB). Brightest, a global exam provider for ISTQB, will run the ISTQB Certified Tester Foundation Level (CTFL) exam for the QualityWorks team.
Brightest CEO, Kyle Siemens shared, "I've witnessed the passion and drive of Stacy Kirk and her team and it has always been clear to me that QualityWorks Consulting Group has what it takes to drive development throughout the Caribbean. Brightest is proud to partner with QualityWorks for ISTQB as well as other certifications in the future to support the local Caribbean markets."
Through this ongoing partnership with Brightest, QualityWorks, once accredited by the CTB in August, they will be able to deliver ISTQB certification courses, preparing individuals and groups from local organizations for the given official ISTQB exams.
QualityWorks CEO, Stacy Kirk shared, "We always continue to raise the bar with leading tech and certification. This is why they have the top technologists on the island and they look forward to sharing their knowledge with this new course offering through the Caribbean."
QualityWorks is already scheduling training in the Caribbean, for more information on how to register, contact firstname.lastname@example.org or call 833-792-4453.
About QualityWorks:QualityWorks is an agile software consulting firm committed to the continuous delivery of high-quality software. They provide end-to-end software solutions that save their clients' thousands in resource costs, decrease their time to market and drive team and process optimization. Their services include custom software development and all aspects of software testing from functional to performance and penetration testing. Their unique value is that they are not just technical experts, they are also coaches who empower teams through process improvement training as well as Cybersecurity, QA, and DevOps coaching based on agile best practices.
To learn more about QualityWorks, visit: https://www.qualityworkscg.com/
About the CTB – Caribbean Testing Board and their role in the ISTQB:The Caribbean Testing Board (CTB) is the regional authority of the ISTQB for the English-speaking Caribbean, with their initial focus on Jamaica, Barbados and Trinidad & Tobago. The International Software Testing Qualifications Board (ISTQB) is a not-for-profit association legally registered in Belgium, comprised of 58 Local Member Boards who are responsible for the given countries or regions they govern.
To learn more about the Caribbean Testing Board, visit: http://caribbeantestingboard.org/
About Brightest:Brightest is a global examination body supporting global certification standards in several languages. In addition to the ISTQB, they also offer exams globally for a wide range of hands-on courses like Selenium United, Blockchain United, Artificial Intelligence United, DevOps United, Agile United, Cloud United, Performance Testing United and the Design Sprint Alliance. In collaboration with the Caribbean Testing Board, they aim to provide a path for measuring and confirming industry-based knowledge in areas of expertise throughout the IT industry of the English-Speaking Caribbean.
To learn more about the Caribbean Testing Board, visit: https://brightest.org/en/.
Contact Information:QualityWorks Consulting GroupJanice Alexander(876) 667-2327Contact via Emailhttp://www.qualityworkscg.com
Read the full story here: https://www.pr.com/press-release/780026
Press Release Distributed by PR.com
The Max also lacked more modern safety features.
Most new Boeing jets have electronic systems that take pilots through their preflight checklists, ensuring they don’t skip a step and potentially miss a malfunctioning part. On the Max, pilots still complete those checklists manually in a book.
A second electronic system found on other Boeing jets also alerts pilots to unusual or hazardous situations during flight and lays out recommended steps to resolve them.
On 737s, a light typically indicates the problem and pilots have to flip through their paper manuals to find next steps. In the doomed Indonesia flight, as the Lion Air pilots struggled with MCAS for control, the pilots consulted the manual moments before the jet plummeted into the Java Sea, killing all 189 people aboard.
“Meanwhile, I’m flying the jet,” said Mr. Tajer, the American Airlines 737 captain. “Versus, pop, it’s on your screen. It tells you, This is the problem and here’s the checklist that’s recommended.”
Boeing decided against adding it to the Max because it could have prompted regulators to require new pilot training, according to two former Boeing employees involved in the decision.
The Max also runs on a complex web of cables and pulleys that, when pilots pull back on the controls, transfer that movement to the tail. By comparison, Airbus jets and Boeing’s more modern aircraft, such as the 777 and 787, are “fly-by-wire,” meaning pilots’ movement of the flight controls is fed to a computer that directs the plane. The design allows for far more automation, including systems that prevent the jet from entering dangerous situations, such as flying too fast or too low. Some 737 pilots said they preferred the cable-and-pulley system to fly-by-wire because they believed it gave them more control.
In the recent crashes, investigators believe the MCAS malfunctioned and moved a tail flap called the stabilizer, tilting the plane toward the ground. On the doomed Ethiopian Airlines flight, the pilots tried to combat the system by cutting power to the stabilizer’s motor, according to the preliminary crash report.
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Aruba [8 Certification Exam(s) ]
ASIS [2 Certification Exam(s) ]
ASQ [3 Certification Exam(s) ]
ASTQB [8 Certification Exam(s) ]
Autodesk [2 Certification Exam(s) ]
Avaya [101 Certification Exam(s) ]
AXELOS [1 Certification Exam(s) ]
Axis [1 Certification Exam(s) ]
Banking [1 Certification Exam(s) ]
BEA [5 Certification Exam(s) ]
BICSI [2 Certification Exam(s) ]
BlackBerry [17 Certification Exam(s) ]
BlueCoat [2 Certification Exam(s) ]
Brocade [4 Certification Exam(s) ]
Business-Objects [11 Certification Exam(s) ]
Business-Tests [4 Certification Exam(s) ]
CA-Technologies [20 Certification Exam(s) ]
Certification-Board [10 Certification Exam(s) ]
Certiport [3 Certification Exam(s) ]
CheckPoint [43 Certification Exam(s) ]
CIDQ [1 Certification Exam(s) ]
CIPS [4 Certification Exam(s) ]
Cisco [319 Certification Exam(s) ]
Citrix [48 Certification Exam(s) ]
CIW [18 Certification Exam(s) ]
Cloudera [10 Certification Exam(s) ]
Cognos [19 Certification Exam(s) ]
College-Board [2 Certification Exam(s) ]
CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
Consultant [2 Certification Exam(s) ]
Counselor [4 Certification Exam(s) ]
CPP-Institute [4 Certification Exam(s) ]
CSP [1 Certification Exam(s) ]
CWNA [1 Certification Exam(s) ]
CWNP [13 Certification Exam(s) ]
CyberArk [1 Certification Exam(s) ]
Dassault [2 Certification Exam(s) ]
DELL [11 Certification Exam(s) ]
DMI [1 Certification Exam(s) ]
DRI [1 Certification Exam(s) ]
ECCouncil [22 Certification Exam(s) ]
ECDL [1 Certification Exam(s) ]
EMC [128 Certification Exam(s) ]
Enterasys [13 Certification Exam(s) ]
Ericsson [5 Certification Exam(s) ]
ESPA [1 Certification Exam(s) ]
Esri [2 Certification Exam(s) ]
ExamExpress [15 Certification Exam(s) ]
Exin [40 Certification Exam(s) ]
ExtremeNetworks [3 Certification Exam(s) ]
F5-Networks [20 Certification Exam(s) ]
FCTC [2 Certification Exam(s) ]
Filemaker [9 Certification Exam(s) ]
Financial [36 Certification Exam(s) ]
Food [4 Certification Exam(s) ]
Fortinet [14 Certification Exam(s) ]
Foundry [6 Certification Exam(s) ]
FSMTB [1 Certification Exam(s) ]
Fujitsu [2 Certification Exam(s) ]
GAQM [9 Certification Exam(s) ]
Genesys [4 Certification Exam(s) ]
GIAC [15 Certification Exam(s) ]
Google [4 Certification Exam(s) ]
GuidanceSoftware [2 Certification Exam(s) ]
H3C [1 Certification Exam(s) ]
HDI [9 Certification Exam(s) ]
Healthcare [3 Certification Exam(s) ]
HIPAA [2 Certification Exam(s) ]
Hitachi [30 Certification Exam(s) ]
Hortonworks [4 Certification Exam(s) ]
Hospitality [2 Certification Exam(s) ]
HP [752 Certification Exam(s) ]
HR [4 Certification Exam(s) ]
HRCI [1 Certification Exam(s) ]
Huawei [21 Certification Exam(s) ]
Hyperion [10 Certification Exam(s) ]
IAAP [1 Certification Exam(s) ]
IAHCSMM [1 Certification Exam(s) ]
IBM [1533 Certification Exam(s) ]
IBQH [1 Certification Exam(s) ]
ICAI [1 Certification Exam(s) ]
ICDL [6 Certification Exam(s) ]
IEEE [1 Certification Exam(s) ]
IELTS [1 Certification Exam(s) ]
IFPUG [1 Certification Exam(s) ]
IIA [3 Certification Exam(s) ]
IIBA [2 Certification Exam(s) ]
IISFA [1 Certification Exam(s) ]
Intel [2 Certification Exam(s) ]
IQN [1 Certification Exam(s) ]
IRS [1 Certification Exam(s) ]
ISA [1 Certification Exam(s) ]
ISACA [4 Certification Exam(s) ]
ISC2 [6 Certification Exam(s) ]
ISEB [24 Certification Exam(s) ]
Isilon [4 Certification Exam(s) ]
ISM [6 Certification Exam(s) ]
iSQI [7 Certification Exam(s) ]
ITEC [1 Certification Exam(s) ]
Juniper [65 Certification Exam(s) ]
LEED [1 Certification Exam(s) ]
Legato [5 Certification Exam(s) ]
Liferay [1 Certification Exam(s) ]
Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [68 Certification Exam(s) ]
Microsoft [375 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [3 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [282 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real Estate [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [135 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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