title: Evaluation of the Balanced Menus Challenge: a healthy food and sustainability programme in hospitals in Maryland.
abstract: OBJECTIVE
  The Balanced Menus Challenge (BMC) is a national effort to bring the healthiest, most sustainably produced meat available into health-care settings to preserve antibiotic effectiveness and promote good nutrition. The present study evaluated the outcomes of the BMC in the Maryland/Washington, DC region.
  
  
  METHODS
  The BMC is a cost-effective programme whereby participating hospitals reduce meat purchases by 20 % of their budget, then invest the savings into purchasing sustainably produced meat. A mixed-methods retrospective assessment was conducted to assess (i) utilization of the BMC 'implementation toolkit' and (ii) achievement of the 20 % reduction in meat purchases. Previous survey data were reviewed and semi-structured interviews were conducted.
  
  
  METHODS
  Hospitals located in the Maryland/Washington, DC region, USA, that adopted the BMC.
  
  
  METHODS
  Twelve hospitals signed the BMC in the Maryland/Washington, DC region and six were available for interview.
  
  
  RESULTS
  Three hospitals in the Maryland/Washington, DC region that signed the BMC tracked their progress and two achieved a reduction in meat procurement by ≥20 %. One hospital demonstrated that the final outcome goal of switching to a local and sustainable source for meat is possible to achieve, at least for a portion of the meal budget. The three hospitals that reduced meat purchases also received and used the highest number of BMC implementation tools. There was a positive correlation between receipt and usage of implementation tools (r=0·93, P=0·005).
  
  
  CONCLUSIONS
  The study demonstrates that hospitals in the Maryland/Washington, DC region that sign the BMC can increase the amount of sustainably produced meat purchased and served.
authors.affiliation: 1Maryland Hospitals for a Healthy Environment,University of Maryland School of Medicine,520 W. Lombard Street,East Hall,Baltimore,MD 21201,USA.
authors.forename: Tarah D
authors.initials: TD
authors.lastname: Ranke
authors.affiliation: 1Maryland Hospitals for a Healthy Environment,University of Maryland School of Medicine,520 W. Lombard Street,East Hall,Baltimore,MD 21201,USA.
authors.forename: C Louise
authors.initials: CL
authors.lastname: Mitchell
authors.affiliation: 2Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,MD,USA.
authors.forename: Diane Marie
authors.initials: DM
authors.lastname: St George
authors.affiliation: 1Maryland Hospitals for a Healthy Environment,University of Maryland School of Medicine,520 W. Lombard Street,East Hall,Baltimore,MD 21201,USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: D'Adamo
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D003247:Conservation of Natural Resources; D003362:Cost-Benefit Analysis; D004219:District of Columbia; D058735:Environmental Policy; D005521:Food Service, Hospital / Q000191:economics; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006801:Humans; D008396:Maryland; D008460:Meat / Q000009:adverse effects / Q000191:economics; D008612:Menu Planning; D018673:Nutrition Policy; D015397:Program Evaluation
keywords: Food sustainability; Hospitals; Meat; Public health