Progress 09/15/23 to 09/14/24

Outputs
Target Audience:During this reporting period, participants were identified among Alivio Medical Center patients based on three eligibility criteria. First, the target audience includes individuals who experience hypertension, a chronic condition that can be impacted by diet. We have prioritized patients with uncontrolled hypertension who are not medication adherent. This is defined by an analysis of medication fill history resulting in a "Percent Days Covered" calculation (PDC) that reflects the percentage of days for which the patient filled their anti-hypertensive prescription(s). Second, the target audience identifies participants who are members of low-income households who suffer from, or are at risk of developing a diet-related health condition. Third, the target audience includes individuals who are eligible for medical assistance under a State plan or a waiver of such a plan under title XIX of the Social Security Act. The three eligibility requirements for this project's target audience were designed to support project goals, which include impacting participants' food security status, consumption of fruits and vegetables, blood pressure, healthcare use and associated costs, and health knowledge. Medical Home Network has used their technology platform - "2.0" - to identify eligible patients of Alivio Medical Center. Eligible patients are introduced to the program by Alivio Medical Center Health Coaches and enrolled, unless they choose to opt out. Once enrolled in the program, participants receive weekly home delivered food boxes of fresh fruits and vegetables from Top Box Foods, attend health care and educational visits virtually and in-person with Alivio Medical Center, and take part in efforts to increase their health literacy. This includes participation in individual coaching from Dietitians and Care Coordinators based around the American Heart Association's DASH (Dietary Approaches to Stop Hypertension) Diet, and other American Heart Association resources. Demographic Data of Patients Enrolled Thus Far: Ethnicity: 88% Hispanic; 12% Non-Hispanic Race: 4% Black/AA; 32% Unspecified; 64% White Preferred Language: 15% English 85% Spanish Age: 83% of patients enrolled are between the ages of 40-69 years (6% below 40 years; 11% Ages 70-84 Years) Socio-Economic and Social Determinant Data of Patients Enrolled Thus Far: Within the past 12 months, the food I/we bought just didn't last and I/we didn't have money to get more. 68% Never 15% Often 17% sometimes Within the past 12 months, I/we worried whether our food would run out before I/we got money to buy more 60% Never 20% Often 20% Sometimes 0.6% No Answer In the last two months, have you had difficulty paying your electric, gas, or water bill? 21% Yes 79% No Do you need help with other essential items (clothing, diapers, home goods, etc.)? 24% Yes 76% No Changes/Problems:This year of grant funding our program enrolled 25 participants. Combined with enrolled participants in the prior project year, our enrollment total of 95 is lower than our targeted number. To ensure robust participation and uncompromised data, we have required prospective participants to meet minimum levels of responsiveness and engagement before entering into full enrollment and receiving food and health coaching. A higher than anticipated number of prospective participants have been unresponsive after initially indicating interest in our program, which has decreased our overall number of participants. Our program extended the enrollment period of this program through February 2024 to recruit additional participants to serve the highest number of people possible during the grant term. Additionally, we requested a No Cost Extension to ensure that these participants are able to complete the full 52-week program period and follow-up assessments. In the future, we might identify a larger participant audience or consider alternate methods of engagement and communication in order to remove barriers to participation to achieve our participation goals. Additionally, we identified an under-utilization of funds allocated to Section E - Participant / Trainee Support Costs: Other Costs for our project. This budget line item is specifically intended to cover the cost of fresh fruits and vegetables for program participants. This under-utilization is due to two factors. First, the under-enrollment of the program overall. Second, the cost-efficient sourcing of fresh produce. To utilize the remaining funds to achieve key project objectives, Top Box Foods (TBF) took two steps. First, produce purchasing transitioned to sourcing fresh fruits and vegetables from local Illinois farmers. This continues support of nutrition and health goals for program participants while further enhancing patient knowledge by providing information about the benefits of healthy, local foods. Second, TBF, MHN, and AMC have agreed to utilize the additional funds to prepare a formal nutrition and health education document for all participants of the program. This material will capture learnings from the program to remain with participants long after it has been completed, to encourage continued engagement with nutrition and health management. ? What opportunities for training and professional development has the project provided?This project period, Alivio Medical Center (AMC) has continued to offer its health coaches training and educational opportunities to ensure quality health and nutrition coaching. This includes meetings with the Medical Home Network (MHN) Master Health Coach for ongoing support and mentorship. Continued learning took place through demonstrations and readings on the subjects of hypertension-related health topics, nutrition and physical activity, patient self-care management and empowerment, and more. As project lead, Top Box Foods (TBF) has engaged in training and professional development opportunities facilitated by GusNIP throughout this year. This includes convenings with lectures that share best practices from project facilitators around the country and thoughtful discussions. Internal professional development at TBF has created opportunities for individual and group study to reflect upon program operations and continuously improve logistics and communication practices. How have the results been disseminated to communities of interest?Because our program is ongoing, and final results have not yet been measured, we have not disseminated final results to communities of interest. However, press coverage highlighting the impact of this ongoing program took place in April 2024. CBS News Chicago filmed a Top Box Foods (TBF) home produce box delivery as well as interviewed one program participant and several program operators across TBF, Medical Home Network (MHN), and Alivio Medical Center (AMC). This publicity drew attention to the importance of this program on participant health and on learnings for organizations working in the food as medicine field. CBS News Press Link: https://www.cbsnews.com/chicago/news/alivio-medical-center-pilot-program-medicaid-high-blood-pressure-healthy-food/ We have also participated in other networking and learning opportunities throughout this project period. This includes recurring Community of Practice virtual sessions for Produce Prescription Program grantees as well as the 2023 Nutrition Incentive Hub Mini-Convening in October, 2023. There, we were able to showcase our program to dozens of other organizations from across the nation working in this field. Our presentation highlighted the program's breadth and depth of reach, our impact on participants so far, and the collaboration between Top Box Foods as a community organization and Medical Home Network and Alivio Medical Center as healthcare providers. What do you plan to do during the next reporting period to accomplish the goals?In the next year, Top Box Foods (TBF), Medical Home Network (MHN), and Alivio Medical Center (AMC) will continue carrying out program activities to achieve our goals and outcomes as well as measure program success. TBF will continue to deliver weekly boxes of fresh produce to participants' homes through the duration of their participation period. AMC will continue to conduct hands-on health education, surveys, and assessments. MHN will continue to aggregate participant data for evaluation. Once all participants have completed the program, evaluation analysis will begin. We will compare between baseline and completion data to understand the program's impact on participants based on our defined program goals. Upon program completion, TBF, MHN, and AMC will look to disseminate learnings and results to key stakeholders and relevant community members and organizations. We hope to secure additional funding in the future to continue this program, building on learnings from this period to further benefit participants in future iterations. Additionally, we will share our lessons learned with other organizations in the food as medicine field looking to improve the circumstances and health of their patients.

Impacts
What was accomplished under these goals? Top Box Foods (TBF), Medical Home Network (MHN), and Alivio Medical Center (AMC) continued our collaborative effort to facilitate a Produce Prescription Program targeting low-income individuals with hypertension. The goal of this project is to study the effectiveness of such interventions at impacting diet-related health and associated healthcare costs, food security, and nutritional knowledge. Participants are members of low-income households who suffer from, or are at risk of developing a diet-related health condition, and are eligible for medical assistance under a State plan or a waiver of such a plan under title XIX of the Social Security Act. The primary goal of this project is to impact participants' health by delivering fresh produce to their homes and engaging patients in their disease management through health coaching. The objectives associated with this goal are as follows: (1) Improve diet-related health of participants, particularly blood pressure, and (2) Increase patient knowledge of the impact of diet on blood pressure. While our program is still ongoing, and therefore final outcomes have yet to be confirmed, we have carried out numerous activities to drive progress towards our goals and objectives. TBF, MHN, and AMC began this project period by continuing the workflows and procedures developed during the first project period, which assure the smooth continued operations of our ongoing program. This includes scheduling routine meetings among the project partners to align on logistics, discuss upcoming activities, and prepare for assessments, evaluations, and reporting. During this project period, we continued to enroll new participants while simultaneously graduating participants who completed their 52 week program period. During the first year of grant programming period, 70 participants were enrolled. During this project period, an additional 25 were enrolled. With newly enrolled participants, we conducted the following activities to drive success. First, MHN and AMC used MHN's 2.0 technology platform to identify and validate the eligibility of prospective patients who met eligibility criteria. Then, staff members identified the last completed Health Risk Assessment (HRA) for prospective participants, and completed a new one if over 12-months had passed. Staff members conducted informational outreach and introduced MHN's hypertension management program and this Produce Prescription Program to prospective participants. Those patients were auto-enrolled in the program unless they opted out. MHN and AMC conducted extensive outreach to ensure participant engagement and responsiveness before completing formal enrollment into the Produce Prescription Program. Once enrolled, AMC dieticians and care coordinator/health coaches began program activities with patients. Participation initiation activities included collecting baseline data such as blood pressure readings from prospective participants as well as screening surveys for food insecurity and health literacy. Survey questions included inquiries into factors that may impact a patient's hypertension, access to food, knowledge of the impact food may have on their health, and more. MHN manages survey and baseline data. As program participation continues, AMC's care coordinators provide coaching and educational materials to participants on an ongoing basis. Materials have centered around the relationship between diet and Hypertension and includes coaching and resources around the DASH diet plan and the impact of eating fast food and prepared food. Follow-up coaching sessions are completed with each enrolled patient up to 3 times a month. During these sessions, the AMC staff assess patients' progress. Additional education and resources have also been provided during or following sessions based on the patient's needs and preferences. Coaches and coordinators received 80 hours of training from Training Leads to prepare to provide quality nutrition education to patients. AMC coaches and care coordinators have conducted 950 nutrition education meetings with participants during this project period. These efforts coincide with weekly food deliveries from TBF. Upon enrollment in the program, new participant information is shared with TBF to begin food operations. TBF coordinates the sourcing, aggregation, and delivery of boxes of fresh produce to the homes of all participating individuals. Boxes have included 15-18 pounds of a rotating assortment of fresh fruits and vegetables tailored to participants' medical needs and cultural background. TBF has also prioritized sourcing fresh produce from local farmers in Illinois, including historically under-represented farms such as woman- and Black-owned businesses. This supports participant education on the local food system and opportunities for nutrition with added community benefits. TBF maintains consistent delivery logistics and reliable communications to ensure a high-quality experience with the program. During this project period, TBF conducted 2,652 home food deliveries with a 98.9% delivery success rate on the first delivery attempt. During this year of grant programming, we enrolled 25 participants. Enrollment continued to take place until February 2024, at which time enrollment closed for new participants. Among new, ongoing, and graduated program participants, AMC and MHN conducted and analyzed 5,158 blood pressure readings, 78 Food Security and Social Determinants of Health Screenings, 67 Hypertension Literacy Screenings, and 707 Hypertension Management Screenings. An additional 761 Produce Prescription Program Assessments and 31 Patient Knowledge Surveys were conducted among participants who completed the program during this project period. During this project period, 39 participants completed the full 52 weeks of food deliveries and health coaching. Program conclusion and follow-up assessments reflect significant progress toward program goals for the majority of patients. 100% of graduated participants saw their blood pressure fall into the controlled range within the year of participation. This is essential progress toward the first objective of the project - improve diet-related health of participants, particularly blood pressure. Graduated participants also communicated success with regard to the second objective of the project - increase patient knowledge of the impact of diet on blood pressure and their confidence in managing it with their care team and through healthy eating. Additionally, survey results from the Produce Prescription Program Assessment showed that 99.5% of patients are satisfied with their produce deliveries and are consuming all of the produce delivered. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree I feel confident in my ability to prepare healthy meals 0.0% 0.0% 8.1% 86.5% 5.4% After working with my health coach at Alivio I feel more confident talking to my doctors and nurses about hypertension 2.7% 0.0% 8.1% 75.7% 13.5% Healthy eating is important to my overall health and well-being 0.0% 0.0% 0.0% 48.6% 51.4% Healthy Eating is Hard to Achieve 2.7% 32.4% 37.8% 18.9% 8.1% Anecdotally, patients have emphasized that the intangibles of this project have had a significant impact on ongoing engagement and progress toward participation goals. For example, Eddie Chavez, a 60-year-old participant managing hypertension and diabetes, expressed gratitude for the relationships and consistency of project touchpoints. This, combined with the significant progress made by completed participants toward improved diet-related health, is extremely promising.

Publications

Progress 09/15/22 to 09/14/23

Outputs
Target Audience:Participants have been drawn from Alivio Medical Center's 400 patients that experience Hypertension. Patients with uncontrolled hypertension who are not medication adherent, as defined by an analysis of medication fill history resulting in a "Percent Days Covered" calculation (PDC) that reflects the percentage of days for which the patient filled their anti-hypertensive prescription(s), have been prioritized. Participants are members of low income households who suffer from, or are at risk of developing a diet related health condition, and are eligible for medical assistance under a State plan or a waiver of such a plan under title XIX of the Social Security Act. Medical Home Network has used their technology platform-"2.0"-to identify eligible patients, who are enrolled in the program, unless they choose to opt out. Participants take part in efforts to increase their health literacy, including participation in individual coaching from Dietitians and Care Coordinators based around the American Heart Association's DASH (Dietary Approaches to Stop Hypertension) Diet, and other American Heart Association resources. Demographic Data of Patients Enrolled Thus Far: Enrolled participants Ethnicity: 89% Hispanic; 11% Non-Hispanic Race: 4% Black/AA; 27% Unspecified; 69% White Preferred Language: 13% English 87% Spanish 83% of patients enrolled are between the ages of 40-69 years (7% below 40 years; 10% Ages 70-84 Years)? ?SocioEconomic and Social Determinant Data of Patients Enrolled Thus Far: Within the past 12 months, the food I/we bought just didn't last and I/we didn't have money to get more. 57% Never 26% Often 16% sometimes 1% No Answer Within the past 12 months, I/we worried whether our food would run out before I/we got money to buy more 67% Never 20% Often 13% Sometimes In the last two months, have you had difficulty paying your electric, gas, or water bill? 19% Yes 81% No Do you need help with other essential items (clothing, diapers, home goods, etc.)? 29% Yes 71% No Changes/Problems:During the first year of grant funding our program enrolled 70 participants, which is lower than our targeted number. To ensure robust participation and uncompromised data, we have required prospective participants to meet minimum levels of responsiveness and engagement before entering into full enrollment and receiving food and health coaching. A higher than anticipated number of prospective participants have been unresponsive after initially indicating interest in our program, which has decreased our overall number of participants. Our program is continuing to recruit participants to serve the highest number of people possible during the grant term. ? What opportunities for training and professional development has the project provided?AMC has hired an individual from the service area community, trained as a health coach with expertise in hypertension by MHN's Master Coach Trainer. Health coaches are becoming a new and emerging allied health profession and do not require a license. The health coach hired through this funding went through robust, immersive health coach training which included: Curriculum Highlights- Delivered through Lectures, Activities, Discussion Topics, and Readings Care Coordination overview Medical Home Network Model of Care What is Health Coaching? GusNIP Program Motivational interviewing Health Coach Overview & Workflows Health Coaching Facilitation, Concepts and Strategies Collaborative Care for Depression Management Patient self-care management and patient empowerment Key hypertension health related topics Hypertension Health Coach Care Coordination National and global health statistics Healthy People 2030 - Social Determinants of Health (SDOH) Nutrition and physical activity Patient case demonstrations Patient education training and practice sessions; coach facilitation Screenings of lived experience documentaries and stories Following the training, the Health Coach has met with the MHN Master Health Coach for ongoing support and mentorship. Alivio's Hypertension Health Coach now has the ability to: empower patients, identify challenges that are preventing change, provide support, and use their knowledge of health and wellness to help patients navigate their healthcare goals. In addition, Top Box Foods' Logistics Coordinator took Excel courses to improve his skills and better perform duties associated with this project. How have the results been disseminated to communities of interest?Because our program is ongoing, and final results have not yet been measured, we have not disseminated final results to communities of interest. Top Box Foods, Medical Home Network, and Alivio Medical Centers did participate in the 2023 Nutrition Incentive Hub Mini-Convening in October, 2023, where we were able to showcase our program to dozens of other organizations from across the nation working in this field. Our presentation showcased the program's breadth and depth of reach, our impact on participants so far, and the collaboration between Top Box Foods as a community organization and Medical Home Network and Alivio Medical Center as healthcare providers. ? What do you plan to do during the next reporting period to accomplish the goals?In the next year, Top Box Foods, Medical Home Network, and Alivio Medical Center will continue carrying out program activities to achieve our goals and outcomes, and measure our program's success. We will continue to identify, screen, and enroll eligible participants. To reach more participants and get as close to our target of 100 as possible, we will begin widening our reach and targeting more participants for enrollment by modifying the eligibility criteria to look at patients who have controlled hypertension, compared to only looking at patients who are uncontrolled. This will greatly increase the number of prospective patients for Alivio staff to outreach and enroll. We will also continue to deliver weekly boxes of fresh produce to their homes, and conduct hands-on health education. New participants will continue to be surveyed to collect baseline information when they enter the program, while participants who have completed the program will also be evaluated. Comparison between baseline and completion data will be conducted and synthesized to understand the program's impact. Upon program completion, Top Box Foods, Medical Home Network, and Alivio Medical Center will look to disseminate learnings and results to key stakeholders and relevant community members and organizations. We also aim to continue the program, and expand to more participants moving forward.

Impacts
What was accomplished under these goals? Top Box Foods, Medical Home Network, and Alivio Medical Center have partnered to launch a Produce Prescription Program targeting individuals with hypertension, and to study the effectiveness of such interventions at impacting diet-related health and nutritional knowledge. Participants are members of low income households who suffer from, or are at risk of developing a diet related health condition, and are eligible for medical assistance under a State plan or a waiver of such a plan under title XIX of the Social Security Act. The key goal of this project is to impact participants' health by delivering fresh produce to their homes and engaging patients in their disease management through health coaching. The objectives associated with this goal are as follows: (1) Improve diet-related health of participants, particularly blood pressure, (2) Increase patient knowledge of the impact of diet on blood pressure. While our program is still ongoing, and thus outcomes have yet to be achieved, we have carried out numerous activities to drive progress towards our goals and objectives. Top Box Foods, Medical Home Network and Alivio Medical Center began this project period by collaborating to create workflows and procedures that would assure the smooth operations of our program once they commenced. We submitted and received an IRB exemption for our program, allowing our intervention to begin as scheduled. Additionally, we worked with the Nutrition Incentive Hub to create surveys to measure our program's impact. Once ongoing program enrollment began in March, we conducted the following activities to drive success. First, MHN and Alivio identified and validated the eligibility of prospective patients who met eligibility criteria prior to outreach by using MHN's 2.0 technology platform. Staff members then identified the last completed Health Risk Assessment (HRA) for prospective participants, and completed a new one if over 12-months had passed. Staff members introduced the MHN's Hypertension management program and the Produce Prescription Program to prospective participants, who were auto-enrolled unless they opted out. MHN and Alivio worked to ensure participant engagement and responsiveness before completing formal enrollment into the Produce Prescription Program, by collecting blood pressure readings from prospective participants at a follow-up call. At this stage, Alivio Dieticians and care coordinator/health coaches began program activities with patients. Patients completed baseline screenings for food insecurity and literacy, including questions that may impact a patient's Hypertension, access to food, knowledge of the impact food may have on their health, in particular, on Hypertension. Coaching and educational materials have been provided to participants on an ongoing basis. Materials have centered around the relationship between diet and Hypertension and includes coaching and resources around the DASH diet plan and the impact of eating fast food and prepared food. Participants also began receiving weekly food deliveries from Top Box Foods. Top Box has sourced, packaged and delivered boxes of fresh produce to the homes of participating individuals. Boxes have included 15-18 pounds of a rotating assortment of fresh fruits and vegetables tailored to participants' medical needs and cultural background. Alivio Medical Center's care coordinators have completed follow-up coaching sessions with each enrolled patient up to 3 times a month. During these sessions, the AMC staff assess patients' progress. Additional education and resources have also been provided during or following sessions based on the patient's needs and asks. During the first year of grant programming we enrolled 70 participants. Enrollment continues to take place on an ongoing basis. While no participants have completed the full 52 weeks of food deliveries and health coaching to this point, and program outcomes have not yet been achieved, initial survey results show that the majority of patients are satisfied with their produce deliveries and are consuming all of the produce delivered. Furthermore, patients are actively engaged with the health coaching and disease management portion of this work. They are meeting with their health coach, the licensed dietician, and taking their blood pressures regularly, providing readings back to the health coach for tracking. These blood pressures will be used for further analysis at grant completion.

Publications