Progress 11/01/22 to 10/31/23

Outputs
Target Audience:Sixty-three CoxHealth patients and their families participated in Health Scripts (n=209). Eighty-nine percent of the participants identified as White, 5% American Indian or Alaska Native, 3% Black or African American, and 3% were mixed race. Almost 70% of the patients reported being food insecure and 48% received Supplemental Nutrition Assistance Program (SNAP) assistance. Fifty-nine percent of the participants lived in a 3-4-member house; 25% in a home with 5 or more people; and 15% had one other person living with them (1-2 person house). Over half of the participants (56%) reported living less than 10 miles from the clinic, nearly one-quarter lived less than 5 miles. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?A total of nine seminars were held for medical and dietetic students (n=31) with six faculty from family medicine and dietetics and a guest lecturer presenting on social determinants of health (SDoH) and food insecurity. How have the results been disseminated to communities of interest?Several articles have been published on-line, including Springfield Business Journal and Forbes Magazine. Additional dissemination will include a report, infographics, and several publications. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Obj 1.1.By Q2, SCG and CoxH MS&HPs will have capacity to implement HEALTH SCRIPT, including knowledge of food insecurity, healthy food access, poverty, social connectedness, and their association with health outcomes. Between November 2022 and October 31, 2023, the Health Scripts Team (an average of 11 people) met for over 55 hours to plan and discuss implementation successes, challenges, and opportunities for growth. During the program planning phase (November 2022 - April 2023), there were five subcommittees working to prepare for a June 1, 2023, launch. The subcommittees consisted of around five people from the larger Health Scripts Team and included: Clinical Education and Participation; Community Shared Agriculture; Shared Medical Appointments; Recruitment and Evaluation; and Marketing/Press Outreach. Three of the participating farmers joined the Health Scripts Team meetings to introduce themselves and to share their experiences implementing CSAs. This meeting was instrumental in building an understanding between the various roles farmers, SCG, and CoxHealth staff would play in Health Scripts. It was also a way for the physicians, nurse practitioner, dietician and administrative staff working on the project to meet the farmers and to hear their experiences in terms of CSAs (e.g., the most popular vegetables, etc.). A total of nine seminars were held for medical and dietetic students (n=31) with six faculty from family medicine and dietetics and a guest lecturer presenting on social determinants of health (SDoH) and food insecurity. Students who completed a post survey (n=5) reported an increase in knowledge on issues related to SDoH and food insecurity and confidence in their ability to work with patients on related topics. The evaluator programmed the survey (with required NTAE and several project-specific questions) into Alchemer. In an effort to monitor progress and to document experiences, the evaluator also set up and trained the Health Scripts Team on Monday.com. This platform allowed for SCG to track CSA pick-ups and for CoxHealth to document patient interactions and shared medical appointments. The administrative assistant, who made weekly calls, also documented the calls and topics discussed with the participant. Obj 1.2.By Q4, a minimum of 100 patients with, or at risk of a chronic conditions, and vulnerable to food insecurity will have received F&V incentives valued between $12.50 and $275 and a minimum of 20 hours of holistic health care. One hundred and twenty-six patients were identified, and 85 patients were screened for participation. Fourteen were not eligible because they were not marginally food insecure to very low food insecure or on Medicaid. Two individuals did not want to participate in Health Scripts after being screened and six could not be reached to enroll after screening took place. A total of 63 CoxHealth patients and their families were enrolled in Health Scripts, but five never picked up on CSA or participated in one shared medical visit (SMV). Just over half of the patients (n=51) completed the 22-week program (meaning, they did not actively drop out). Seven individuals who enrolled in Health Scripts and participated at least once dropped out at some point before the 22 weeks were up. Reasons included transportation challenges and health conditions (e.g., in the hospital, broke a leg and can't drive, etc.). Among those who participated at least one time (n=58), eight were from a 1 - 2-person household, 35 were from a 3 - 4-person household, and 15 lived in a home with 5 ore more people. After the first few weeks, when we did a short satisfaction survey, we learned that the original price of $12.50 for a half share box (for 1-2 member households) was not enough. Participants receiving this amount said it wasn't worth the gas money to get to the clinic to pick it up. Accordingly, we increased the value to a full share ($25). Households with 1 to 4 people received a CSA box valued at $25 every week and households with 5 ore more received $37.50. The total amount of produce distributed through the CSA boxes was $18,050. Forty-four hours of holistic health care was provided over the 22-week period via SMVs. The mean number of hours a participant was engaged in an SMV was 2.90 hours ranging from a low of 0 to a high of 14. Topics covered during the SMVs included healthy eating, cooking with kids, and eating w/ diabetes. Obj. 1.3. By Q4, a minimum of 20 hours of social interaction between the ~100 participants and Site Coordinator, Physician Leads, MS&HPs, and dietetic students will have occurred. Forty-four hours of holistic health care was provided over the 22-week period via SMVs. The mean number of hours a participant was engaged in an SMV was 2.90 hours ranging from a low of 0 to a high of 14. These sessions also allowed time for networking between participants as well as participants and providers. "Today was something else, though. The regular participants were in charge, leading the meeting, sharing with each other, sharing leadership with each other. Amidst a room of known and new faces of healthcare professionals- resident physicians, dieticians, student, etc- the participants shared freely how this program and the food they are engaging with is changing their lives." In total with the CSAs, SMVs, and phone calls, there were a total of 1,062 "touches" that occurred with the participants, meaning contact between them and healthcare providers, students, and/or SCG staff. Obj 2.1.By Q4, a minimum of 20 hours of opportunities will have been provided to provide MS&HPs and opportunity to connect, interact, and engage around HEALTH SCRIPT. MS&HPs could have engaged in more than 66 hours with participants at CSA pick-ups and SMVs. Obj 3.1By Q4, The evaluator will compile data, present findings, and facilitate discussionswith SCG and CoxH regarding the expansion and/or sustainability of HEALTH SCRIPT. Data have been compiled and two grants have been written to sustain Health Scripts.

Publications

Progress 11/01/22 to 10/31/23

Outputs
Target Audience:Sixty-three CoxHealth patients and their familiesparticipated in Health Scripts (n=209).Eighty-nine percent of the participants identified as White, 5% American Indian or Alaska Native, 3% Black or African American, and 3% were mixed race. Almost 70% of the patients reported being food insecure and 48% received Supplemental Nutrition Assistance Program (SNAP) assistance. Fifty-nine percent of the participants lived in a 3-4-member house; 25% in a home with 5 or more people; and 15% had one other person living with them (1-2 person house).Over half of the participants (56%) reported living less than 10 miles from the clinic, nearly one-quarter lived less than 5 miles. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?A total of nine seminars were held for medical and dietetic students (n=31) with six faculty from family medicine and dietetics and a guest lecturer presenting on social determinants of health (SDoH) and food insecurity. How have the results been disseminated to communities of interest?Several articles have been published on-line, including Springfield Business Journal and Forbes Magazine. Additional dissemination will include a report, infographics, and several publications. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Obj 1.1.By Q2, SCG and CoxH MS&HPs will have capacity to implement HEALTH SCRIPT, including knowledge of food insecurity, healthy food access, poverty, social connectedness, and their association with health outcomes. Between November 2022 and October 31, 2023, the Health Scripts Team (an average of 11 people) met for over 55 hours to plan and discuss implementation successes, challenges, and opportunities for growth. During the program planning phase (November 2022 - April 2023), there were five subcommittees working to prepare for a June 1, 2023, launch. The subcommittees consisted of around five people from the larger Health Scripts Team and included: Clinical Education and Participation; Community Shared Agriculture; Shared Medical Appointments; Recruitment and Evaluation; and Marketing/Press Outreach. Three of the participating farmers joined the Health Scripts Team meetings to introduce themselves and to share their experiences implementing CSAs. This meeting was instrumental in building an understanding between the various roles farmers, SCG, and CoxHealth staff would play in Health Scripts. It was also a way for the physicians, nurse practitioner, dietician and administrative staff working on the project to meet the farmers and to hear their experiences in terms of CSAs (e.g., the most popular vegetables, etc.). A total of nine seminars were held for medical and dietetic students (n=31) with six faculty from family medicine and dietetics and a guest lecturer presenting on social determinants of health (SDoH) and food insecurity. Students who completed a post survey (n=5) reported an increase in knowledge on issues related to SDoH and food insecurity and confidence in their ability to work with patients on related topics. The evaluator programmed the survey (with required NTAE and several project-specific questions) into Alchemer. In an effort to monitor progress and to document experiences, the evaluator also set up and trained the Health Scripts Team on Monday.com. This platform allowed for SCG to track CSA pick-ups and for CoxHealth to document patient interactions and shared medical appointments. The administrative assistant, who made weekly calls, also documented the calls and topics discussed with the participant. Obj 1.2.By Q4, a minimum of 100 patients with, or at risk of a chronic conditions, and vulnerable to food insecurity will have received F&V incentives valued between $12.50 and $275 and a minimum of 20 hours of holistic health care. One hundred and twenty-six patients were identified, and 85 patients were screened for participation. Fourteen were not eligible because they were not marginally food insecure to very low food insecure or on Medicaid. Two individuals did not want to participate in Health Scripts after being screened and six could not be reached to enroll after screening took place. A total of 63 CoxHealth patients and their families were enrolled in Health Scripts, but five never picked up on CSA or participated in one shared medical visit (SMV). Just over half of the patients (n=51) completed the 22-week program (meaning, they did not actively drop out). Seven individuals who enrolled in Health Scripts and participated at least once dropped out at some point before the 22 weeks were up. Reasons included transportation challenges and health conditions (e.g., in the hospital, broke a leg and can't drive, etc.). Among those who participated at least one time (n=58), eight were from a 1 - 2-person household, 35 were from a 3 - 4-person household, and 15 lived in a home with 5 ore more people. After the first few weeks, when we did a short satisfaction survey, we learned that the original price of $12.50 for a half share box (for 1-2 member households) was not enough. Participants receiving this amount said it wasn't worth the gas money to get to the clinic to pick it up. Accordingly, we increased the value to a full share ($25). Households with 1 to 4 people received a CSA box valued at $25 every week and households with 5 ore more received $37.50. The total amount of produce distributed through the CSA boxes was $18,050. Forty-four hours of holistic health care was provided over the 22-week period via SMVs. The mean number of hours a participant was engaged in an SMV was 2.90 hours ranging from a low of 0 to a high of 14. Topics covered during the SMVs included healthy eating, cooking with kids, and eating w/ diabetes. Obj. 1.3. By Q4, a minimum of 20 hours of social interaction between the ~100 participants and Site Coordinator, Physician Leads, MS&HPs, and dietetic students will have occurred. Forty-four hours of holistic health care was provided over the 22-week period via SMVs. The mean number of hours a participant was engaged in an SMV was 2.90 hours ranging from a low of 0 to a high of 14. These sessions also allowed time for networking between participants as well as participants and providers. "Today was something else, though. The regular participants were in charge, leading the meeting, sharing with each other, sharing leadership with each other. Amidst a room of known and new faces of healthcare professionals- resident physicians, dieticians, student, etc- the participants shared freely how this program and the food they are engaging with is changing their lives." In total with the CSAs, SMVs, and phone calls, there were a total of 1,062 "touches" that occurred with the participants, meaning contact between them and healthcare providers, students, and/or SCG staff. Obj 2.1.By Q4, a minimum of 20 hours of opportunities will have been provided to provide MS&HPs and opportunity to connect, interact, and engage around HEALTH SCRIPT. MS&HPs could have engaged in more than 66 hours with participants at CSA pick-ups and SMVs. Obj 3.1By Q4, The evaluator will compile data, present findings, and facilitate discussionswith SCG and CoxH regarding the expansion and/or sustainability of HEALTH SCRIPT. Data have been compiled and two grants have been written to sustain Health Scripts.

Publications