Performing Department
(N/A)
Non Technical Summary
Non-Technical SummaryFarm to You Mobile is a Produce Prescription (PRx) program designed to improve community health and support local agriculture in the Eastern Panhandle of West Virginia (WV). Like many other regions of WV, our tri-county area suffers from interconnected problems of chronic disease, food insecurity, educational gaps, and socioeconomic barriers to healthy eating. Our local farmers are also struggling against low market prices and shrinking markets. University Health Associates East recognizes the importance of community collaborations that improve health literacy and access to resources to improve the long-term health and personal agency of our community residents. Our current program, Farm to You, partners with local farmers to connect patients with fresh, local produce and nutrition/cooking education at no cost. We aim to expand this into a formal produce prescription program with a mobile "food truck" unit that delivers local produce to 7 clinical sites across theregion at no cost to patients, increasing to 8 clinical sites in year 2 and 9 clinical sites in year 3. The unit will be equipped for cooking demonstrations, interactive nutrition education, and electronic health record access to measure participation and impact on both individuals (health outcomes) and the health system (healthcare utilization patterns). Because of our extensive work in nutrition and cooking education with low-income communities, and our experience with Farm to You, we have a strong support network of knowledgeable staff and resources to manage this project. We plan to conduct a thorough program evaluation to analyze our impact on fruit/vegetable consumption, food insecurity, healthcare usage/costs, and physical health metrics for enrolled participants. We recognize that reducing barriers to healthy eating, including cost, transportation, and knowledge, are crucial to reverse the worsening trends of chronic illness in our community. Farm to You Mobile aims to reduce these barriers and empower patients to make lasting investments to better their long-term health.?
Animal Health Component
50%
Research Effort Categories
Basic
0%
Applied
50%
Developmental
50%
Goals / Objectives
We seek to expand our current produce access and education program, Farm to You, to increase reach, educational programming, and clinical integration to a tri-county region in WV's Eastern Panhandle. The Farm to You Mobile PRx Program will employ a mobile teaching kitchen/distribution unit that expands access to healthy food and culturally appropriate cooking and nutrition education across our clinical sites in the Eastern Panhandle of West Virginia. We will also integrate PRx into the clinical encounter and electronic health record (EHR), and invest directly in local agriculture across our region.1) Expand Access to Fresh Produce: Launch Farm to You Mobile to reduce barriers to access among our eligible population by increasing the number of participating clinical access points across our counties.2) Expand Education: Use Farm to You Mobile to expand upon our teaching and nutrition education programming and reduce barriers to healthy eating with a mobile teaching kitchen for our patients and community members. Develop programing tailored to specific populations including families, children, pregnancy, and the elderly.3) Integrate into EHR: Implement EHR-based provider prescription functionality for PRx integrated into clinical encounters and build upon the provider and staff incorporation of produce prescriptions and education into clinical care.4) Invest Locally: Invest in and market our local agricultural economy and construct flexible procurement system that leverages assets and accommodates needs of local farmers.Objectives:For Goal 1:1a) Over 3 years, increase access to fresh, local, GusNIP-qualifying fruits and vegetables for maximum enrollment funding allow of low-income consumers participating in Farm to You by prescribing eligible patients biweekly access to financial incentives that completely subsidize the cost of the produce at point of purchase.1b) Provide information on community-wide resources for nutrition access, lifestyle health and food security such as local farmers' market nutrition incentive programs, cooking resources, community gardens, and emergency food organizations. For Goal 2:2a) At each distribution event, deliver practical and culturally appropriate nutrition and cooking education events tailored to the seasonal produce available onsite, with accompanying recipes and a reusable produce bag.For Goal 3:3a) Initiate the use of EHR-based PRx in the clinical encounter in at least 5 clinical sites in Year 1, with an additional increase of providers and sites in Years 2 and 3.For Goal 4:4a) Partner with a cooperative network of local farmers to fulfill at least 10,000 PRx of $20 value to eligible patients over 3 years of mobile outreach at 6-9 clinical sites per week, 42 weeks per year (including winter boxes), with an average of 25 patients per site enrolled for 6 months each with rolling enrollment.4b) Increase direct-to-consumer marketing for local agricultural partners via coordinated social media efforts, community partnerships and coalitions, and match these marketing efforts to our expanded sites over the 3 years.
Project Methods
MethodsPrimary programmatic efforts include:1. Expand Access to Fresh Produce2. Expand Nutrition/Cooking Education3. Integrate Produce Prescriptions into Clinical Care4. Invest in Local Agriculture5. Improve Dietary Health and Social/Clinical Outcomes1: Expand Access to Fresh ProduceOver 3 years, we will increase access to fresh, local produce for our participants by prescribing eligible patients biweekly access to produce prescriptions distributed via our mobile unit.We will also provide community-wide resource guides for healthy food access, lifestyle health and food security to improve overall access.Methods: Eligible patients will be enrolled in the PPR with discussion with their referring provider to participate in a multi-faceted intervention to improve their health. This includes 1) nutrition incentives twice monthly,2) onsite nutrition/cooking education offered during events, 3)n online nutrition/cooking education, and 4) regular provider check-ups to discuss their progress.Evaluation:The following metrics will be collected to evaluate access expansion over the project period: Number of patients enrolledNumber of prescription redemptionsNumber of unique participants per site Number of eligible participants per clinical siteMonetary value of incentives issued and redeemed per site Average incentive value redeemed per recipientSurvey data on participant awareness of community-wide resources2: Expand Nutrition/Cooking EducationAt each distribution event, we will deliver practical and culturally appropriate nutrition and cooking education events tailored to the seasonal produce available onsite, with accompanying recipes. Additional recipes, nutritional education and health tips will be available on our website, Facebook page and mailings.Evaluation:Nutrition education components of each distribution event will be tracked using Qualtrics secure online software. The following metrics will be collected to evaluate education expansion via participant surveys:Level of nutritional knowledge Cooking and dietary self-efficacy Knowledge of cooking techniquesKnowledge of nutritional approaches to applicable diet-sensitive conditionsParticipants will be surveyed on their nutrition/cooking knowledge, attitudes and access upon enrollment and at the conclusion of each project year.3: Integrate Produce Prescriptions into Clinical CareWe will initiate the use of EHR-based PRx in the clinical encounter in at least 6 clinical sites in Year 1, with an additional increase of providers and sites in Years 2 and 3.Evaluation:Program evaluation focuses on process-level and outcomes-level evaluation metrics. Part of the process evaluation will include a self-assessment on intervention development and implementation. Using USDA guidance, the intervention team will document information on the implementation process, challenges experienced, solutions to overcoming those challenges, and project implementation and operations successes.Using Qualtrics secure online software, the following project-specific data will be collected as well: number of redemption (clinical) sites; months/days/hours of operation of redemption sites; fruit and vegetable products offered at each site/event.We will also survey staff and providers on their experiences with clinical integration, measuring satisfaction levels with the implementation process and perceptions of program impact and effectiveness.4: Invest in Local AgricultureWe will partner with a cooperative network of local farmers to fulfill at least 10.000 PRx of $20 value to eligible patients over 3 years of mobile outreach at 6-9 clinical sites per week, 42 weeks per year, with an average of 25 patients per site enrolled for 6 months each with rolling enrollment, We will also increase direct-to-consumer marketing for local agricultural partners via coordinated social media efforts, community partnerships and coalitions, and match these marketing efforts to our expanded sites over the 3 years.Evaluation:Using Qualtrics secure online software, the following project-specific data will be collected to evaluate financial investments in local agriculture: expenses associated with the program; monetary value of incentives issues and redeemed per site; and average incentive value redeemed per recipient.We will also survey our farmer partners on their experiences with the cooperative network of procurement, measuring satisfaction levels with the implementation process and perceptions of program impact and effectiveness on their business operations.We will measure website traffic data on our various social media sites and community coalition sites promoting the program to evaluate marketing goals.5: Improve Dietary Health and Social/Clinical OutcomesWe aim to increase fruit and vegetable intake, decrease food insecurity, improve physical health outcomes, and decrease healthcare usage/associated costs.Evaluation:Using Qualtrics secure online software and/or the Epic electronic health record, the following data will be collected: fruit and vegetable intake; food security focused questions; COVID-19 related questions; household characteristics. These metrics are outlined in detail in the pre-supplied pre/post survey questionnaires via USDA.From the Epic EHR, the following information will be collected: health profile, including indication of pre-diabetes, diabetes, gestational diabetes, high blood pressure, cardiovascular disease, pregnancy and obesity; sociodemographic data, including age, sex, race and ethnicity; vitals and laboratory values, including systolic and diastolic blood pressure, height, weight, body mass index, Hemoglobin A1c, and lipid panel [HDL, LDL, total cholesterol, triglycerides] as available. We anticipate collecting baseline data on patients, and with additional data collection at 6-month intervals throughout the duration of the program. WVU OHSR aims to work with project leadership and NTAE evaluation leadership in crafting specific, measurable, attainable, realistic, and time-based (SMART) goals for monitoring program success. These goals will be based, in large part, on baseline statistics among program participants.From the WV Medicaid claims data, the following information will be collected given appropriate approvals: supplemental health care usage and cost data on program participants. These variables will be defined in more detail with project leadership and any needed NTAE guidance.We will address all core program metrics as outlined in the "Participant-Level Core Metrics Toolkit for Produce Prescription Projects" documentation provided by USDA.?