Recipient Organization
THE RICHFORD HEALTH CENTER, INC
44 MAIN ST
RICHFORD,VT 05476
Performing Department
(N/A)
Non Technical Summary
The NOTCH Produce PrescriptionProject is a 3-year research collaboration between medical clinics of Northern Tier Center for Health (NOTCH) and strategic grocery retail partners to reduce healthcare use and associated costs and to increase the consumption of fresh fruits and vegetables for at risk individuals in northwestern, Vermont. Foundational project partners in Richford, Vermont, are owned and operated by a Federally Qualified Health Center (FQHC) and co-located in the same building. In 2020, 36% of Richford residents had been told at some point they have high blood pressure, and according to 2020 data, 11% had been told they have diabetes. Evidence indicates a healthy diet consisting of fresh fruits and vegetables can prevent and improve diet-related health conditions. Additionally, this community has a low-income population rate of 43.7%, which is higher than the state average, and increased rate of patients screening for food insecurity compared to other communities in Northwesternbased on recent data.This comprehensive program will involve: 225 GusNIP eligible patients, nutrition consults, produce prescriptions ($20 each week/participant/years; dosage based on general disbursement model and amount used by a number of GusNIP-funded programs), and tools, and self-management resources. Program modeling for this collaboration will be the basis for program expansion in other local communities during the funded period. This project will collect information from patients at the point of care (labs, blood pressure measurements, etc.) and self-reported data from patients using pre- and post-survey activities to measure change and/or improvement in health status, food security status, food agency/resources, and dietary pattern change. This project will also track patient utilization of health services (primary care visits, no-show appointment rates, etc.), in evaluating the impact a produce prescription program may have on healthcare costs.
Animal Health Component
60%
Research Effort Categories
Basic
10%
Applied
60%
Developmental
30%
Goals / Objectives
The goals of the NOTCH Produce Produce Prescription Projectare aimed at supporting anintegrative approach to the healing arts, promoting "food as medicine" in the treatment and prevention of diet-related illnesses among staff and patients, improving health and wellbeing through increasing participants' access and agency inthe procurement of fresh fruits and vegetables.Additionally, this project willevaluate cost-savings impacts for afederally qualified health center (FQHC) in Vermont through monitoring patient service utilization with the goal of informing and creating an effective base program model for other FQHCs to adopt.Twenty-five percent of participants will increase their consumption of fruits and/or vegetables through increased capacity to procure fresh produce and increased understand of the importance of consuming fruits of vegetables for health.There will be a 30% reduction in participants screening positive for food insecurity as measured by the Hunger Vitals™ screening tool.Participants with chronic conditions that impact mortality, morbidity, cardiovascular health, and metabolic dysfunctions will see an improvement in their biomarkers.Patients with insulin, and non-insulin dependent diabetes with a HbA1c over 7% at the beginning of the study should see a 1%, or more, decrease in their HbA1c percentages by the end of the study.Patients with hypertension should see a decrease in their blood pressure measurements by at least 10 mmHg (systolic and diastolic) or more.Patients with dyslipidemia and mixed hyperlipidemia should see a reduction in their low-density lipoprotein (LDL) by at least 10% and increase their high-density lipoprotein (HDL) by at least 10% after the study period.Seventy-five percent of participants will visit their Primary Care Provider for an annual well visit.There will be a 30% reduction in no-show appointment rate to primary care appointments achieved by the study population.
Project Methods
Health Care Partners will refer eligible participants to the NOTCH Produce Prescription Project. Eligibility will be based on a patient presenting with a positive food insecurity screening and/or meeting income eligibilty requirements, and an evaluated risk and/or diagnosis of one or more diet-related chronic conditions based on documentation in the electronic medical records (EMR).Patients receive nutrition consultation with their healthcare provider and referral to a nutrition specialist, if appropriate based on diagnosis and/or chronic care management plan. Patients schedule an enrollment appointment with the healthcare partner which will include goal setting, nutrition education referral (SNAP-Ed cooking classes, food demonstrations, grocery store tour, etc.)and self-management resources. Consent for study participation and pre-survey data collection activities to collect core metrics and baseline data will take place at enrollment. Patients will receive programmatic information on obtaining and redeeming their produce prescription with retail partners. Patients will receive a toolkit containing basic kitchen supplies and nutrition education resources to support them in the preparation of fresh, nutritious whole foods.Patients enrolled will receive 12-months of produce prescription, which includes a $20 per week disbursement utilizing a novel point-of-sale software platform at grocery store partner locations. The produce prescription will be redeemable for fresh, whole fruits and vegetables from participating retailer locations which can be redeemed and tracked via the software application at the retailer's point-of-sale checkout app reader. Patients will have access to ongoing in-person nutrition education activities facilited by the healthcare partner using evidence-based SNAP-Ed curricula that will focus on healthy food preparation techniques and recipes, food resource management skills, and general nutrition education to support healthy eating patterns.One-on-one and group grocery store tours will be made available ongoingly and upon request for patients, in addition to supportive materials at the retailer partner locations, including recipe cards and point-of-sale shelf educators.Patients participating in classroom-based or grocery tour educationactivities will participate in pre- and post-activities to capture change in knowledge and confidence in cooking, nutrition and/or food resource management topics. Patients will participate in an program exit process at the end of the 12-month period where a post-survey will be administered to evaluate change against baseline data collected at the beginning of the program period.NOTCH will evaluate the project based on a cluster evaluation model that builds on the collaboration and coordination of individual project assessments and an overall program evaluation. Evaluation will involve process analysis, outcome analysis, comparative analysis, including longitudinal participant data in evaluating change in dietary behavior, biometrics, and health care utilization through the survey activities and data collected in the EMR.Two main types of data are expected to be collected in the NOTCH Produce Prescription Project: (1) Institutional and firm-level data collected monthly or quarterly via online forms and/or system platforms from the grantee and participating GusNIP firms (e.g., grocery store(s), Health Center Electronic Medical Records (EMR) platform, vendor platform(s), survey platform, etc.); and (2) Participant-level data, to be collected by cohort via survey (pre- and post-program). Participant surveys willbe administered using multiple formats (in-person with assistance, email, paper, etc.) to ensure accessibility for all participants.Firm-Level Data: Firm level data variables may include but are not limited to the following based on final program design:Numberof produce prescription redemption at sitesExpenses associated with the program, months/days/hours of operation of redemption sitesFinancial instrument used for incentives, other nutrition assistance program benefits offered at sites (e.g., SNAP enrollment assistance, healthcare CSA program)Nutrition education components (e.g., nutrition consultation, SNAP-Ed direct education, grocery store tours)Fruit and vegetable products eligible for incentivesIncentive delivery mechanismNumber of eligible participants per siteValue of incentives issued and redeemed per siteNumber of unique participants per site, and average incentive value redeemed per recipientData related to redemption, patient elibility, site participants, and incentive values will be evaluated on a monthly basis with succes measured by increased and/or sustained utilization and participant access, depending on the program enrollment status. Firm data assessing nutrition education, product eligibility and financial instruments will be collected annually and discussed and evaluated with partners, as appropriate.Institutional-Level Data: Health center partner metrics will include cohort-level data:Biometrics: LDL panels, HbA1c, blood pressure measurementsSocio-demographicsFood insecurity screening resultsNumber of no-show appointments to primary care providerNumber of annual wellness visits attendedNutrition education/resource management pre- and post-activity survey (by module/session)Insittutional data will be evaluated on a quarterly basis in trackingtrends in participant biometrics and healthcare utilization, allowing for monitoring of study progress and participant engagement to inform intervention and/or program adjustment, if and as needed. Success will measured by datatrends that align with projectobjectives including reduced measurement readingsin health biomarkers, reduced no-show appointment rates, reported increased knowledge, skill, and competency in nutrition education/resource management topics.Participant-Level Data: Survey tools will be designed to measure outcomes will leverage GusNIP participant-level baseline and core metrics survey tools combined with data collected by the Health Center(s).Data collected through survey activities will additionally support the evaluation of patient experience, food resource/agency,and satisfaction with the program. The study sample will include the collection of participants at program enrollment and at 12-months from enrollment.Food assistance receiptSNAP utilizationProduce prescription redemption behaviors (post-survey)Intake of produce prescription dosageHealth education participationProject satisfactionFruit and vegetable consumptionFood security statusHealth statusFood resourcemanagement skills and behaviors (i.e. shopping with a list, meal planning, preparing meals from 'scratch")Success will be measured by data indicating increased fruit/vegetable consumption among participants, reported increase in food resource management skills and behaviors, reduced food insecurity rates, and improved health status. Satisfaction and/or feedback with theproject will inform quality improvement measures and/or other interventions that are necessary to ensure the success of the project long-term.NOTCH will meet periodically with staff from NIFA, FNS, the NTAE centers, and other GusNIP grantees to review project plans, evaluation objectives and methods, data collection and reporting requirements, and analysis and reporting of results. NOTCH will further facilitate access to or provide documentation of project implementation, operations, costs, and outcomes andsite visits and interviews with project staff, partners, and program participants if necessary. Data will be delivered to GusNIP project partners accord to grant timelines and upon request.