Non Technical Summary
Banco de Alimentos will partenr with local community health clinics(Centros 330) to address 2 of the most prominent conditions among older adults in Puerto Rico(diabetes and hypertension) through healhtier eating habits. Through health screening ando our malnutrition and food insecurity screening test, we will identify 200 older adults (65+) witha health condition that can be maintained or improved with proper nutrition and provide nutritionally and condition-appropriate food boxes on a monthly basis to help manage and improve these health conditions. These food boxess will contain contition-appropriate fresh produce (fruits and vegetables) to help inprove nutrition and thus health conditions. In addition to produce, these boxxes will contain educational materials that are important to proper condition management.Food boxes will be distributed montlhy by clinic personnel who will also conduct monthly health monitoring and health education. This monthly monitoring will be reported on a quarterly and yearly trackign report that will help us measure the success of the program.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6099	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism;

Goals / Objectives
Goals:Manage and control malnutrition-related diseases through diet, nutrition and education in order to reduce hospitalizations.Reduce hospitalizations due to malnutrition-related chronic conditionsImprove overall household health through increased fruits & vegetables and education;Improve overall health and nutrition-related health conditions as well as food insecurity in 200 NAP/Medicare/Medicaid participants who are food insecureAssociated Objectives:Two hundred participants throughout the 9 participating 330 Centers (in rural and urban areas of Puerto Rico), and other community hospitals, will receive nutrition education complimentary reading material in their prescription food boxes.Education material will include a list of beneficial fresh fruits and vegetables to use, depending on their medical conditions, as suggested by licensed nutrition professionals and/or medical staff, proper meal combinations and healthy recipes.Information on all Banco de Alimento Programs and Services will be provided.Expected Outputs:Produce prescriptions to 200 participants monthly200 monthly produce prescription boxes to participating clinics.Monthly purchases, produce receipt, produce storage, and preparation of 200 fresh produce boxes and their transportation to participating 330 Centers around the island.Quarterly patient health monitoring by participating clinic personnel to measure produce prescription results.Yearly surveys to monitor program performance and successExpected Outcomes:200 participants will be impacted during program duration100% will receive monthly prescription food boxes with fresh produce free of charge (Goal: Provide non-financial incentives for eligible individuals to purchase or procure fresh fruits and vegetables;)100% will receive nutrition education material free of chargeOver 80% will experience stability and/or improvement of health conditions (Goal: The improvement of dietary health through increased consumption of fruits and vegetables;)Over 80% will experience a decrease in their food insecurity (Goal: The reduction of individual and household food insecurity;)Over 80% will experience healthier eating habits (Goal: The improvement of dietary health through increased consumption of fruits and vegetables;)Over 80% will not have hospital readmissions due to nutrition related diseases (Goal: The reduction in healthcare use and associated costs;)

Project Methods
Activities to Achieve the Goals:Grant funds will be used to prepare health center produce prescription fulfillment spaces with proper shelving and refrigeration, so that product is adequately stored according to USDA standards.BDAPR will procure produce from local vendors and Feeding America cooperatives to ensure we maximize the funds available.BDAPR (personnel and volunteers) will pack prescription boxes to be distributed to participating clinics.Participating clinics will administer the malnutrition test provided and qualify potential participants. This test is currently used successfully in our Food is Medicine program.Clinic professionals will prescribe patients with a produce prescription to be fulfilled at the clinics.Patients will pick up their produce at the clinics, or will have their produce delivered to their homes when necessary. This will be in addition to our mobile pantry that will make scheduled visits to participating sites;The produce prescription boxes will take the following into consideration: Prescription prescribed by the clinic professionalsLocal products, including fresh local fruits and vegetables (eg: avocado, oranges, limes, guava, plantains, papaya, bananas, root vegetables, greens, etc).All produce prescription food boxes will be free of cost for program participants. We confirm that no tax will be collected as no money will be collected from participants at any point in time during the program period.An estimated $46 cost prescription food box per month, per participant, will provide a mix of shelf stable fresh and refrigerated produce to be consumed at home. As previously mentioned, Puerto Rico imports 85% of its food. Our participants are food insecure older adultswho with malnutrition-related chronic conditions.Banco de Alimento will transport prescription boxes to the participating clinics, and other community health centers to be stored in refrigerated spaces. This will be in addition to our mobile pantry that will make scheduled visits in participating sites.Clinic personnel will conduct periodical (at least quarterly) visits to patients for health monitoring.Clinic personnel will conduct yearly surveys to a minimum of 100-130 participants out of the 200 expected participants.Clinic personnel will analyze participant data to monitor health changes/improvements on participants - the same participants will be monitored during the three-year program period.2. Implement an effective produce prescription project, including the role of each healthcare partner in implementing the project, such as screening and referring potential participants (Health Center role), tracking health outcomes (Health Center Role and Banco de Alimento joint effort), and/or reporting healthcare utilization and healthcare costs (Health Center Role and Banco de Alimento joint effort).3. Evaluate individuals participating in a produce prescription project with respect to the impact of the project participation on (1) the improvement of dietary health through increased consumption of fruits and vegetables (Health Center role); (2) the reduction of individual and household food insecurity (Banco de Alimento role); and (3) the reduction in healthcare use and associated costs (Health Center Role and Banco de Alimento joint effort).4. Provide educational opportunities relating to nutrition to eligible individuals participating in a produce prescription program (Banco de Alimento role).5. Inform eligible individuals of the availability of produce prescription program, including locations at which produce prescriptions may be redeemed (Health Center Role and Banco de Alimento joint effort).