Recipient Organization
COUNTY OF ALAMEDA PUBLIC HEALTH DEPARTMENT
1100 SAN LEANDRO BLVD
SAN LEANDRO,CA 94577
Performing Department
(N/A)
Non Technical Summary
Since receiving it'sfirst GusNIP grant in 2019,the Recipe4Health (R4H) "Food as Medicine" initiative has partnered with a network of Federally Qualified Health Centers (FQHC) to improve food security and health outcomes for Medi-Cal eligible residents who are in high need of nutritional and behavioral supports. By equipping FQHC staff with specialized clinical training and implementing a multifaceted approach including regenerative and organic food prescription and delivery alongside behavioral health coaching for patients, R4H has positively impacted the lives of 1000+ residents annually. Findings published in peer reviewed medical journalsindicate a significant reduction in risk factors that lead to heart disease and long-term complications associated with diabetes,food security status improvements, and reductions in the likelihood of emergency room visits among patients participating in the program.Under the current GusNIP grant project, R4H willextend this model to the county's core safety-net health provider, enabling R4H to reach a wider audience and set the stage to incorporate the initiative system-wide. This project will initiate partnership with Alameda Health System (AHS) network and anticipatespartneringwithtwo AHShealth centers andservingat least 500additional patients during the three-year award period.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Goals / Objectives
R4H's overarching program goals match the GusNIP goals of (1) improvement of dietary health through increased consumption of fruits and vegetables; (2) reduction of individual and household food insecurity; and (3) reduction in unnecessary healthcare use and associated costs.Goal 1: Expand the Recipe4Health program to Alameda Health System (AHS), Alameda County's safety net health system Objectives:By April 2026, complete necessary IRB, Data Use Agreements, Data Risk Assessments needed to set up data infrastructure at AHS parallel to existing data infrastructure between current R4H partner freestanding FQHCs and evaluation team.By January 2026, finalize adaptation of existing workflows (clinical and EHR) used at network of R4H partner clinics to AHSBy February 2026, train 70% of relevant staff from one AHS FQHC on s "Food as Medicine" nutrition training.By March 2027, train 70% of relevant staff from a second AHS FQHC.Goal 2: Improve health-related behaviors and health outcomes among Recipe4Health patients in Alameda Health System Objectives:By February 2027 (completion of year 1 for AHS clinic 1, a large clinic) at least 300 patients will have received the Food Farmacy doorstep delivery of regenerative and organic produce and at least 150 patients will receive Behavioral Pharmacy health coaching with the food.By March 2028 (completion of year 1 for AHS clinic 2, a small clinic), at least 200 patients will have received the Food Farmacy doorstep delivery of regenerative and organic produce and at least 100 patients will receive Behavioral Pharmacy health coaching with the food.By August 2028, conduct before and after surveys with at least 120 R4H participants to measure pre/post changes in vegetable and fruit intake, household food security, self-reported health behaviors and health status, and mental health outcomes.By August 2028, obtain patient self-report survey data on healthcare utilization (e.g. emergency room visits and hospital admissions) at baseline out to 12 months for at least 120 participants.By August 2028, laboratory data for a randomly selected subsample of 120 patients will be assessed directly (home visits) for changes in anthropometrics (e.g., blood pressure, waist-height ratio) and changes in relevant cardiometabolic labs using point of care testing.By August 2028, EHR data will be abstracted from all R4H participants with available data, to compare levels in relevant health anthropometrics (e.g. blood pressure, waist and height ratio) and cardiometabolic laboratory data pertinent to prediabetes/diabetes, hyperlipidemia, insulin resistance, and other conditions such as non-alcoholic fatty liver disease.By August 2028, EHR data on all R4H participants with available data will be abstracted to compare healthcare utilization (e.g. emergency room visits and hospital admissions) at baseline out to 12 months.
Project Methods
The evaluation will be conducted by evaluators and researchers at Stanford University School of Medicine and the University of California, San Francisco.Recipe4Health will help project manage the evaluation and ensure alignment between evaluation team and Recipe4Health program team. The evaluationteam has experience establishinginfrastructure such as IRB approvals, data sharing agreements and protocols, trained research coordinators, REDCap database, surveys, informed consents, and data reporting templates. We previously published our protocol for evaluating R4Hand the results of our evaluation of data through 2023 was published in February 2025.The research team was awarded a R01 grant from the National Institute of Diabetes and Digestive and Kidney Diseases to examine the effectiveness of R4H. The funded research study includes analysis of EHR data on participants and propensity score matched controls as well as surveys, 24-hour dietary recalls and direct lab testing with a random subsample of 240 participants and 240 controls. We will leverage the infrastructure and research planned to conduct process and impact evaluation according to the goals outlined in this proposal.Process evaluation: We will leverage infrastructure that we have already established to track and monitor onboarding new clinics, training staff to implement R4H, and implementing the Food Farmacy and Behavioral Pharmacy. For goal 2, we plan to monitor and track participation in the Food Farmacy and the Behavioral Pharmacy by key client clinical characteristics such as diagnosed chronic conditions. The data for key client characteristics are abstracted from the Electronic Health Record (EHR). We summarize our data on a dashboard that is updated monthly so stakeholders have an up-to-date understanding of program implementation. Additionally, the process evaluation supports understanding the results of our impact evaluation.Impact evaluation: There are two sources of data for the impact evaluation: 1) EHR data from participating clinics on labs and vital signs that are abstracted within relevant time periods to the participants' time in R4H; and 2) Surveys that are conducted at the time of enrollment in the program (baseline) and follow-up (3 months). We will use EHR data to assess pre/post changes in health outcomes related to cardiometabolic health (e.g. HbA1c) and healthcare utilization including hospitalizations and emergency room visits. We will use surveys to assess changes in core NTAE metrics including produce consumption, food security, and healthcare utilization. Additional survey items will assess changes in mental health (depression and anxiety). We will also use the survey to assess program satisfaction. With funding from NIH, the research team will hire and train research assistants who will conduct surveys and in-depth dietary assessments (24 hour recalls) with 240 participants.