Progress 09/01/19 to 08/31/22
Outputs
Target Audience:Over the course of this 3-year project, The Food Trust's (TFT's) Food Bucks Rx (FBRx) program has successfully engaged numerous participants and other stakeholders across the public and private sectors. Patients: The FBRx program reaches families in key regions of Pennsylvania (PA) and New Jersey (NJ) who are enrolled in eligible state-sponsored insurance plans (primarily Medicaid or dual eligible) and who are experiencing or at risk of diet-related disease. Eligible patients are provided "prescriptions'' in the form of $10 FBRx coupons that can be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase SNAP incentive program (known as Food Bucks). Patients receive FBRx in a variety of settings, including hospital-located Healthy Food Centers/Food "Farmacies", chronic disease management programs, pediatric offices and community clinics. Through this GusNIP award, over 4,000 patients received FBRx coupons from their healthcare providers, with approximately $250,000 redeemed for fresh fruits and vegetables. Along with FBRx, participating patients received nutrition education in the healthcare setting, online and/or at retail redemption sites. Some healthcare partners used their own nutrition education curriculum, such as CHOP's Home Plate, while others distributed FBRx in conjunction with medical nutrition therapy from a registered dietitian. Most patients received a link to TFT's Online Learning Hub, which offers English and Spanish video lessons from a variety of SNAP-Ed-approved curricula for adults and children, including Just Say Yes, which focuses on purchasing, storing and preparing fresh produce. Except during a COVID-related pause, TFT's SNAP-Ed educators also provided in-person cooking demos and lessons at store and farmers market redemption sites in Philadelphia and Camden. Healthcare Providers: TFT worked with 15 healthcare partners in 25 clinical distribution locations in NJ and PA to provide FBRx to eligible patients, with seven new healthcare partners and 11 new clinical distribution locations added in Year 3. Partners included (new in Year 3 marked with asterisk): Cooper Pediatrics (Camden, NJ) Cooper Pediatric Care at Camden Cooper Health Center at KIPP Lanning Square charter school Camden Coalition of Healthcare Providers (Camden, NJ) Accountable Health Communities care navigation services Virtua (Camden, NJ) Food Farmacy Einstein Hospital (Philadelphia, PA) Community Practice Center Einstein Care Partners Stephen Klein Wellness Center (Philadelphia, PA) Self-Monitored Blood Pressure (SMBP) program Congreso Health Center (Philadelphia, PA)* SMBP program Delaware Valley Community Health (Philadelphia, PA)* Fairmount Primary Care - SMBP program Fairmount Primary Care at Girard Medical Center - SMBP program Penn Family Care* SMBP program Children's Hospital of Philadelphia (CHOP)* Randomized Controlled Trial of FBRx + Home Plate education program UPMC Children's Hospital (Pittsburgh, PA) General Academic Pediatrics Oakland Hilltop Health Hub CCP Bellevue CCP Gil* Allegheny Health Network's Healthy Food Centers (Pittsburgh, PA) West Penn Hospital Allegheny General Hospital Jefferson Hospital Forbes Hospital* Adagio Health (New Castle, PA) WIC Office + Medical Office American Heart Association* Hill House Health Center Duquesne University School of Pharmacy* Clairton Hazelwood UPMC Health Plan* Vale-U-Health TFT also engaged in robust planning with additional healthcare partners and sites for the continued expansion of the FBRx program under a GusCRR award, including expanding partnerships with UPMC Health Plan, the American Heart Association, Allegheny Health Network, Delaware County Community Health and other federally qualified health centers, and introducing FBRx programming in new PA and NJ geographies. Redeeming Firms: Throughout the grant period, firms participating in the FBRx program redeemed approximately $250,000 for fresh produce, with over $165,000 redeemed in Year 3. The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks program, which began over a decade ago and is currently funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most firm locations serve as redemption sites for both the Food Bucks and Food Bucks Rx programs. These retail partners include supermarket chains such as Save A Lot, Shop N' Save and Fresh Grocer, as well as neighborhood healthy corner stores, food co-ops, farmers markets and mobile markets. Under this award, new stores were added each year to provide patients with a variety of redemption settings and ensure ease of accessibility. Over $75,000 in FBRx was redeemed at farmers markets and mobile markets, and many of the brick and mortar firms also sell locally grown produce. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to the success of FBRx. In the final year, 15 new firms (located across the Pittsburgh and Philadelphia regions) joined the program as FBRx redemption sites, bringing the total number of locations during the grant period to 82 and providing patients with more options to redeem their prescriptions. Other State and Community Partners: Along with healthcare and retail partners, TFT engaged with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden, TFT continued partnerships that grew out of the Campbell Soup Healthy Communities Initiative and the BUILD Health "Roots to Prevention" project, which facilitated expansion of FBRx distribution to new healthcare partners and developed connections with urban farmers. In southeastern PA, TFT continued longstanding partnerships to enhance FBRx programming, including the American Heart Association and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council and the Allegheny County Health Department continued to enhance the FBRx program. New partnerships with UPMC Health Plan and the American Heart Association brought FBRx to more patients in southwest PA in Year 3. Finally, TFT strengthened relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center providing technical assistance and support to grantees and core partners. Changes/Problems:Overall, the project is being implemented in line with the proposal, and there were no significant changes in approach. Below are a few challenges and unexpected outcomes: Delays in healthcare distribution: In several clinical settings, the COVID-19 pandemic led to fewer in-person patient visits and therefore a lower volume of FBRx distribution, particularly during Year 1 of the project. Some newer healthcare sites took longer to launch the FBRx program as staff capacity was limited. At the same time, healthcare partners were increasingly interested in addressing food security and many were successfully able to identify capacity to distribute FBRx, especially in Year 3. Fewer farmers market redemption sites: As a response to the COVID-19 pandemic, dozens of farmers markets and farm stands operated by partners in Philadelphia transitioned entirely to emergency food distributions; most of these sites had served as FBRx redemption sites. The original proposal contained a goal to "Expand the number of non-traditional retail outlets and farmers markets accepting Food Bucks Rx incentives to 80," but with the loss of these markets as redemption sites, as well as ceased operations of a mobile market partner, that was no longer feasible. Still, there were a significant number of farm-direct redemption sites who participated in this project, and a number of non-traditional retail outlets, including food co-ops and produce markets were added during this time. Evaluation: While project staff are strongly committed to documenting outcomes of the GusNIP program, most reporting from healthcare and retail partners is not directly within TFT's control. Additionally, all patient health data contained is in electronic health records, which project staff cannot directly access. Lastly, there is limited funding within the GusNIP budget to support research staff, especially with the increased expectation of an IRB process. To address these challenges, project staff have identified several solutions to reach evaluation goals: Some healthcare partners have analyzed and shared de-identified cumulative data to show clinical findings connected to produce prescriptions. Outside funding has allowed for hospital and academic partners to pursue IRB approval for research studies. Some of these studies experienced delays and final data will be shared after this grant concludes, though early data shows promising results. Leveraging non-federal funds: A positive unexpected outcome has been the ability to use GusNIP to leverage additional funds to support and expand our FBRx work. Two key partners in this have been UPMC Health Plan and the American Heart Association. Additional funding from these partners enabled the expansion of the FBRx program to reach new participants, and to expand the network of clinical partners and redemption locations. Healthcare staff well-being: Another positive unexpected outcome has been providers and other healthcare staff reporting that being able to offer FBRx improves their own sense of well-being and ability to care for their patients. Many resources offered in response to needs identified during social determinants of health screening involve an application process and a wait for services even if the patient is found eligible. Healthcare staff appreciate that, in contrast, they can hand patients the FBRx as soon as they screen eligible and respond to a short survey. What opportunities for training and professional development has the project provided?Opportunities for professional development have arisen both for project staff and for retail and healthcare partners. Over the grant period, the project team has grown to include a full-time associate and manager in both the Philadelphia and Pittsburgh regions. Additionally, training around surveying and data collection was provided by Candace Young of New Leaf Consulting, who has research expertise in the area of nutrition incentives. Ongoing training on implementation, tracking, data collection and promotion of the FBRx program was provided to all retail and healthcare partners. TFT staff worked closely with healthcare partners to ensure they were able to screen patients for eligibility, accurately track and report FBRx distributions, and administer patient surveys using online survey tools. Additional opportunities for training and professional development included: In the Philadelphia area, monthly COACH (Collaborative Opportunities to Advance Community Health) meetings offer strong networking and training opportunities with healthcare partners interested in food insecurity. During their blocks or semesters volunteering with the Nutrition Incentives team, medical school and public health students from Jefferson, Temple and Rowan University gained experience in produce prescription programming by assisting with program administration and data analysis. TFT is participating in the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center, both as a grantee in a learning capacity and as a partner/TA provider. TFT staff are convening the Hub's communities of practice focusing on incentive programming in corner stores, as well as SNAP-Ed/nutrition education, and are participants in the produce prescription community of practice. Staff have also benefited from the Hub's annual convening, a produce prescription community of practice, and webinars on a variety of topics pertaining to nutrition incentives and healthy food retail. How have the results been disseminated to communities of interest?Results have been shared through a variety of venues to reach interested stakeholders. Findings from this grant were shared in the following settings: TFT staff and healthcare/evaluation partners presented at the annual Nutrition Incentive Hub Convening and during the Hub's Produce Prescription Community of Practice. TFT staff presented on the Food Bucks Rx program to Philadelphia College of Osteopathic Medicine Medical Student Advocates, who volunteer in the community to conduct social needs assessments and connect respondents with appropriate resources, and to Jefferson University medical students participating in the JeffSTARS advocacy program. TFT staff presented at USDA NIFA's annual GusNIP Project Directors Meeting. TFT staff presented on Food Bucks Rx programming as part of the "Where To Turn Fair," a resource-sharing event for service providers in western PA. TFT staff presented to the Health Equity Working Group, convened by the Pittsburgh Food Policy Council. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Over the course of the GusNIP project, TFT partnered with 25 clinical distribution sites associated with 15 healthcare partners and over 80 redemption sites to bring FBRx produce prescriptions to patients in and near Pittsburgh and Philadelphia, PA, and Camden, NJ. The program grew to serve over 4,000 patients, with approximately $250,000 in FBRx redeemed for fresh fruits and vegetables. FBRx distributions and redemptions, the number of patients reached, and the number of prescriptions and refills issued grew year over year as new clinical partners and redemption sites joined the program, and as many clinics resumed in-person visits that had been suspended during the COVID-19 pandemic. Via participant-level surveys, patients who used FBRx reported that they were important for helping purchase fruits and vegetables and that their consumption of fruits and vegetables had increased since they started using FBRx. Data Collection: Staff worked with each firm to create systems to collect the number and value of FBRx distributed and redeemed. Firms used various data collection methods (e.g., paper FBRx tracking, POS systems) to serve as inputs for TFT's database, where FBRx distributions and redemptions were tracked individually by serial number. Below are the metrics and other data collected from firms and program participants to assess impacts (note: not all metrics are collected from each site): # of individual FBRx coupons distributed and redeemed at all sites $ amount of FBRx distributed and redeemed at all sites (and % redemption) Monthly SNAP sales and # of SNAP transactions # of unique patients reached Patient surveys reporting impacts on produce purchasing and consumption # or value of produce items sold at corner stores # of vendors/farmers at farmers market stops Corner store sales receipts from purchases where incentive is redeemed (for quality assurance period) Major Activities and Findings: Objective 1: Increase purchase and consumption of fresh fruits and vegetables by patients who receive Food Bucks Rx across health systems in a multi-state region. Major Activities Completed TFT collaborated with a wide variety of healthcare partners (large hospital systems to small clinics) to customize and refine FBRx programs in a variety of settings, including nutrition-focused programs at hospitals, chronic disease management programs (e.g. diabetes, hypertension), care coordination and routine adult and pediatric visits. All sites identified champions, including physicians, nurses, social workers, dieticians and community health workers, to support implementation and data collection. Over the 3-year project, TFT implemented FBRx programming with 15 healthcare partners at 25 clinical distribution sites in PA and NJ. In most settings, TFT increased monthly FBRx distribution to $60 for households with 3 or fewer members, with additional coupons provided to larger households. TFT partnered with Children's Hospital of Philadelphia (CHOP), Virtua and Duquesne to formally study the impacts of FBRx in combination with other interventions. Summary Statistics and Key Outcomes Healthcare partners distributed over $600,000 in FBRx to approximately 4,000 patients, in the form of ~11,000 "prescriptions" and "refills." Over $250,000 was redeemed for fresh produce, with an increase from ~$42,000 redeemed in Year 1 to ~$165,000 in Year 3. The Virtua Food Farmacy study is ongoing, but a preliminary finding shows a statistically significant change in fruit and vegetable intake of approximately 0.5 cups from baseline to 3 months for the group receiving FBRx, an increase that has been associated with improved health outcomes. Across distribution sites utilizing the TFT survey template, 3,433 surveys were collected from patients receiving first-time FBRx and "refills." Findings included: Among the 1536 responses from patients who had used FBRx, 95% reported that Food Bucks Rx were important (21.5%) or very important (73%) in helping them purchase fruits and vegetables, and 82% reported that their consumption of fruits and vegetables had increased since they started using FBRx. Objective 2: Reduce food insecurity and improve dietary health among households that utilize the Food Bucks Rx program. Major Activities Completed Facilitated collaboration between several FBRx healthcare partners and the Gretchen Swanson Center for Nutrition to implement studies investigating behavioral and health outcomes in patients receiving Food Bucks Rx Provided FBRx as a component of wrap-around nutrition interventions offered to patients by partner sites, including Allegheny Health Network and Virtua, to combat food insecurity and address diet-related disease Summary Statistics and Key Outcomes Duquesne University School of Pharmacy concluded Cohort 1 of the Rx for Change study, in which FBRx were given every three months along with other resources, incentives and coaching. Among participants in the DMSES classes, A1c decreased from an average of 7.7 to 6.0 in one year. The percent of participants with "normal" blood pressure readings increased from 28% at baseline to 50% after one year. Lastly, more than a third of participants experienced weight loss of 5% or more. Among a sample of 54 patients at the Allegheny Health Network (AHN) Healthy Food Centers, those receiving FBRx (n=38) showed larger decreases in A1c (1.7 for FBRx, 1.3 for non-FBRx), cholesterol (44 for FBRx, 43 for non-FBRx) and HDL (4.4 for FBRx, 1 for non-FBRx) levels. Limited data regarding food security has shown modest positive impacts among FBRx users. Not all sites collected food security data, either because all participants had already screened positive for food insecurity before receiving FBRx, or due to limited clinical capacity. More sensitive question sets were incorporated into the studies that were underway at the close of this grant. Among the 88 Virtua Food Farmacy patients who received FBRx in the study to date, the rate of food insecurity decreased from 83% at baseline to 66% at 3 months to 51% at 6 months. 98% of patients (n=182) from the AHN Healthy Food Centers receiving FBRx reported lower stress and better access to healthy foods for their households. Community health workers from the Camden Coalition of Healthcare Providers' Accountable Health Communities program reported that introducing FBRx for patients receiving care navigation not only assisted in meeting food needs but also enabled them to resolve other social needs, e.g. housing, because patients were more responsive to follow-up and remained in navigation longer. Patient reported impacts: "It has been SO helpful! My blood pressure is down and I've been eating healthier because of this program!" "I started this program a month ago. It has been a big help for me and I have been able to make healthier recipes that your program provides. Thank you so much." Objective 3: Increase number of redemption locations for Food Bucks Rx, especially those that are open for increased hours and/or that sell regionally-grown produce. Major Activities Completed Over the grant period, staff partnered with 82 firms as FBRx redemption sites: 42 farm-direct firms, 23 small grocery retail locations, 14 supermarkets, two mobile farmers markets and a mobile grocery store. All supermarkets and most small retail firms are open all day, 7 days/week. Of 30 redemption firms that responded to a retailer survey, 100% reported that participating in Food Bucks and FBRx was profitable (93%) or cost neutral for their business. Piloted Snap2Save digital FBRx model in partnership with Congreso Health Center and a nearby Save A Lot supermarket. Summary Statistics and Key Outcomes Over $250,000 redeemed for fresh fruits and vegetables with year-on-year increases in redemptions at both brick and mortar and farm-direct firms. Farm-direct: increase from ~$13,000 in Year 1 to ~$37,000 in Year 3 Brick and mortar: increase from ~$29,000 in Year 1 to ~$130,000 in Year 3
Publications
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Progress 09/01/20 to 08/31/21
Outputs
Target Audience:The Food Trust's (TFT's) Food Bucks Rx (FBRx) program has successfully engaged participants and other stakeholders across the public and private sectors. Patients: The FBRx program reaches families in key regions of Pennsylvania (PA) and New Jersey (NJ) who utilize eligible state-sponsored insurance plans (primarily Medicaid or dual eligible), and who are experiencing or at risk of diet-related disease. Eligible patients are provided with "prescriptions'' in the form of $10 FBRx coupons that can be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase SNAP incentive program (known as Food Bucks). Through this program, which originated under a 2017 FINI award, over 2,000 patients have received FBRx coupons from their healthcare providers to date (10/1/2019-8/31/21). In Year 2, the program served approximately 1,170 patients, with 2,762 "prescriptions'' provided, including "refills." Patients receive FBRx in a variety of settings, including hospital-located Healthy Food Centers/Food Farmacies, a diabetes program in a high-Medicaid clinic, pediatric well visit locations, a WIC clinic, and Accountable Health Community care navigation. Healthcare Providers: TFT worked with eight healthcare providers in 15 clinical distribution locations in NJ and PA to provide FBRx to eligible patients. In Year 2 of this GusNIP grant, TFT added one new healthcare provider and four new clinical distribution locations to the existing network. Current partners include: Cooper Pediatrics (Camden, NJ) Cooper Pediatric Care at Camden Cooper Health Center at KIPP Lanning Square charter school Camden Coalition of Healthcare Providers (Camden, NJ) Accountable Health Communities care navigation services Virtua (Camden, NJ) Food Farmacy Einstein Hospital (Philadelphia, PA) Community Practice Center Einstein Care Partners (new) Stephen Klein Wellness Center (Philadelphia, PA) (new) Self-Monitored Blood Pressure Program (new) UPMC Children's Hospital (Pittsburgh, PA) General Academic Pediatrics Hilltop Health Hub CCP Bellevue (new) Allegheny Health Network's Healthy Food Centers (Pittsburgh, PA) West Penn Hospital Allegheny General Hospital Jefferson Hospital (new) Adagio Health (New Castle, PA) WIC Office Medical Office TFT also engaged in robust planning with additional healthcare partners and sites, including Duquesne University School of Pharmacy, Congreso Health Center, Children's Hospital of Philadelphia and UPMC/Vale-U-Health, which plan to begin distributing FBRx in Year 3. Redeeming Firms: In Year 2, participating firms in the FBRx program redeemed almost $46,000 for fresh produce, split evenly between farm-direct and brick-and-mortar firms. The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks program, funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most of the 60+ Food Bucks retail partners are already redemption sites for FBRx or will serve as redemption sites as the program expands. These retail partners include supermarket chains such as Save-a-Lot and Fresh Grocer, as well as neighborhood healthy corner stores, farmers markets and mobile markets, to provide patients with a variety of redemption settings and ensure ease of accessibility. The Pittsburgh region in particular saw nearly $20,000 in FBRx redeemed at 15 farmers markets and one mobile market, which continued to serve as key redemption points during the COVID-19 pandemic. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to the success of FBRx. In the past year, 11 new firms (located across Pittsburgh, Philadelphia and Camden, NJ) were added into the program as FBRx redemption sites, bringing the total number of sites to 66 and providing patients with more opportunities to redeem their prescriptions. These sites include 43 farm-direct firms in Philadelphia and Pittsburgh; 12 small grocery retail locations in Camden, Philadelphia, and Pittsburgh; nine supermarkets in Philadelphia and New Castle, PA; and a mobile farmers market and mobile grocery store in Camden. TFT also engaged in planning with additional firms, including a group of Save-a-Lot supermarkets in Philadelphia and Cox Market, an independent grocery store in the Monongahela Valley, south of Pittsburgh. Other State and Community Partners: Along with healthcare and retail partners, TFT engages with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden, TFT has continued a partnership with the Campbell Soup Healthy Communities Initiative, a 10-year multi-partner initiative to measurably improve the health of children in Camden by focusing on food access, physical activity, nutrition education and public will. TFT also continues to work with multiple partners as part of the BUILD Health "Roots to Prevention" project, which facilitated expansion of FBRx distribution to new healthcare partners and developed connections with urban farmers. In southeastern PA, TFT continued longstanding partnerships to enhance FBRx programming, including the Philadelphia Department of Public Health, the American Heart Association and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council and the Allegheny County Health Department continue to enhance the FBRx program. New partnerships with UPMC Health Plan and the American Heart Association will bring increased access to more patients in southwest PA in Year 3. Finally, TFT is strengthening relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center providing technical assistance and support to grantees and core partners. Changes/Problems:Overall, the project is being implemented in line with the proposal, and there are no significant changes in approach. Below are a few challenges and unexpected outcomes: Delays in healthcare distribution: In several clinical settings, the COVID-19 pandemic led to fewer in-person patient visits and therefore a lower volume of FBRx distribution, particularly during Year 1 of the project. Some newer healthcare sites took longer to launch the FBRx program as staff capacity was limited. As a result, the project team will be continuing implementation for another year to meet our distribution and redemption goals for FBRx. Fewer farmers market redemption sites: As a response to the COVID-19 pandemic, dozens of pop up farmers markets and farm stands operated by partners in Philadelphia transitioned entirely to emergency food distributions; many, if not all, of these sites had served as FBRx redemption sites. The original proposal contained a goal to "Expand the number of non-traditional retail outlets and farmers markets accepting Food Bucks Rx incentives to 80," but with the loss of these markets as redemption sites, that will no longer be feasible. TFT continues to seek out farm-direct and other non-traditional firms to accept FBRx and onboarded 2 new firms (Virtua Health's mobile grocery store and mobile farmers market) in Year 2. Evaluation: As noted previously, while project staff are committed to documenting outcomes of the GusNIP program, most reporting from healthcare and retail partners is not directly within TFT's control. Additionally, all patient health data contained is in electronic health records, which project staff cannot directly access. Lastly, there is limited funding within the GusNIP budget to support research staff, especially with the increased expectation of an IRB process. To address these challenges, project staff have identified several solutions to reach evaluation goals: Some healthcare partners have analyzed and shared de-identified cumulative data to show clinical findings connected to produce prescriptions. Outside funding has allowed for hospital and academic partners to pursue IRB approval for research studies. For the longer survey to be conducted as part of the national evaluation, The Food Trust is working with partners who have additional research capacity to conduct longer pre- and post- surveys, and with support from the Gretchen Swanson Center for Nutrition, will document these findings in the final year of the project. Leveraging non-federal funds: A positive unexpected outcome has been the ability to use GusNIP to leverage additional funds to support and expand our FBRx work. Two key partners in this have been UPMC Health Plan and the American Heart Association. Additional funding from these partners will enable the expansion of the FBRx program to reach new and more participants, and to expand the network of clinical partners and redemption locations. What opportunities for training and professional development has the project provided?Opportunities for professional development have arisen both for project staff and for retail and healthcare partners. Within the last year, the project team has grown to include a full-time Associate in Philadelphia and two part-time Associates in Pittsburgh. Additionally, training around surveying and data collection was provided by Candace Young of New Leaf Consulting, who has research expertise in the area of nutrition incentives. Ongoing training on implementation, tracking, data collection and promotion of the FBRx program was provided to all retail and healthcare partners. TFT staff worked closely with healthcare partners to ensure they were able to screen patients for eligibility, accurately track and report FBRx distributions, and administer patient surveys using online survey tools. Additional opportunities for training and professional development included: In the Philadelphia area, monthly COACH (Collaborative Opportunities to Advance Community Health) meetings offer strong networking and training opportunities with healthcare partners interested in food insecurity. TFT is participating in the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center, both as a grantee in a learning capacity and as a partner/TA provider. TFT staff are convening the Hub's communities of practice focusing on incentive programming in corner stores, as well as SNAP-Ed/nutrition education, and are participants in the produce prescription community of practice. Staff have also benefited from the Hub's annual convening, a produce prescription community of practice, and webinars on a variety of topics pertaining to nutrition incentives and healthy food retail. How have the results been disseminated to communities of interest?Results have been shared through a variety of venues to reach interested stakeholders. Findings from this grant were shared in the following settings over the last year: TFT staff and healthcare/evaluation partners presented at the annual Nutrition Incentive Hub Convening and during the Hub's Produce Prescription Community of Practice. TFT staff presented on the Food Bucks Rx program to Philadelphia College of Osteopathic Medicine Medical Student Advocates, who volunteer in the community to conduct social needs assessments and connect respondents with appropriate resources, and to Jefferson University medical students participating in the JeffSTARS advocacy program. TFT staff presented at USDA NIFA's annual GusNIP Project Directors Meeting. TFT staff presented on Food Bucks Rx programming as part of the "Where To Turn Fair," a resource-sharing event for service providers in western PA. What do you plan to do during the next reporting period to accomplish the goals?Year 3 (no-cost extension) will focus on continued expansion of the FBRx program to reach more patients in additional clinical settings and distribution of remaining funds for fruit and vegetable prescriptions. Established partnerships with existing healthcare providers will facilitate the addition of new clinical distribution sites, including another Pittsburgh-area Healthy Food Center location (Forbes Hospital), an additional pediatric clinic within UPMC Children's Hospital, a community-based program through Duquesne University's School of Pharmacy to combat racial and ethnic health disparities, and Children's Hospital of Philadelphia (CHOP). Overall, Year 3 will see five new distribution sites added into the program, to meet our goal of 20 total. TFT will prioritize distribution settings where patients have more frequent interactions with their healthcare providers to compound the positive impacts of the Food Bucks Rx program. In addition to expanding the number of clinical distribution sites, TFT will continue to onboard new redemption sites, with a focus on firms that are open for increased days/hours and/or sell locally grown produce. TFT is currently pursuing a partnership with Snap2Save and InComm, which will enable patients to receive their FBRx in the form of gift cards that can only be used to purchase eligible fresh produce items. This partnership will be piloted in the Pittsburgh region, and will open a vast redemption network for patients, including Giant Eagle, a popular regional chain of supermarkets with 96 locations in western PA. In Philadelphia, TFT will begin working with Save-a-Lot to accept FBRx through a partnership with Snap2Save, where coupons can be distributed via text or email in addition to paper. TFT will also continue to work with farmers markets and other non-traditional retail outlets into the program as redemption sites, providing patients access to fresh, locally grown produce. Another priority in the upcoming year will be to complete data collection for the first cohort of the national GusNIP evaluation. TFT has been working closely with the Gretchen Swanson Center for Nutrition to implement comprehensive patient surveys at Virtua in Camden and Children's Hospital of Pennsylvania in Philadelphia. Pre- and post-surveys are documenting the impacts of the FBRx program on produce purchasing and consumption, and on select clinical markers. The incentive distribution strategies that are being pursued through Snap2Save will also enable TFT to more easily collect and track program and participant data.
Impacts
What was accomplished under these goals?
In Year 2, TFT added four new clinical distribution sites and 11 new redemption sites into the FBRx program. The program grew both through new sites and through increased reach at existing sites, serving 1,170 patients, in the form of 2,760 "prescriptions" and "refills." In year 2, over $46,000 in FBRx was redeemed for fresh fruits and vegetables. FBRx distributions and redemptions, the number of patients reached, and the number of prescriptions and refills issued in Year 2 all increased over Year 1 as new clinical partners and redemption sites joined the program, and as many clinics resumed in-person visits that had been suspended during the first year of the COVID-19 pandemic, with an emphasis on providing additional resources to patients. Participant level surveys reveal that patients who receive and utilize FBRx say that they are important for helping purchase fruits and vegetables and that they have increased their consumption of fruits and vegetables since they started using FBRx. Data Collection: Staff worked with each firm to create systems that collect the number and value of FBRx that are distributed and redeemed. Firms use various data collection methods (e.g., paper FBRx tracking, POS systems) to serve as inputs for TFT's database, where FBRx distributions and redemptions are tracked individually by serial number. Below are the metrics and other data collected from firms and program participants to assess impacts (note: not all metrics are collected from each site): ? # of individual FBRx coupons distributed and redeemed at all sites ? $ amount of FBRx distributed and redeemed at all sites (and % redemption) ? Monthly SNAP sales and # of SNAP transactions ? # of unique patients reached ? Patient surveys reporting impacts on produce purchasing and consumption ? # or value of produce items sold at corner stores ? # of vendors/farmers at farmers market stops ? Corner store sales receipts from customer purchases where incentive is redeemed (for quality assurance period) Major Activities and Findings: Objective 1: Increase purchase and consumption of fresh fruits and vegetables by patients who receive Food Bucks Rx across health systems in a multi-state region. Major Activities Completed To reach new eligible patients, two new clinical distribution locations were added in Pittsburgh, PA: a new Healthy Food Center location at Jefferson Hospital and Children's Community Pediatrics-Bellevue. Einstein Healthcare Network in Philadelphia expanded FBRx distribution to its Einstein Care Partners Accountable Care Organization, where community health specialists offer FBRx as part of their efforts to improve patient disease management and address social determinants of health. Including sites added in Year 2, implemented FBRx programming with eight healthcare systems at 15 clinical distribution sites in NJ and PA. In some settings, provided patients with an increased monthly FBRx distribution (from $30 to $60) for households with 3 or more members. Summary Statistics and Key Outcomes In Year 2, healthcare partners distributed $119,000 in FBRx to 1,170 patients, in the form of 2,760 "prescriptions" and "refills." Over $46,000 was redeemed for fresh produce. Compared with Year 1, this represents a 30% increase in distributions, a 15% increase in redemptions, a 12% increase in the number of patients reached and a 55% increase in the number of prescriptions. The Healthy Food Center at West Penn Hospital, one of the first sites to start distributing FBRx, provided 843 prescriptions and refills to 180 patients, resulting in $14,000 in redemptions. Across distribution sites, 1,841 patient surveys were collected from patients receiving first-time and refill FBRx. Among the 40% of patients who reported having used FBRx before, findings include: 96% of respondents thought Food Bucks Rx were either important or very important in helping to purchase fruits and vegetables. 81% of respondents reported increased fruit and vegetable consumption since they started using Food Bucks/FBRx. Patients who had previously used FBRx reported consuming fruits or vegetables more frequently (in the last day and in the last week) than patients who had not previously used FBRx. Objective 2: Reduce food insecurity and improve dietary health among households that utilize the Food Bucks Rx program. Major Activities Completed Facilitated collaboration between several FBRx healthcare partners and the Gretchen Swanson Center for Nutrition to implement studies investigating behavioral and health outcomes in patients receiving Food Bucks Rx. Provided FBRx as a component of wrap-around nutrition interventions offered to patients by partner sites, including Allegheny Health Network's Healthy Food Centers and Virtua's Food Farmacy, to combat food insecurity and address diet-related disease. Summary Statistics and Key Outcomes Among a sample of 54 patients at the Allegheny Health Network Healthy Food Centers, those receiving FBRx (n=38) are showing larger decreases in A1c (1.7 for FBRx, 1.3 for non-FBRx), cholesterol (44 for FBRx, 43 for non-FBRx) and HDL (4.4 for FBRx, 1 for non-FBRx) levels. 73% of Healthy Food Center patients that are showing clinical improvement are receiving FBRx. Preliminary data from Virtua Health patients who had consistent visits to Virtua Camden's Food Farmacy and regular lab draws showed a clinical decrease - on average - of quarterly A1c readings from 7.67 in Q1 2021 to 6.98 in Q3 2021. Limited data regarding food security has shown modest positive impacts among FBRx users from at least two participating sites. Not all sites collected food security data, either because all participants had already screened positive for food insecurity before receiving FBRx, or due to limited capacity during COVID-19. More sensitive question sets have been incorporated into some of the studies currently being developed with the Gretchen Swanson Center for Nutrition. Among a sample of 85 surveyed Virtua Food Farmacy patients in Camden, a lower percentage of patients reported as food insecure after redeeming FBRx (8%) compared with patients who had never received FBRx (19%). Additionally, patients from Virtua's Food Farmacy in Camden saw a larger improvement in their overall outlook on having enough money for food between a baseline survey and 6-month follow-up survey, when compared with a different Food Farmacy site that did not distribute FBRx. Among Adagio Health patients who have completed surveys since the program began in 2019, 37% of patients (n=234) who had previously redeemed FBRx reported having received food from a food pantry in the last year, compared with 56% of patients (n=423) who were receiving FBRx for the first time. Objective 3: Increase number of redemption locations for Food Bucks Rx, especially those that are open for increased hours and/or that sell regionally-grown produce. Major Activities Completed Onboarded eleven new brick and mortar firms into the FBRx program, for a total of 21. Engaged in planning with Snap2Save to pilot digital FBRx models with Save-a-Lot and Giant Eagle in Year 3. Onboarded a mobile farmers market and mobile grocery store affiliated with Virtua Hospital into the FBRx program. Of 21 redemption firms that responded to a retailer survey, 100% reported that participating in Food Bucks and FBRx was profitable for their business. Summary Statistics and Key Outcomes $22,500 in FBRx redeemed across 16 brick and mortar firms Save-a-Lot in New Castle, PA redeemed over $6,000 in FBRx. Another $6,000 was redeemed between two large corner stores/superettes, Dylamato's Market in Pittsburgh and Fayers in Camden. $23,500 in FBRx redeemed across 48 farm-direct firms, a $10,000 increase over Year 1
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Progress 09/01/19 to 08/31/20
Outputs
Target Audience:The Food Trust's (TFT's) Food Bucks Rx (FBRx) program has successfully engaged participants and other stakeholders across the public and private sectors. Patients: The FBRx program reaches families in key regions of Pennsylvania (PA) and New Jersey (NJ) that utilize eligible insurance (Medicaid, Medicare, and other state-sponsored plans) or receive SNAP benefits, and who are experiencing or are at risk of diet-related disease. Eligible patients are provided with "prescriptions" in the form of $10 FBRx coupons that can be used to purchase fresh fruits and vegetables at eligible firms, including the majority of firms participating in TFT's point-of-purchase SNAP incentives program (known as Food Bucks). This program originated under a 2017 FINI award, and from 10/1/2019 to 8/31/2020, over 1,000 patients received FBRx coupons from their healthcare providers, with 1,775 "prescriptions" provided, including "refills." Patients receive FBRx in a variety of settings, including hospital-located Healthy Food Centers/food pantries, a diabetes program in a high-Medicaid clinic, pediatric well visit locations, a WIC clinic, and Accountable Health Community care navigation. Healthcare Providers: TFT worked with seven healthcare providers in 11 clinical distribution locations in NJ and PA to provide FBRx to eligible patients. Five of these providers were already participating in TFT's FBRx programming and chose to continue or expand participation. In Year 1 of this GusNIP grant, TFT added five new clinical distribution locations to the existing network (bolded). Current partners include: Healthcare Provider Location Clinical Distribution Locations Cooper Pediatrics Camden, NJ Cooper Pediatric Care at Camden, Cooper Health Center at KIPP Lanning Square charter school (new) Camden Coalition of Healthcare Providers Camden, NJ Accountable Health Communities (new) Virtua Camden, NJ Food Farmacy (new) Einstein Hospital Philadelphia, PA Community Practice Center Diabetes Program UMPC Children's Hospital Pittsburgh, PA General Academic Pediatrics Clinic, Hilltop Health Hub (new) Allegheny Health Network Pittsburgh, PA Healthy Food Centers: West Penn Hospital, Allegheny General Hospital (new) Adagio Health New Castle, PA WIC office, Medical office TFT also engaged in robust planning with additional healthcare partners and sites, including Children's Hospital of Philadelphia and Einstein Care Partners, which plan to begin distributing FBRx in Year 2. Redeeming Firms: In Year 1, participating firms in the FBRx program redeemed over $40,000 for fresh produce. Of that amount, $13,000 was redeemed at farm-direct sites and $29,000 at brick-and-mortar firms. The FBRx program aligns closely with and benefits from the infrastructure of TFT's Food Bucks program, funded under a separate GusNIP award. The Food Bucks program distributes incentives to shoppers using SNAP benefits at the point of purchase. Most of the 100+ Food Bucks retail partners are already redemption sites for FBRx or will serve as redemption sites as the program expands. These retail partners include supermarket chains such as Save-A-Lot and Fresh Grocer, as well as neighborhood healthy corner stores, farmers markets and mobile markets, to provide patients with a variety of redemption settings and ensure ease of accessibility. TFT adds unique value and expertise in expanding healthy food retail by operating a network of farmers markets and providing technical assistance to other markets, supporting corner store owners in sourcing and marketing fresh produce, and working with supermarket operators to open or expand in underserved communities. These close ties with various types of retailers provide a substantial benefit to the success of FBRx. In the past year, three new firms (located in Philadelphia and Camden, NJ) were added into the program as FBRx redemption sites, bringing the total number of sites to 59 and providing patients with more opportunities to redeem their prescriptions. These sites include 44 farmers or mobile markets in Philadelphia and Pittsburgh; nine small grocery retail locations in Camden, Philadelphia, and Pittsburgh; and six supermarkets in Philadelphia and New Castle, PA. TFT also engaged in planning with additional firms, including two additional healthy corner stores in Camden, a ShopRite supermarket in southern NJ, and the East End Food Co-op in Pittsburgh, which is currently a Food Bucks partner and plans to begin accepting FBRx in Year 2. Other State and Community Partners: Along with healthcare and retail partners, TFT engages with many other nonprofit organizations, foundations and community partners to enrich the FBRx program, especially as this grant covers several geographies. In Camden, TFT has continued a partnership with the Campbell Soup Healthy Communities Initiative, a 10-year multi-partner initiative to measurably improve the health of children in Camden by focusing on food access, physical activity, nutrition education, and public will. Additionally, staff participated in the Camden Food Access Working Group, which brings together community-based partners including hospital systems, affordable housing, emergency food, urban agriculture, and community development to identify assets and solutions for increased food access. TFT also partnered with the Cooper Foundation to expand FBRx into an on-site health clinic at KIPP Lanning Square charter school, and is working with multiple partners as part of the BUILD Health "Roots to Prevention" project, which facilitated expansion of FBRx distribution to new healthcare partners and developed connections with urban farmers. In southeastern PA, TFT continued longstanding partnerships to enhance Food Bucks Rx programming, including the Philadelphia Department of Public Health, Greensgrow, SHARE and COACH (Collaborative Opportunities to Advance Community Health), a group of hospitals and nonprofit partners (including TFT) that work together on community health efforts. In Pittsburgh and western PA, strong partnerships with Just Harvest (an anti-hunger organization), the Greater Pittsburgh Community Food Bank, the Pittsburgh Food Policy Council and the Allegheny County Health Department continue to enhance the FBRx program. Additionally, TFT is strengthening relationships with other grantees through the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center providing technical assistance and support to grantees and core partners. Finally, TFT's national Center for Healthy Food Access, funded by the Robert Wood Johnson Foundation, supports both nutrition incentives and healthcare partnerships like FBRx. Changes/Problems:COVID-19 Pandemic: Like many GusNIP grantees, the COVID-19 pandemic has affected TFT's programming, creating both challenges and opportunities. Challenges included: Temporary closure of multiple FBRx redeeming firms (all have since re-opened) Difficulty in collecting survey health and food security data from patients and store sales data from retailers, given limited capacity and additional demands at participating clinics/stores. Inability to continue providing SNAP-Ed nutrition lessons at FBRx redemption sites Difficulty/slow downs in onboarding some new clinical and retail partners Decreased FBRx distribution by healthcare partners due to decreased patient visits Some sites were closed to non-urgent visits during the first peak of the pandemic and many patients continued to avoid routine care long after sites re-opened. Efforts were made to identify eligible patients via telehealth and mail out FBRx, but at one site distributions this summer were only 10 percent of what they were in summer 2019. However, the pandemic also provided opportunities to increase programming: In response to the pandemic and increased food insecurity, TFT and healthcare partners Camden Coalition and Virtua Health launched a pilot FBRx program this summer while awaiting design and approval of the formal FBRx studies that will be conducted in Year 2. This acceleration enabled existing patients to benefit immediately from FBRx during a time of heightened food insecurity, and provided an opportunity to test and streamline logistics in advance of the studies. Evaluation: While project staff are committed to documenting outcomes of the GusNIP program, most reporting from healthcare and retail partners is not directly within TFT's control and relies on partner staff to voluntarily perform additional tasks. Additionally, all patient health data contained is in electronic health records, which project staff cannot directly access. Lastly, there is limited funding within the GusNIP budget to support research staff, especially with the increased expectation of an IRB process. To address these challenges, project staff have identified several solutions to reach evaluation goals: Some healthcare partners have analyzed and shared de-identified cumulative data to show clinical findings connected to produce prescriptions Outside funding has allowed for hospital and academic partners to pursue IRB approval for research studies More sensitive question sets from the Gretchen Swanson Center will be used for surveys in Year 2 to obtain food security data ?For the longer survey to be conducted as part of the national evaluation, The Food Trust will work with partners who have additional research capacity to conduct longer pre- and post- surveys. What opportunities for training and professional development has the project provided?Opportunities for professional development have arisen both for project staff and for retail and healthcare partners. Within the last year, several previous positions were consolidated and one new full-time staff member with direct healthcare experience joined the GusNIP team, overseeing programming in Camden and Philadelphia. Ongoing training on implementation, tracking, data collection and promotion of the FBRx program continued to be provided to all retail and healthcare partners. TFT staff worked closely with healthcare partners to ensure they were able to screen patients for eligibility, especially as it expanded from SNAP enrollment to include eligibility based on health insurance plan, accurately track and report FBRx distributions, and administer patient surveys using Zoho, an online survey tool. Additional opportunities for training and professional development included: In the Philadelphia area, monthly COACH (Collaborative Opportunities to Advance Community Health) meetings offered strong networking and training opportunities with healthcare partners interested in food insecurity. Additionally, staff in Philadelphia and Camden, along with FBRx healthcare partners, attended a Trauma-Informed Care and Organizational Practices workshop organized by COACH, which focused on the effects of trauma on health disparities and provided tips for applying trauma-informed strategies to our work. TFT is participating in the Nutrition Incentive Hub, GusNIP's National Technical Assistance and Evaluation (NTAE) Center, both as a grantee in a learning capacity and as a partner/TA provider. TFT staff are convening the Hub's communities of practice focusing on incentive programming in corner stores, as well as SNAP-Ed/nutrition education, and are participants in the produce prescription community of practice. Staff have also benefited from the Hub's annual convening and webinars on a variety of topics pertaining to nutrition incentives and healthy food retail. How have the results been disseminated to communities of interest?Results have been shared through a variety of venues to reach interested stakeholders. Findings from both this grant and TFT's 2017 FINI grant, which included FBRx programming, were shared in the following settings over the last year: National Healthy Retail Call, convened by DC Central Kitchen, bringing together several organizations who work on healthy corner store initiatives or similar nutrition-based efforts in smaller retail settings "Incentivizing Fruits and Vegetables: The Latest on the USDA GusNIP (FINI) Program and Beyond" webinar, presented to nearly 300 attendees by www.healthyfoodaccess.org and TFT's Center for Healthy Food Access. Presentation at a monthly meeting of CDC REACH grantee partners in Pittsburgh. Presentation at a monthly meeting of PCOM (Philadelphia College of Osteopathic Medicine) Medical Student Advocates, medical students who volunteer in the community to conduct social needs assessments and connect respondents with appropriate resources The PA Department of Health featured the Food Bucks program in its quarterly newsletter, reaching 400 subscribers interested in public health issues. TFT staff presented on a Community Engagement/DEI panel as part of the Nutrition Incentive Hub's first annual convening. TFT staff presented on Food Bucks Rx programming, conducted in collaboration with the Roots to Prevention project along with partners, to other BUILD Health grantees. What do you plan to do during the next reporting period to accomplish the goals?Year 2 will focus on continued expansion of the FBRx program to reach more patients in additional clinical settings. Established partnerships with existing healthcare providers will facilitate the addition of new clinical distribution sites, including another Pittsburgh-area Healthy Food Center location and additional pediatric clinics within UPMC Children's Hospital and Children's Hospital of Philadelphia (CHOP). Overall, Year 2 will see 10 new distribution sites added into the program, to meet our goal of 20 total. TFT will prioritize distribution settings where patients have more frequent interactions with their healthcare providers to compound the positive impacts of the Food Bucks Rx program. One notable example is a partnership with Duquesne University's School of Pharmacy, which will incorporate FBRx as part of its "Prescription for Change" program, in which 50 eligible patients will be enrolled, and will meet with a pharmacist on a quarterly basis. At each visit, patients will receive FBRx and health applicable screenings will be conducted (height, weight, BMI, blood pressure, blood glucose, hemoglobin A1c (HbA1C), cholesterol, carbon monoxide). Data will also be collected on physical activity and fruit and vegetable consumption. In addition to expanding the number of clinical distribution sites, TFT will continue to onboard new redemption sites, with a focus on firms that are open for increased days/hours and/or sell locally grown produce. The East End Food Co-op in Pittsburgh, which meets both these criteria, has put technology in place to begin accepting FBRx in 2021. Discussions are also underway with additional grocery stores in the Camden area and potential redemption sites in South Philadelphia that will support the planned FBRx distributions at CHOP's South Philadelphia clinic. Over the next year, TFT will add 12 additional supermarkets and corner stores into the FBRx program as redemption sites. In addition to brick-and-mortar sites, TFT will also bring new farmers markets and other non-traditional retail outlets into the program as redemption sites, providing patients with access to fresh, locally grown produce. Planning has already begun with Virtua Health to onboard its Mobile Farmers Market and Mobile Grocery Store, which serve the greater Camden area and prioritize local produce. Another priority in the upcoming year will be to commence data collection for the national GusNIP evaluation. TFT has been working closely with the Gretchen Swanson Center for Nutrition to implement comprehensive patient surveys at Virtua in Camden, Children's Hospital of Pennsylvania in Philadelphia, and the Healthy Food Centers in Pittsburgh. Pre- and post-surveys will document the impacts of the FBRx program on produce purchasing and consumption, and potentially on select clinical markers. Technology, and increasing the ease with which FBRx can be distributed and redeemed, will be another area of focus. TFT is in conversation with Snap 2 Save, a company that provides programming for healthcare providers and select retailers to implement digital FBRx programs, where coupons can be distributed via text or email. In 2021, TFT expects to implement this new model with Adagio Health and Save-a-Lot in New Castle, PA. Snap 2 Save's partnership with Save-a-Lot may also facilitate the addition of additional supermarket locations in the Philadelphia area as FBRx redemption sites.
Impacts
What was accomplished under these goals?
In Year 1, TFT added five new clinical distribution sites and three new redemption sites into the FBRx program, and expanded eligibility to include patients receiving insurance through Medicaid, Medicare, and other approved state plans, enabling the program to reach additional patients at existing clinical locations. The program's growth, both through new sites and through increased reach at existing sites, reached a combined 1,039 patients, resulting in over $40,000 in FBRx redemptions. Data Collection: Staff worked with each firm to create systems that collect the number and value of FBRx that are distributed and redeemed. Firms use various data collection methods (e.g., paper FBRx tracking, POS systems) to serve as inputs for TFT's database, where FBRx distributions and redemptions are tracked individually by serial number. Below are the metrics and other data collected from firms and program participants to assess impacts (note: not all metrics are collected from each site): # of individual FBRx coupons distributed and redeemed at all sites $ amount of FBRx distributed and redeemed at all sites (and % redemption) Monthly SNAP sales and # of SNAP transactions # of unique patients reached Patient surveys reporting impacts on produce purchasing and consumption # or value of produce items sold at corner stores # of vendors/farmers at farmers market stops Corner store sales receipts from customer purchases where incentive is redeemed(for quality assurance period) Major Activities and Findings: Objective 1: Increase purchase and consumption of fresh fruits and vegetables by patients who receive Food Bucks Rx across health systems in a multi-state region. Major Activities Completed Two new clinical distribution locations were added in Pittsburgh, PA: a new Healthy Food Center location at Allegheny General Hospital and the Hilltop Community Health Hub. Three new clinical distribution locations were added in Camden, NJ: Cooper Health clinic at KIPP Lanning Square (charter school), the Virtua Food Farmacy, and the Camden Coalition of Healthcare Partners' Accountable Health Communities, a program connecting patients with navigators who help identify and address health-related social needs such as housing instability and food insecurity. Continued FBRx programming with five healthcare systems at six clinical distribution sites in NJ and PA. Over 1,000 patients received FBRx across all sites. Summary Statistics and Key Outcomes Combined, healthcare partners distributed $90,000 in FBRx to 1,039 patients, in the form of 1,775 "prescriptions" and "refills." Over $40,000 was redeemed for fresh produce, a 46% redemption rate, which is significantly higher than the 20% redemption rate seen earlier in the program (June 2018-May 2019) Across distribution sites, 790 patient surveys were collected from patients receiving first-time and refill FBRx. Among the 30% of patients who reported having used FBRx before, findings include 94% of respondents thought Food Bucks Rx were either important or very important in helping to purchase fruits and vegetables. 83% of respondents reported increased fruit and vegetable consumption since they started using Food Bucks/FBRx. 80% of patients who had previously used FBRx reported consuming fruits or vegetables one or more times per day, compared to 30% of patients who had not previously used FBRx. Objective 2: Reduce food insecurity and improve dietary health among households that utilize the Food Bucks Rx program. Major Activities Completed Facilitated collaboration between several FBRx healthcare partners and the Gretchen Swanson Center for Nutrition to develop studies investigating behavioral and health outcomes in patients receiving Food Bucks Rx (studies awaiting IRB approval as of the end of this reporting period). Provided FBRx as a component of wrap-around nutrition interventions offered to patients by partner sites, including Allegheny Health Network's Healthy Food Centers and Virtua's Food Farmacy, to combat food insecurity and address diet-related disease. Summary Statistics and Key Outcomes Physician leading diabetes management program at Einstein Community Practice Center reported improved attendance at recurring appointments among patients receiving Food Bucks Rx. Among Einstein CPC patients, 60% of patients who had previously received FBRx described their health as "Good" or "Very Good," compared to 25% of patients who were receiving FBRx for the first time. Limited data regarding food security has shown modest positive impacts among FBRx users from at least one participating site. Not all sites collected food security data, either because all participants had already screened positive for food insecurity before receiving FBRx, or due to limited capacity during COVID-19. More sensitive question sets will be incorporated into some of the studies currently being developed with the Gretchen Swanson Center for Nutrition. Among Adagio Health patients, 35% of patients (n=54) who had previously redeemed FBRx reported having received food from a food pantry in the last year, compared with 50% of patients (n=57) who were receiving FBRx for the first time. Additionally, when responding to the following question, "Within the past 12 months, the food we bought just didn't last and we didn't have money to get more", 41% of FBRx users (n=61) reported this was "never true", compared with 33% of non FBRx users (n=37). Objective 3: Increase number of redemption locations for Food Bucks Rx, especially those that are open for increased hours and/or that sell regionally-grown produce. Major Activities Completed Onboarded three new brick and mortar firms into the FBRx program. Engaged in planning with an additional four firms to accept FBRx in Year 2. Summary Statistics and Key Outcomes $29,000 in FBRx redeemed across 13 brick and mortar firms $13,000 in FBRx redeemed across 19 farm-direct firms
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