Progress 09/01/19 to 08/31/24
Outputs
Target Audience:The target audience for this project was low-income individuals at risk for developing, or diagnosed with, diabetes that currently reside in the Yukon Kuskokwim Health Corporation's service area. A majority of the target audience were Alaska Native Changes/Problems:Several major challenges occurred throughout the duration of the program, with recrutiment and retention of staff being the most significant. An initial technical staff was hired in early 2020, but left the program within less than 3 months. It took 6 months to fill this vacancy and the hired individual remained in the position for approximately 1 year. This role was then vacant for the next 12-15 months before we could develop a partnership and Business Administration Agreement with a local non-profit organization....... Produce delivery and availability is inherently a challenge in rural Alaska, which ultimately led YKHC to apply for GusNIP funding. Village stores do not routinely stock fresh produce due to challenges receiving it in a palatable, fresh state. YKHC partnered with Meyers Farm to coordinate shipping of fresh boxes of produce to participants. This was not without challenges as the produce was shipped via the United States Postal Service, which frequently had delays in transit and delivery due to the remote locations of program participants. Often village post offices are closed due to lack of staffing, making receiving of boxes in a timely fashion challenging. Survey collections posed challenges due to multiple reasons.IRB approval wasrequired prior to collecting surveys. Participants were not all local to where Prescription Produce staff are located, thus requiring coordination of participants coming in for an appointment and availability of program staff. Maintaining qualified staff to collect surveys proved difficult as well. All staff administering/offering surveys are required to complete CITI certification trainings. Four different staff members completed training, but then did not maintain employment for longer than an average of 3 months after completion of training, thus making survey collection challenging. The original plan for program participation required participants receiving and redeeming paper vouchers at participating stores. Receving invoices and purchase documentation from individual stores was a challenging and non-linear process. Multiple stores did not keep electronic receipts, multiple stores would mail several months worth of receipts at a time which was time consuming to reconcile and process, some stores would both paper mail and e-mail receipts making reconciliation challenging as well. Adherence to program guidelines by participating vendors was a challenge throughout the project. Vendors received training and guidance for how to process vouchers, what items were eligible for purchase, and how to submit for payment at the beginning of the project. Upon reviewing invoices and payment requests, several vendors were identified as having issues with following guidelines and had to be reminded how the program worked and what items were considered eligible. Having vendors not adhere to guidelines led to not being able to reimburse vendors for inappropriate purchases and often discourse between the vendor and the program. What opportunities for training and professional development has the project provided?YKHC staff attended multiple trainings and professional development opportunities related specifically to the GusNIP Grant. Multiple community of practice meetings, coffee hour sessions, annual project director meetings were attended throughout the project period. Staff members also participated in trainings specific to diabetes and prediabetes treatment and education, in addition to motivational interviewing trainings. YKHC staff also hosted multiple training opportunities to a variety of audiences to provide program highlights, facilitate networking, and attempt to increase awareness of this USDA funding opportunity. How have the results been disseminated to communities of interest?Bi-monthly board reports were communicated to YKHC's Board of Directors. YKHC's Board of Directors is made of up 21 Board Members that represent each YKHC's 58 tribal communities. In addition to the Board of Directors, YKHC's President/CEO and 8 additional Senior Leadership Team members are provided with participant enrollment numbers and outcomes. Two presentations were provided by YKHC staff to State of Alaska staff to give an overview of the program and to encourage Prescription Produce Programming be adopted by the State of Alaska. Data and program successes were presented at the 38th Annual Alaska Diabetes Conference. Program implementation tips, program successes, and ways to navigate barriers to implementing a prescription produce program were presented at the Diabetes in Indian Country Conference in August of 2024 in Albuquerque, New Mexico. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
By the end of the grant period, 318 participants were actively enrolled in YKHC's Prescription Produce Program. On average participants received approximately $85 of produce per months; some participants received vouchers to be redeemed at local stores; some participants received boxes of produce sent directly from a local farm/wholesaler; some participants received curated boxes prepared by program staff and sent to the participants home community Increasing the health of individuals in the program.The averageA1C by completion of the project period was 6.84; The average decrease in A1C amongst participants was 0.1% 90% of participants had a hemoglobin A1C drawn during the reporting period 72% of participants had a hemoglobin A1C <7% (a recommended target for most persons with diabetes) This is an increase from 62% during the last reporting period. 60% of participants had a hemoglobin A1C <6.5% (the diagnostic threshold for diabetes) 83% of participants had a hemoglobin A1C <8% (an acceptable target for many persons with diabetes) This is an increase from 71% during the last reporting period 12% of participants had a hemoglobin A1C >9% (a value considered to be high risk and making a person susceptible to diabetes complications) This is an improvement from 18% during the last reporting period.
Publications
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Progress 09/01/22 to 08/31/23
Outputs
Target Audience:The target audience reached by ourefforts during this reporting period was individuals who have a diagnosis of diabetes, gestational diabetes, or prediabetes, are eligible to receive Medicaid benefits, and reside within the YKHC service area.. A majority of the target audience isAlaska Native. Using YKHC's electronic medical record population management tools, potentially eligible individuals were identified and contacted to offer participation. Diabetes education staff were trained on program eligibility and encouraged to offer enrollment during individual education sessions Changes/Problems:Maintaining consistent and reliable staffing has been a challenge from the beginning. YKHC is chronically plagued by staffing challenges due to our report location. The main employee responsible for voucher distribution, reporting, and data collection left his position in November of 2022, leaving the program drastically challenged to complete project objectives. Receiving timely invoices and data from participating firms has been a challenge since project inception as well, which has caused delays in funding expenditures. In an attempt to resolve these challenges,YKHC solidified a partnership with Bethel Community Services Foundation to assist in prescription distribution and voucher reconciliation from participating firms. This partnership has allowed for increased recruitment of participants, increased buy-in from local firms, and coordination of produce boxes mailed to participants when a local firm is not a viable option for participants. An additional challenge has been survey collection due to lack of staffing; after the end of this reporting period staff have now been hired and will be able to resume survey collection during the next reporting period. What opportunities for training and professional development has the project provided?Multiple training and networking opportunities were provided by NIFA, Gretchen Swanson Center, and USDA. In partnership with the Grocer's Association, collaborative efforts took place to develop a document to assist in advocating for and devloping an electronic voucher redemption process. How have the results been disseminated to communities of interest?Results have been shared with the State of Alaska via conference calls; presented during statewide Diabetes conferences; and shared via periodic board reports to YKHC's leadership. What do you plan to do during the next reporting period to accomplish the goals?We plan to wrap-up the 2019 project and transition in to the 2022 ARPA Enhancement Project. Additionally, we plan to continue to recruit additional participants and resume survey collection due to the availability of additional staff. More frequent utilization of the Nutrition Hub Dashboard to update monthly/annual reports and improve enrollment tracking.
Impacts
What was accomplished under these goals?
Our goals have changed to reflect changes in the way our program was functioning, as approved in a budget modification request submitted to NIFA. The revised goals are listed below. 1. Increasing access to fruits and vegetables: (a) Enroll 150 individuals in the prescription produce program, as tracked through an excel spreadsheet; Our program ended the reporting period with approximately 130individual participants enrolled in the program. (b) ensure that 50% of participants remain active in the program, receiving vouchers and completing any required follow up measures (ie. Surveys and lab draws) 95% remained active at the end of the program year; those switched to inactive status were modified due to having moved out of the service area or passed away Surveys were not collected during the reporting period due to lack of staff with appropriate certifications to complete surveys 2.Increasing the health of individuals in the program: 93% of participants had an A1C drawn during the reporting period 62% of participants had an A1C <7 ( a recommended target for most persons with diabetes) 71% of participants had an A1C that was <8 (an acceptable target for many persons with diabetes) 18% of participants had an A1C considered to be high risk at >9
Publications
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Progress 09/01/21 to 08/31/22
Outputs
Target Audience:The target audience reached by oru efforts during this reporting period was individuals who have a diagnosis of diabetes or prediabetes, are eligible to receive Medicaid benefits, and live in one of 13 communities that has a participating store in the YKHC service area. Changes/Problems:Maintaining/recruiting staff to work on this project has been a challenge from the beginning. Initially there were 2 staff working on the project, 0.75 FTE and the other 0.3 FTE. By the end of the project period, there was only one staff member working 0.25 FTE. We are working to partner with a local entity to assist in voucher distribution and participant coordination moving forward. What opportunities for training and professional development has the project provided?This projectworked closely with participating stores to ensure understanding of the process foraccepting vouchers. This includedtraining store staff on what was eligible to be purchased with the produce vouchers, how to track the vouchers, when and how to submit to our department for reimbursement, and what to do if someone spends more or less than the amount of the voucher. Additionally, Diabetes Prevention and Control staff were trained on how to enroll patients to participate in the program, participant eligibility requirements, and how to appropriately track data. New/additional diabetes staff were trained on the program procedures and how to enroll clients. Project staff participated in GusNIP PPR Community of Practice Meetings. Project staff participated in multiple continuing education opportunities related to diabetes, diabetes prevention, and food insecurity. How have the results been disseminated to communities of interest?YKHC's Prescription Produce Program was included in a research article, "Food sovereignty, health, and produce prescriptions progurams: A case study in two rural tribal communites,"that was published in the Journal of Agriculture, food Systems, and Community Development. Quarterly reports were shared with YKHC's Senior Leadership and Board of Directors that highlighted participation levels and voucher redemption rates. What do you plan to do during the next reporting period to accomplish the goals?YKHC's Prescription Produce Program was awarded Project enhancement funding and authorized to continue to utilize unspent funds via a carryover request. We expect to continue to distribute vouchers to active participants and begin to recruit additional participants from additional YKHC communities. We will continue to have Registered Dietitians offernutrition education and more specifically medical nutrition therapy. We will continue to collect data on redemption rates . We plan to provide additional advertisement opportunities to assist in recruiting additional participants.
Impacts
What was accomplished under these goals?
1. Our goals have changed to reflect changes in the way our program wasfunctioning, as approved in a budget modification request submitted to NIFA. The revised goals are listed below. 1. Increasing access to fruits and vegetables: (1) Enroll 150 individuals in the prescription produce program, as tracked through an excel spreadsheet; (2) ensure that 50% of participants remain active in the program, receiving vouchers and completing any required follow up measures (ie. Surveys and lab draws) 1. Our program ended the reporting period with146individual participants enrolled in the program. Of those participants enrolled, 75% remained active atthe end of the program year. 2. Increasing the health of individuals in the program: (1) Decreased A1c 0.5% from baseline compared with A1c performed at follow-up that is required prior to issuing renewal prescriptions, as tracked through EHR and excel spreadsheet; (2) evaluate the # of vouchers actually used, as tracked through invoices provided by vendors and tracked on excels spreadsheet 1. Our program has ensured that individuals participating in our PPR program are getting their A1cs drawn when appropriate. Approximately 25% of participating patients had decrease in A1C by the end of the Fiscal Year. At the end of the fiscal year, approximately 38% of vouchers provided were redeemed by participants.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2022
Citation:
Budd Nugent, N., Ridberg, R. A., Fricke, H., Byker Shanks, C., Stotz, S. A., Jones Chung, A. G., Shin, S., Yaroch, A. L., Akers, M., Lowe, R., Goerge, C., Thomas, K., & Seligman, H. K. (2022). Food sovereignty, health, and produce prescription programs: A case study in two rural tribal communities. Journal of Agriculture, Food Systems, and Community Development, 11(3), 177196.
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Progress 09/01/20 to 08/31/21
Outputs
Target Audience:The target audience reached by our efforts during this reporting period are individuals who are diagnosed with diabetes or prediabetes, who are covered by Medicaid, and who live in one of 8 participating communities in our service area. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?This project has worked closely with participating stores to get ready for accepting vouchers. This includes training store staff on what is eligible to be purchased with the produce vouchers, how to track the vouchers, when and how to submit to our department for reimbursement, and what to do if someone spends more or less than the amount of the voucher. Additionally, Diabetes Prevention and Control staff have been trained in how to enroll patients to participate in the program, what the eligibility requirements are, and how to appropriately track data. New/additional diabetes staff have been on the program procedures and how to enroll clients. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we expect to continue distributing vouchers to active participants and collect data from them. Additionally, we will continue to recruit additional, eligible patients to participate in the program in hopes of gaining a large cohort of participants. A Registered Dietitian/Nutritionist has been added to the greater Diabetes Program that will offer education in participating communities/stores.
Impacts
What was accomplished under these goals?
Our goals have changed to reflect changes in the way our program is functioning, as approved in a budget modification request submitted to NIFA. The revised goals are listed below. Increasing access to fruits and vegetables: (1) Enroll 150 individuals in the prescription produce program, as tracked through an excel spreadsheet; (2) ensure that 50% of participants remain active in the program, receiving vouchers and completing any required follow up measures (ie. Surveys and lab draws) Our program current has 69 individual participants enrolled in the program. Of those participants enrolled, 93% have remained active in the program. Increasing the health of individuals in the program: (1) Decreased A1c 0.5% from baseline compared with A1c performed at follow-up that is required prior to issuing renewal prescriptions, as tracked through EHR and excel spreadsheet; (2) evaluate the # of vouchers actually used, as tracked through invoices provided by vendors and tracked on excels spreadsheet Our program has ensured that individuals participating in our PPR program are getting their A1cs drawn when appropriate. However, we have not analyzed this data for trends at this time. The plan for the program is to wait until completion before analyzing trends in health outcomes. At this point in time, we are showing a 39% redemption rate of vouchers by participants. We anticipate that this number is lower than the actual rate of redemption because several local stores have been struggling to submit receipts for reimbursement, which is our primary form of tracking redemption.
Publications
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Progress 09/01/19 to 08/31/20
Outputs
Target Audience:The target audience reached by our efforts during this reporting period are individuals who are diagnosed with diabetes or prediabetes, who are covered by Medicaid, and who live in one of 8 participating communities in our service area. Changes/Problems:Several changes have been made to the protocol for prescription produce in order to meet the requirements set forth by the Alaska Area IRB and YKHC Human Studies Committtees that are overseeing the research component that has been added to our Prescription Produce Program. The most notable change is that participants are no longer limited to 2 refills, but are able to participate until either the funding for vouchers runs out or the grant period ends. We would be happy to submit the revised protocol, as approved by the Alaska Area IRB and YKHC Human Studies Committee. What opportunities for training and professional development has the project provided?This project has worked closely with participating stores to get ready for accepting vouchers. This includes training store staff on what is eligible to be purchased with the produce vouchers, how to track the vouchers, when and how to submit to our department for reimbursement, and what to do if someone spends more or less than the amount of the voucher. Additionally, Diabetes Prevention and Control staff have been trained in how to enroll patients to participate in the program, what the eligibility requirements are, and how to appropriately track data. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we expect to continue distributing vouchers to active participants and collect data from them. Additionally, we will continue to recruit additional, eligible patients to participate in the program in hopes of gaining a large cohort of participants.
Impacts
What was accomplished under these goals?
1. During this time period our program began registering patients to participate in this program. Due to COVID, it has been challenging to enroll participants as they live in remote locations and often do not have access to internet to send in their forms. Due to this, people rely on being able to go to their local clinics to fill out of the consent forms and submit them, but the clinics are trying to keep people from going to the clinic in person due to COVID. Additionally, the primary airline that delivers mail to our region went bankrupt due to COVID and this has created significant delays in the transportation of mail, making it challenging to mail consent forms to patients and have those forms returned. As such, our enrollment numbers are still low, but consistently growing over time. Additionally, it was decided that we would create a research project to go along with the prescription produce program. This led to delays in implementation of the program, as well as some modifications to our goals. At this point in time, participants are not limited to 2 refills. Instead, they can participate until we either run out of funding oruntil the end of the grant. 2. At this point in time we have not had any follow up labs ordered to determine if there were significant changes to participants A1c levels. All patients are currently working through their first set of vouchers. We anticipate having follow up data available in the next reporting period.
Publications
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