Performing Department
(N/A)
Non Technical Summary
The KKV PPR Pilot is a three-year program studying the use of fruit and vegetable prescriptions (FVRx) written by clinical providers for 210 very low-income patients with chronic medical conditions that are diet-related. The Pilot addresses critical issues of food insecurity brought about by poverty and urbanization for a largely Asian and Pacific Islander community with high rates of diabetes, heart disease, cancer, and other diseases. It aligns strongly with KKV's holistic approach, focusing on social determinants of health (SDOH) and on strong relationships between patients, their providers, and their community. This Pilot brings together two KKV programs, its primary care services and the Roots Food program, a cultural-based program that includes a café, organic gardens, food and cooking education, and a SNAP-authorized Food Hub that aggregates and sells produce from small local farmers. Its goal is to draw upon KKV's history of building trust between providers and patients to use FVRx prescriptions to build new agency among patients in managing their care and to underscore the importance of a healthy food system in uplifting the community's health. The Roots staff will work with clinical partners to provide curriculum based on cooking, indigenous Pacific Islander diets, and will provide engagement opportunities for gardening and learning from the land. Through this program, KKV will build data acquired from multiple channels, including an indigenous-based evaluation system, to substantiate an approach to healthcare that emphasizes SDOH.
Animal Health Component
0%
Research Effort Categories
Basic
33%
Applied
34%
Developmental
33%
Goals / Objectives
KKV's PPR project has the following Goals:To Increase the consumption of fruits and vegetables by low-income patients with chronic health conditions;To Integrate KKV's Clinical care services and the Roots Food Hub;To Provide Deep educational opportunities around nutrition and cultural foods and Broad access to healthier foods;To Uplift and Build food agency among patients with chronic conditions and their families;To Support and sustain local organic farm partners; andTo Develop evaluation protocols and build data with respect to food and health for chronic care patients and their families around social determinants of health.
Project Methods
KKV estimates a relatively short Planning phase for the PPR pilot program because we have been testing an informal emergency food Rx program with the Covid 19 pandemic. This has established a protocol and collaborative engagement between KKV clinical staff and the Roots Food Hub, and because the Covid emergency program at KKV known as Hui Hoaka has redeployed staff from various programs to assist in providing emergency food support, there is a broad and growing understanding of community needs and simultaneously better understanding of cultural conditions and values that will help KKV carry out the PPR program more effectively.Design of PPR Pilot Program:The KKV Clinical team and Roots Food Hub team will work together to design the PPR pilot program for the first three months; the teams will identify any training needed to ensure staff are able to manage the pilot program. The program design will focus on making the Rx process of writing prescriptions and fulfilling them as easy as possible for all staff involved. Additionally, the design phase will address the educational components, including nutrition education provided by clinical staff; and food/ cultural food education, cooking/food preparation, and farming education provided by the Roots Food Hub. At the end of this period, Clinical staff will have Rx forms, as well as an understanding of how to integrate this into the care of their patients. Roots Food Hub will have a means for staff to fulfill the prescriptions, track the fulfillment, and assist patients in renewing their prescriptions.Additionally, KKV will have developed a menu of educational programs to offer to patients participating in the PPR pilot program.Selection and Recruitment of PPR Patients:During the first two months, KKV's Clinical team will identify and recruit patients who they believe will benefit from and participate in the PPR pilot program. KKV will verify whether patients have a SNAP/Medicaid card; are enrolled under a State plan under title XIX of the Social Security Act; or are a member of a low-income household suffering from (or at risk for) a diet-related condition. Staff will also identify these patients within their EMR and determine specific dietary requirements, family size, and other issues that will impact success of the program.Food Hub Organized Capacity to fulfill FVRx:To ensure the Roots Food Hub is ready to fulfill FVRx, Roots must prepare staffing and farm partners. Through Hui Hoaka, the Roots team has established a process to order produce from farmers, pick up some of the produce (some will be delivered), sort, price, weigh and bag, inventory, and sell the produce. At present, some of these activities are done with the help of volunteers from other KKV departments who have been redeployed because of Covid.During the first two months, Roots must put in place the staffing to ensure that the F&V required to fulfill prescriptions is available on a weekly basis. Roots must train employees to process FVRx and to work with patients who are redeeming these. Additionally, Roots must coordinate with farmers to make sure that KKV has the types of produce required for the different types of patients.Clarify and Establish Evaluation Protocols:KKV's Clinical team will put in place coding for EMR to track participation, prescriptions, and questions regarding diet and health. At the same time, Roots Food Hub will develop tracking for FVRx prescriptions, fulfillment, and renewals. KKV's evaluation team, working together with Clinical and Roots, will focus on the patients and their families through surveys.Clinical Visit:By month 3, KKV will enroll patients in the PPR pilot program. KKV will verify whether patients have a SNAP/Medicaid card; are enrolled under a State plan under title XIX of the Social Security Act; or are a member of a low-income household suffering from (or at risk for) a diet related condition. Because the PPR pilot is new for KKV, the plan is to start with a smaller group of patients - 60 in Year 1 and to increase the number of patients added to the program each year. Year 2 would add 70 patients, and Year 3 would see an additional 80 patients. The goal is to use Year 1 to develop staff capacity and knowledge in order to make the most of the PPR program. Some patients may only participate for one year, while others may be extended through the entire three-year pilot.The initial Clinical visit will ask patients if they are interested in participating in the pilot PPR study and introduce the program benefits and participation requirements. Requirements will include nutritional counseling visits and any follow up health care provider visits required, where to redeem prescriptions, how to renew, and evaluation.The provider will enter information into the EMR, issue the FVRx, and administer a pre-program survey, as well as collect health metrics (BMI, height, weight, BP), and assess F & V consumption.During each patient's return visit, Clinical staff collects health metrics and assesses F & V consumption. Providers also survey patients about their families and about the FVRx program.Fulfillment of FVRx:Roots Food Hub staff receives the initial FVRx and logs the patient into a database set up to track prescriptions. We anticipate that Roots staff will organize the Food Hub prescription produce into four F&V categories: 1) Roots and starches; 2) Greens; 3) Fruits; and 4) Herbs and immune-potent items. Each category of patient Rx, whether diabetic, obese and diabetic, immune compromised, etc. will have a specific array of produce bags that are pre-bagged by Roots staff. When a patient comes to fulfill her FVRx, Roots will provide her with the quantity allotted to her family and the specific F & V bag types designated to her specific condition.By establishing specific categories of bagged produce, Roots will have the capacity to fulfill FVRx prescriptions on certain days of the week and during certain hours. Patients will not be able to alter the contents of their produce bags, nor will they be able to partially redeem prescriptions in order to save up for a larger quantity of food later in the month. In this way, Roots will be able to manage orders and track quantities of F & V they purchase for the program. Additionally, Roots will work with Clinical staff quarterly to assess how the Rx program is working, and whether patients need additional support for particular food items.Education of PPR Patients and Families:KKV uses the Cohort or Affinity group structure for many educational activities and programs. Clinical staff have access to various Diabetes groups, Senior groups, and other cohorts that meet weekly, monthly and quarterly. This structure will incorporate nutritional counseling. KKV also has access to a 100-acre nature preserve and Roots farms at the preserve and at a community garden behind the main clinic. Programs frequently are run within the garden setting, including planting, harvesting, and other garden activities.Roots has developed an array of cultural food programs for families and patients of all ages. These are based in indigenous practices an engage people around cooking, eating, growing food, and connecting with the land. For this reason, Roots staff will take an active role in developing curriculum for the PPR pilot program as well as leading classes and activities for patients.KKV Clinical and Roots evaluators will work with each team to ensure that data is being collected, to assist with preparing and collecting surveys, and to coordinate data evaluation.