Progress 09/01/22 to 08/31/23
Outputs
Target Audience:This project is based at the Waianae Coast Comprehensive Health Center (WCCHC), one of thelargest federally-qualified community health centers in Hawaii. WCCHC provides comprehensive health, social, and community services to the medically-underserved communities of the Waianae Coast. WCCHC was founded by the Waianae Coast community, for the community 50 years ago and is now among the largest and oldest of the community health centers in Hawaii. In 2022, the Health Center served 35,217 patients through 202,041visits. The majority of patients are Native Hawaiian (47%), followed by Asian & other Pacific Islanders (26%), and Caucasians (11%). The majority (71%)of patients live at/below 100% of the federal poverty level, 3% are uninsured, and 60% receive coverage under QUEST, the State of Hawaii's Medicaid program. Our target audience for this program includes WCCHC patients who meet the following criteria: Adult 18 years and older SNAP Benefit Recipient OR enrollment in Hawaii Medicaid MedQuest Has a chronic diet-related health condition consisting of pre-diabetes, diabetes, cardiovascular disease, hypertension, or other nutrition-related chronic disease. Lives along the Leeward Coast of Oahu (primary service area for patients utilizing WCCHC services) Changes/Problems:During this report period, the main issue we encountered was a shortage of funding for staff. Since we began this program at the start of the coronavirus 2019 pandemic, there were substantial delays in recruitment and enrollments. This required us to extend the duration of the program beyond our initial timeline. Consequently, our grant funding for staff was depleted, which required us to leverage funds from other programs to sustain staffing for this project. To alleviate the burden on our limited staff, we implemented changes in our other Food as Medicine programs. One change was the transition from paper vouchers to an electronic card system. Although this program continues to use paper vouchers since it is near completion, the new system has saved valuable time each week, allowing our staff to dedicate more time to this project. We also improved our tracking procedures by revising our Excel tracking sheets for a streamlined process of tracking distributions and redemptions, which ultimately helps cut down on staff-time required for this project. What opportunities for training and professional development has the project provided?Our program staff had the privilege to participate in the 2023 National Nutrition Convening, which took place from June 6 - 8, 2023. This gathering presented an excellent opportunity to liaise with and gain insights from a diverse group of professionals nationwide. This encompassed teams working on nutrition incentives and produce prescription initiatives, researchers, policymakers, and notable leaders in the field. How have the results been disseminated to communities of interest?As the program is still in the process of finishing current participants, we have not yet analyzed outcomes. However, we have regularly communicated program updates, challenges, and achievements to our health center providers, administration, support staff, and community. Below are a list of events/meetings and dates at which updates were shared. Waianae Coast Comprehensive Health Center Leadership meetings - monthly Hawaii Good Food Alliance - once every quarter Hawaii Farmers Market Association - once every quarter Hawaii Food Bank Meetings - monthly Stupski Foundation meeting - November 2022 Council for Native Hawaiian Advancement - December 2022 Lunalilo Trust Meeting - April 2022 Office of Hawaiian Affairs Board of Trustees Communtiy Meeting - June 2024 University of Hawaii Lightning Talk- Health Sciences Convening, "Collaborations to Address Healthy Food Access and Food Security" May 4, 2023 What do you plan to do during the next reporting period to accomplish the goals?Goal 1: To enhance the dietary-health of participants by increasing fruit and vegetable consumption Continue to improve retention efforts by maintaining regular communication between program staff and participants, such as via phone call reminders about picking up vouchers and requesting program feedback at regular intervals throughout program. Increase the number of recipes and nutrition education materials available to program participants Goal 2: To improve health outcomes and reduce healthcare utilization costs of program participants. Continue to meet with providers to communicate program requirements and updates and explore the barriers to optimize "food as medicine" strategies. Continue to work with providers and WOPRx Health Educator to schedule regular health maintenance visits to measure patient's blood pressure, BMI, and HgbA1C (for those with diabetes or prediabetes) Refine mechanisms to record and extract EMR data to assess outcomes Refine mechanisms to refer participants to other services, such as Case Management, to support all aspects of their chronic disease care Continue to monitor program participation and provide reminders and check-ins regularly to ensure maximum program participation Goal 3: To decrease food insecurity among program participants Continue to assess food insecurity at regular intervals Increase availability of resources to help with food insecurity, including informational handouts regarding resources available at the WCCHC and within the community Goal 4: To strengthen Waianae Coast community food systems Continue to work with local farmers and the online marketplace to support increased access to produce Continue to work with farmers to feature a produce of the month to support produce sales Present programs updates and preliminary results to Community Advisory Committee and other communities of interest to grow support and establish new partnerships Work with other local organizations to advocate for strategies to sustain Produce Prescription Programs
Impacts
What was accomplished under these goals?
IMPACT STATEMENT Issue Many residents on the Waianae Coast of Oahu, Hawaii have high rates of nutrition-related chronic diseases, such as diabetes, and heart disease, as well as food insecurity. Implementing healthy lifestyle changes to treat these chronic disease is difficult, especially for those experiencing complex social determinants of health, such as poverty and food insecurity. These circumstances make it difficult individuals to access nutritious foods, which can ultimately improve health and further avert the onset of other conditions. Who did what and the results At the Waianae Coast Comprehensive Health Center, one of Hawaii's largest federally-qualified community health centers, primary care and specialty clinic providers referred adult patients with a nutrition-related chronic disease to the WOPRx project. By the end of this grant period, WOPRx project staff enrolled a total of 505 participants and distributed $232,980 in produce prescription vouchers redeemable for local produce at the health center's farmers markets. As a result, $206,464 in vouchers were redeemed, resulting in a redemption rate of 88.6%. A health educators working with the WOPRx team distributed more than 200 blood pressure machines and 200 weight scales to program participants for at-home monitoring throughout the program. Broader outcomes In this time frame, the WOPRx team collaborated with WCCHC healthcare providers, market staff, case managers, the electronic medical record (EMR) team, local farmers and community partners to support patients and establish a framework for a sustainable produce prescription program. WOPRx participants benefited from increased access and availability to local fresh produce and one-one-one health education sessions to support efforts towards improving health. In turn, local farmers benefited from produce prescription redemptions, supporting the local food system. Also, WCCHC healthcare providers appreciated the ability to provide "food as medicine" prescription, to augment chronic disease management. The following are accomplishments specific to each goal: ? Goal 1: To enhance the dietary-health of participants by increasing fruit and vegetable consumption 1) Major activities completed / experiments conducted: WCCHC patients continued to be referred to the program. WOPRx staff verified eligibility and completed enrollment process (consent form and baseline survey) with interested patients. Staff tracked funds distributed and redeemed and contacted patients for mid-program surveys at 6 months and 12 months. The final participant was enrolled into the program in March 2023. 2) Data collected: # of participants referred, enrolled and dropped out/removed; # of vouchers distributed and redeemed; FV intake at baseline, 6 months, 12 months, and 18 months. 3) Summary statistics and discussion of results: At the end of the reporting period, a total of approximately 695 unduplicated referrals have been received. Of these referrals, 505 became program participants by completing the baseline process and 432 picked up their 1st voucher while the remaining 73 did not and therefore did not complete enrollment. Of the 432 enrolled participants,180 completed the 18-month program and 90 dropped out, leaving 162 currently active participants in the program. Between August 2022 - 2023, a total of $170,820 vouchers were distributed and $157,440 redeemed, resulting in a voucher redemption rate of approximately 92%. FV intake data was collected at baseline from 505 participants, at 6 months from 78 participants, at 12 months from 137 participants, and at 18 months from 134 participants. Overall, the majority of patients referred were enrolled and of those enrolled, a majority were retained. Patients were not completely enrolled for several main reasons: 1) Program staff were unable to get in contact with the patient to enroll, 2) patient did not complete all steps for the enrollment process, 3) patient was not interested in joining program, and 4) patient did not meet eligibility criteria. The primary reason for participants being dropped from the program was due to not using vouchers for six consecutive months and no response when program staff attempted to contact the participant. 4) Key outcomes or other accomplishments realized: In this timeframe, program outcomes were in the beginning stages (cleaning up data, developing a codebook, etc.) of analysis. An accomplishment to share is that all enrollment slots in the program were filled as of March 2023. Goal 2:To improve health outcomes and reduce healthcare utilization costs of program participants. 1) Major activities completed / experiments conducted: Meetings were conducted between WOPRx staff, referring providers, clinic managers, and diabetes educator to ensure program participants receive comprehensive support. Patients were referred to WOPRx Health Educator for guidance on using at-home blood pressure machine and weight scale, as well as monitoring and controlling diabetes and hypertension. 2) Data collected; appointments with providers; emergency room visits; patient's health (diagnoses, BMI, blood pressure, and Hemoglobin A1c) 3) Summary statistics and discussion of results: Final data are being collected and analyzed. 4) Key outcomes or other accomplishments realized. 1) WOPRx exceeded its recruitment and enrollment goals; 2) WOPRx retention was very high; 3) Qualitative data indicates very high satisfaction with the program to support health and well-being; 4) In this timeframe, outcome data are still being collected and processed. The analysis plan is being developed and implemented with the support from the University of Hawaii John A. Burns School of Medicine. Goal 3:To decrease food insecurity among program participants 1) Major activities completed / experiments conducted: We have been measuring self-reported food insecurity via baseline, 6 month, 12 month, and 18 month (immediate post-intervention) surveys with program participants. 2) Data collected; Self-reported food insecurity 3) Summary statistics and discussion of results: Data are still in the process of being analyzed. 4) Key outcomes or other accomplishments realized. In this timeframe, as above, program outcome data are still being collected and processed. The analysis plan is being developed and implemented with the support from the University of Hawaii John A. Burns School of Medicine. Goal 4:To strengthen Waianae Coast community food systems 1) Major activities completed / experiments conducted: WOPRx staff tracked produce prescription vouchers redeemed at market vendors. 2) Data collected: Total FV vouchers ($ value) redeemed at vendors; average monthly percentage of vendor reimbursements/payouts attributed to this program 3) Summary statistics and discussion of results: To date, approximately $206,464 in vouchers from this program has been redeemed and paid out to a total of 6 farmers' market vendors and 1 online marketplace that offers local groceries. 4) Key outcomes or other accomplishments realized. Overall our voucher redemption rate is very high - almost 90% of vouchers distributed. In addition, to meet the needs of all participants, we have continued to explore different ways to increase participant access to local produce - especially for those who have challenges getting to the Makeke Farmer's Markets. We have continued our partnerships with Farmlink, an online ordering service. However, just a few participants continue to use this service.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2023
Citation:
Shelton, C. (2023). Baseline Characteristics of Adults in a Produce Prescription Program at a Federally Qualified Health Center in Hawaii. Journal of Nutrition Education and Behavior, 55(74), S62
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Progress 09/01/21 to 08/31/22
Outputs
Target Audience:This project is based at the Waianae Coast Comprehensive Health Center (WCCHC). WCCHC is Hawaii's largest federally-qualified community health center and provide comprehensive health, social, and community services to the medically-underserved communities on the Waianae Coast. WCCHC was founded by the Waianae Coast community, for the community, 48 years ago and is now the largest, and oldest of the fifteen community health centers in Hawaii. In 2019, WCCHC served 38,699 patients through 219,339 visits. The majority of patients are Native Hawaiian (47%), followed by Asian & other Pacific Islanders (25%), and Caucasians (10%). Over 67% of patients live at/below 100% of the federal poverty level, 8% are uninsured, and 56% receive coverage under QUEST, the State of Hawaii's Medicaid program. Our first target audence includes WCCHC patients who meet the following criteria:1) Adult 18 years and older; 2) SNAP Benefit Recipient ORenrollment in Hawaii Medicaid MedQuest; and 3) Has a chronic diet-related health condition consisting of pre-diabetes, diabetes, cardiovascular disease, hypertension, or other nutrition-related chronic disease. Our second audience are WCCHC healthcare providers, which includes those providing primary adult and pediatric care, Dental, Behavioral Health, Substance Abuse Treatment, Tobacco Cessation, Nutrition, Fitness, Pharmacy, and Specialty Care including Cardiology, Endocrinology, Psychiatry. Staff also provide services in comprehensive case management, drug abuse treatment, and community outreach. Changes/Problems:The COVID-19 pandemic severally impacted the initial implementation of this project. 1. The Makeke Farmers Markets: Makeke Market is operated by the Waianae Coast Comprehensive Health Center (WCCHC) and is essential to the Produce Prescription Program since this where our participants can access local produce by redeeming their prescriptions. Unfortunately, due to the pandemic, the Markets were closed for most of 2021 and early 2022. The Markets finally re-opened in March 2022. 2. Online System to Order: We worked with a vendor to try to create an online produce ordering system, however, it was not well received by our participants who found the produce selection too limited. We are now working with a new vendor, Farm Link Hawaii, whichhas an easier user interface and is working well for those participants who would rather order online and get produce delivered. 3. Limited In-Person Clinic Visits: WCCHC limited in-person clinic visits through 2021 until March 2022. This limited recruitment to the program. Now that clinic volume has increased to near normal levels, we are actively engaging in recruitment. 4. Establishment of Elepaio Social Services: WCCHC created Elepaio Social Services in 2021 to more effectively and efficiently expand and operate the social services, including the food systems programs, for the community served by the health center. This includes moving all the community outreach and food systems personnel, including those for the WOPRx projectto Elepaio. The change in subcontract was recentily discussed with USDA staff. What opportunities for training and professional development has the project provided?September 2021- August 2022 - bi-weekly meetings with all WOPRx staffto discuss program progress. Project Directorprovided mentorship on ways to address program challenges. May 2022 through July 2022 - a program manager and two research assistants were hired and trained to support program operations. Staff were trained to use the Electronic Health Records system and Microsoft Excel for creating and managing program tracking sheets. How have the results been disseminated to communities of interest?On 8/18/2022-presentation at WCCHC Chief Medical Officer meeting with updates on WOPRx program in terms of participants enrolled, eligibility criteria, and the referral template in EHR. The purpose of the meeting was to give providers with an update on program participation and toensureproviders were well-informed about the process of referring eligible participants to ultimatelyimprove the verification and enrollment process for WOPRx staff. (Audience: 43 providers). What do you plan to do during the next reporting period to accomplish the goals?Goal 1: To enhance the dietary-health of participants by increasing fruit and vegetable consumption Continue to improve retention efforts by working on ways to increase communication between program staff and participants, such as via phone call reminders about picking up vouchers and requesting program feedback at regular intervals throughout program. Work with farmers to feature a produce of the month to support produce salesand consumption Goal 2:To improve health outcomes and reduce healthcare utilization costs of program participants. Continue to meet with providers to communicate program requirements and updates Continue to work with providers and WOPRx Health Educatorto schedule regularhealth maintenance visitsto measure patient'sblood pressure, BMI, and HgbA1C (for those with diabetes or prediabetes) Refine mechanisms to record and extract EMR data to assess outcomes Refine mechanisms to refer participants to other services, such as Case Management, to support all aspects of their chronic disease care. Continue to monitor program participation and provide reminders and check-ins regularly to ensure maximum program participation. ?Goal 3:To decrease food insecurity among program participants Assess food security at regular intervals and provide resources, including referrals to Case Management, SNAP/EBT, and educational print resources. Goal 4:To strengthen Waianae Coast community food systems Continue to work with local farmers and the online marketplace to support increased access to produce Work with farmers to feature a produce of the month to support produce sales Present programs updates and preliminary results to Community Advisory Committee and other communities of interest to grow support and establish new partnerships Work with other local organizations to advocate for strategies to sustain Produce Prescription Programs
Impacts
What was accomplished under these goals?
IMPACT STATEMENT Issue Many residents on the Waianae Coast of Oahu, Hawaii have high rates of nutrition-related chronic diseases, such as diabetes, and heart disease, as well as food insecurity. Implementing healthy lifestyle changes to treat these chronic diseases is difficult, especially for those experiencing complex social determinants of health, such as poverty and food insecurity. These circumstances prevent individuals from accessing nutritious foods that can ultimately improve health and further avert the onset of other conditions. Who did what and the results At the Waianae Coast Comprehensive Health Center, Hawaii's largest federally-qualified community health center, primary care and specialty clinic providers referred adult patients with a nutrition-related chronic disease to the WOPRx project. Between September 2021 through August 2022, WOPRx project staff enrolled 398 participants and distributed over $73000 in produce prescription vouchers redeemable for local produce at the health center's farmers markets. As a result, over $58000 in vouchers were redeemed. Health Educators working with the WOPRx team distributed 170 blood pressure machines and 170 weight scales to program participants for at-home monitoring throughout the program. Broader outcomes In this time frame, the WOPRx team collaborated with WCCHC providers, market staff, case managers, the electronic medical record team, local farmers and community partners to support patients and establish a framework for a sustainable produce prescription program. WOPRx participants benefited from increased access and availability to local fresh produce and one-one-one health education sessions to support efforts towards improving health. In turn, local farmers benefited from produce prescription redemptions, supporting local agriculture. ACCOMPLISHMENTS Goal 1: To enhance the dietary-health of participants by increasing fruit and vegetable consumption Objective 1.1: Enroll and retain 400 low-income WCCHC adult patients, with nutrition-related chronic disease, to the WOPRx Program. Objective 1.2: Provide produce prescription vouchers to WOPRx participants for up to 18 months. Objective 1.3: Promote and assess fruit/veg (FV) sales & consumption 1) Major activities completed / experiments conducted: WCCHC providers referred patients to WOPRx program and WOPRx staff verified eligibility and completed enrollment process (consent form and baseline survey) with interested patients. Continued efforts to advertise program to providers andcommunity through social media, flyers atfarmers market, and posters around health center. Partnered with an online grocery store dedicated to selling only local food. This allowed online voucher redemption with free home delivery. 2) Data collected: # of participants referred, enrolled and dropped out/removed; # of vouchers distributed and redeemed; voucher redemption rate, FV intake at baseline, number of participants using online market and vouchers redeemed online. 3) Summary statistics and discussion of results: Of the 541 patients referred to the program, a total of 398 patients enrolled. Of those enrolled, 91 dropped, leaving a remaining 307 active participants. $73,230 in vouchers were distributed and $58,428 redeemed. Voucher redemption rate was 79.8%. FV intake data was collected at baseline from all 398 participants. 41 participants used the online market and redeemed a total of $2381.80. A majority of patients referred were enrolled and of those enrolled, a majority were retained. Patients were not enrolled for several main reasons: 1) WOPRx staff unable to get in contact with patient to enroll, 2) incomplete enrollment, 3) patient not interested in joining program, and 4) patient didn't meet eligibility criteria. Most participants dropped from the program were due to not using vouchers for six consecutive months and no response when WOPRx staffattempted to contactparticipant. Majority of vouchers distributed were redeemed. 4) Key outcomes or other accomplishments realized: Changes in knowledge, action, or condition were not measured in this timeframe, but will be analyzed and reported on at the end of program. Goal 2:To improve health outcomes and reduce healthcare utilization costs of program participants. Objective 2.1: To increase the confidence/competence of healthcare providers to provide nutrition support to patients. Objective 2.2: Implement, and improve, effective communication strategies with participants in order to maximize program participation.Objective 2.3: Refer participants to WCCHC comprehensive support services to maximize program participation.Objective 2.4: Promote health maintenance visits including regular measurements:body mass index (BMI), blood pressure,A1c for those with prediabetes &diabetes 1) Major activities completed / experiments conducted: Meetings conducted between WOPRx staff and referring providers. Check-up reminder sheet created to remind program participants about 3-month vitals check-ups. Patients referred to WOPRx Health Educators for guidance on using at-home blood pressure machine and weight scale, as well as monitoring and controlling diabetes and hypertension. 2) Data collected: # of kept appointments with WOPRx Health Educators, # of blood pressure machines and weight scales distributed. 3) Summary statistics and discussion of results: Approximately 350 kept appointments (in-person and virtual) with the WOPRx Health Educators to provide education on diabetes and high blood pressure and to collect WOPRx vitals. Two Health Educators distributed a total of 170 blood pressure machines and 170 weight scales to WOPRx participants for at-home monitoring. 4) Key outcomes or other accomplishments realized: Changes in knowledge, action, or condition were not measured in this timeframe, but will be analyzed and reported on at the end of the program. Goal 3:To decrease food insecurity among program participants Objective 3.1: Assess food security at regular intervals to assess changes in status and address challenges. 1) Major activities completed / experiments conducted: Food security is currently assessed at baseline and 18 months (immediate post-intervention). A midpoint survey was developed to additionally assess food security at 6 months, 12 months, and 24 months (6 month follow-up survey). 2) Data collected: Baseline food security has been collected so far. 3) Summary statistics and discussion of results: Data will be analyzed and reported on at the end of the program. 4) Key outcomes or other accomplishments realized: Changes in knowledge, action, or condition were not measured in this timeframe, but will be analyzed and reported on at the end of the program. Goal 4:To strengthen Waianae Coast community food systems Objective 4.1: Assess WOPRx project impact on WCCHC Farmers Market farmers and vendors (F&V) sales. Objective 4.2: Assess WOPRx Project overall value to Market F&V 1) Major activities completed / experiments conducted: WOPRx staff tracked produce prescription vouchers redeemed at market vendors. 2) Data collected: Total FV vouchers ($ value) redeemed at vendors. We also measured the average monthly percentage of vendor reimbursements/payouts that were from the produce prescription program. 3) Summary statistics and discussion of results: $58,428 in WOPRx vouchers were redeemed for produce across 6 market vendors and the online marketplace. For the month of September 2021, vouchers made up an average of 1% of vendor payouts. This gradually increased to a monthly average of 17% of vendor payouts in August 2022. The remaining percentage of vednor reimbursementsare from the double bucks program, food subscription program, and farmers market gift certificates. 4) Key outcomes or other accomplishments realized: Changes in knowledge, action, or condition were not measured in this timeframe, but will be analyzed and reported on atend ofprogram.
Publications
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