Progress 09/01/23 to 08/31/24
Outputs
Target Audience:For this reporting period, the VeggieRx to HEAL program was made available to adult residents of Allen County with diagnoses of pre-diabetes or diabetes, cardiac diseases, and at-risk pregnant women. Changes/Problems:Changes were made to the nutrition education format of the second and third education sessions due to participant preference of in person instruction. This modification led to an increase in the amount of program coordination required. As a result, this limited the number of participants we were able to serve due to staff capacity. What opportunities for training and professional development has the project provided?In October 2023, the VeggieRx to HEAL project coordinator attended the Nutrition Incentive Hub's Mini-Convening in Chicago, Illinois. In December 2023, the VeggieRx to HEAL project coordinator attended the NIFA PD meeting, which provided a time to interact with fellow grantees and learn more about other PPR offerings. Project Coordinator enrolled in continuing education sessions for Epic's SlicerDicer module. Program staff attended Community of Practice meetings offered by the NTAE in order to learn from fellow grantees. How have the results been disseminated to communities of interest?Program staff met withgroups of providers within the Parkiew network and throughout Allen County, reaching out to share the referral process and eligibility requirements. These presentations and interactions contributed to increased familiarity with the referral process and program among providers and staff. An Ambassador group continues to share information within their communities. Having information come from a trusted source serves to reassure those who may be wary of participating in a program that is new to them. An internal and external website with contact forms,posters, and fliers were updated and distributed at local retailers and community spaces to help notify the public about the enrollment period and eligibility requirements. Parkview GME residents learned about VeggieRx during a culinary medicine orientation module. What do you plan to do during the next reporting period to accomplish the goals?Use of EHR data to inform future program direction Focus outreach using EHR data to contact eligible participants Focus on staff technology training to increase program efficiency Implement continuous enrollment to reduce backlog of referrals Addition of engagement specialist to increase participant involvement
Impacts
What was accomplished under these goals?
Goal 1:During this program period, using an electronic debit card program through Fresh Connect allowed increased access to larger retailers including Kroger and Wal-Mart. Redemption occurred at 44 of these supermarkets with $57,336.62 being spent in incentive dollars during the reporting period. Electronic redemption was also an easier way to reach additional farm direct retailers. During the reporting period $1,302.84 was spent at farm direct vendors by VeggieRx participants using the debit card at 12 different locations. Goal 2:In 2024, the program moved away from a cohort model and switched to a year-round enrollment. For the period of April to August 2024, 134 patients were enrolled, attended their first education session, and began receiving incentive funds. Goal 3:Of the 243 total patients, 230 were able to be cross-referenced in the hospital's electronic health record (EHR) and had a documented diagnosis in the EHR that fit within at least one category of interest (i.e., diabetes/pre-diabetes, pregnancy, and/or heart disease). Of note, many individuals had multiple diagnoses: 113 patients had pre-diabetes/diabetes with heart disease or hypertension, and 4 patients had pre-diabetes/diabetes with pregnancy. For healthcare utilization and associated costs, we analyzed metrics 6 months prior to (pre-intervention) and 6 months following (post-intervention) the individual's first education session date for those starting in 2023. Regarding healthcare utilization metrics, we did not meet our goal of a 25% reduction in hospitalizations and emergency department visits. For this cohort, hospitalizations increased from 28 (pre-intervention) to 32 (post-intervention), which represents a 14% increase. Emergency department visits decreased though, decreasing from 30 to 26, a 13% decrease. We also saw increases in 30-day readmissions, which went from 6 to 7 (17% increase) and wellness visits, which increased from 1638 to 1984, a 21% increase. In terms of cost, total hospitalization costs increased from $452,031.20 to $790,377.70 (75% increase), but emergency visit costs decreased from $77,055.03 to $50,144.24 (35% decrease). Overall, total healthcare utilization, including wellness visits, increased from $3,477,835 to $6,066,828 (74% increase). It must be noted that utilization statistics and thus cost statistics are skewed heavily due to a proportion of heavy healthcare users: 4% of the sample (10 patients) account for 44% of the hospitalization and 65% of the ED visits. Goal 4:With regard to chronic disease, we selected several disease indicators to measure improvement in chronic disease symptoms, including blood pressure and glycemic control (HbA1c). Our goal was to decrease an individual's blood pressures (systolic, diastolic, or both) on average five points or more (in six months). Across all patients, many of whom had heart disease or hypertension, we met our goal and saw a six-point reduction in blood pressure from pre-intervention to post-intervention, from an average of 132/70 to an average of 130/66. Regarding glycemic control, our goal was to decrease an individual's HbA1C by 0.5% points or more for those with pre-diabetes/diabetes. Total scores within the entire cohort went down from 7.89 to 6.53, a 1.36 point decrease. Meanwhile, for the group of those with pre-diabetes/diabetes with heart disease (n = 113), we saw a reduction from 7.89 to 6.45. Thus, we exceeded our goal for this health metric. Of note, during 2023 individuals with diabetes with up-to-date HbA1c labs were also eligible for a research study examining the impact of produce prescription on diabetes related outcomes. Individuals were not eligible to be in both samples, therefore some subgroup analyses were not conducted due to non-representative sample characteristics.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2023
Citation:
Bojrab-Way, M., GiaQuinta, S., Albright, D., Reining, L., Drouin, M., Wehrle, K., Knoop, L. (2023, October) Community Buy-In and Client Engagement in a Produce Prescription Program. Poster Presentation at Food and Nutrition Conference and Expo, Denver, CO, United States.
Wehrle, K., GiaQuinta, S., Bojrab, M., Drouin, M., Albright, D., Reining, L., Knoop, L. (2023, October) Produce Prescriptions: A Recipe for a Successful VeggieRx Grant Application Led by RDNs. Poster Presentation at Food and Nutrition Conference and Expo, Denver, CO, United States.
|
Progress 09/01/22 to 08/31/23
Outputs
Target Audience:For this reporting period, the VeggieRx to HEAL program was made available to adult residents of Allen County with diagnoses of pre-diabetes or diabetes, cardiac diseases, at-risk pregnant women, and obesity. Pediatric patients who are over the 95th percentile for weight are eligible to participate as part of the pediatric obesity expansion. VeggieRx to HEAL enrolled 388 participants at the beginning of the active phase of the cohort in 2023. Participants represented 30 zip codes in Allen County, with 37.1% of participants residing in the zip codes identified as areas of greatest need in the domains of education, food insecurity, income, rent payments and insurance coverage. 304 participants completed their first nutrition education session. Of the total number of enrolled participants, 14 are Spanish speaking and 52 are Burmese speaking. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?In 2022, the VeggieRx to HEAL project coordinator attended the Nutrition Incentive Hub's mini-convening held in Los Angeles and San Diego, which provided a time to interact with fellow grantees and learn more about other PPR offerings. The project coordinator also participated in a workgroup facilitated by the National Grocers' Association Foundation regarding point-of-sale technology and redemption options for PPR programs. Program staff attended Community of Practice meetings offered by the NTAE in order to learn from fellow grantees. Participants in the VeggieRx to HEAL program are required to participate in four nutrition education sessions, led by the Parkview Community Outreach Dietitians. The nutrition education sessions include information on recommended daily intake of fruits and vegetables, the benefits of increased fruit and vegetable consumption, and demonstrations or tastings. The education sessions take place both in-person and virtually via a pre-recorded video sent through emails or text messages using the secure REDCap platform. The in-person classes are held at Parkview Learning Kitchen and participants are able to interact with dietitians in a comfortable environment. Participant feedback from the 2022 sessions was positive and included comments like, "I really enjoyed the class very much. I know more techniques of learning more about different variety of foods," and, "The program was very helpful. Help with making my money go longer and also helped me getting out in the community and meeting new people. Very good." How have the results been disseminated to communities of interest?In early 2022, program staff met with 22 groups of providers within the Parkiew network and throughout Allen County, reaching out to share the referral process and eligibility requirements. These presentations and interactions contributed to increased familiarity with the referral process and program among providers and staff. Based on the number of referrals and popularity of the program among participants in 2022, an Ambassador group received training and materials to share within their communities with those who may be eligible for VeggieRx. Having information come from a trusted source serves to reassure those who may be wary of participating in a program that is new to them. Local news media reported on the increased capacity and new electronic redemption option available in 2023, an internal and external website with contact forms were developed, and posters and fliers were distributed at local retailers and community spaces to help notify the public about the enrollment period and eligibility requirements. What do you plan to do during the next reporting period to accomplish the goals?For our next program period, we will be making some modifications to the program operations to help us reach our goals: • Engaging more farmers and vendors in order to increase redemption among local retailers; • Establishing consistency among program protocols to allow for expansion into other service areas; • Continue to tailor the program to meet the needs of our participants-using community health workers, virtual classes, and produce delivery options to help those who may not be able to attend in-person classes or shop in-person; • Increase efforts to promote local produce as an affordable option as prices of groceries increase; • Using volunteers to assist with administrative operations due to capacity of staff and resources.
Impacts
What was accomplished under these goals?
The VeggieRx to HEAL program is making an impact in Allen County byaiding our community's most vulnerable patients at risk for diet-related disease and food insecurity. Through the efforts of our providers, market partners, and program administrators, we have observed: A reduction in food insecurity among program participants An increase in referrals from providers in Allen County, with over 600 referrals being submitted during the enrollment phase of the 2023 cohort from 68 clinics Participants enjoy thesocialization and food preparation of the nutrition education Increased community knowledge of the program from the Ambassador program working withing the community Increased number of retailers to choose among, including larger grocery stores and supercenters Increased knowledge and access to additional nutrition incentives such as Double Up, senior vouchers, and SNAP Self-reported improvements in energy levels, weight loss, overall health, and increased intake of fruits and vegetables during our education sessions and interactions with program staff ??Goal 1:During this program period, using an electronic debit card program through Fresh Connect allowed increased access to larger retailers including Kroger and Wal-Mart. Redemption occurred at 20 of these supermarkets with $21,855.38 being spent in incentive dollars during the reporting period. Electronic redemption was also an easier way to reach additional farm direct retailers and 13 retailers were added. During the reporting period $1,311 was spent at farm direct vendors by VeggieRx participants using the debit card at 12 different locations. Community health workers met with participants who had transportation barriersto facilitate education sessions and onboarding into the program. Gift cards for rideshare services were distributed to assist participants with transportation to nutrition education sessions and produce retailers. Participants from 2022 self-reported increased fruit and vegetable consumption, weight loss, lower A1c values, feeling better overall, increased energy levels, sleep improvements, and decreased blood pressure. Goal 2:In our 2022 cohort, 174 participants started the program by attending their first nutrition education session. 152 participants completed their second education session, and 142 completed their third session. 100 participants completed all four education sessions, resulting in a completion rate of 57%. During our second program year, 388 participants were enrolled in VeggieRx to HEAL. Over 600 participants were referred to the program by 68 different clinics located throughout the program area, representing 223 unique providers. 51% of the program participants had referrals from outside of the Parkview system, demonstrating the increased reach of the program and community support. 304 participants completed their first nutrition education session during the reporting period and received incentive funds. Goal 3:Of the 173 patients, 162 were able to be cross-referenced in the hospital's electronic health record (EHR). 145 had a documented diagnosis in the EHR that fit within at least one category of interest (i.e., diabetes/pre-diabetes, pregnancy, and/or heart disease). Of note, many individuals had multiple diagnoses. For healthcare utilization and associated costs, we analyzed collected metrics 6 months prior to (pre-intervention) and 6 months following (post-intervention) the individual's first education session date for those whose first education sessions took place in 2022. Regarding healthcare utilization metrics, we saw significant improvements in healthcare utilization and associated costs, exceeding our goal of a 25% reduction. Healthcare utilization metrics showed a reduction in hospitalizations. For this cohort, hospitalizations were reduced from 27 (pre-intervention) to 20 (post-intervention), which represents a 26% decrease Readmissions within 30 days also went down in this cohort, from 5 to 0, which is a 100% decrease Additionally, emergency department visits also decreased from 15 to 11, which is a 27% decrease In line with this improvement (decrease) in healthcare utilization, we also saw improvements in healthcare costs. Hospitalization costs decreased from $18,796.67 to $9,616.97 per patient (49% decrease) Emergency visit costs decreased from $2103.79 to $524.77 per patient (75% decrease) Overall, total healthcare utilization, including wellness visits, decreased from $65,566.99 to $45,722.38 per patient, (30% decrease) ?Goal 4:At baseline, 69% of our 2022 cohort reported being food insecure as measured by the Hunger Vital Sign Screening Tool. At post-program, 46% of the 2022 cohort reported being food insecure, representing an increase of improved food insecurity status. With regard to chronic disease, we selected several disease indicators to measure improvement in chronic disease symptoms, including blood pressure and glycemic control (HbA1c). Our goal was to decrease an individual's blood pressures (systolic, diastolic, or both) on average five points or more (in six months) for those with hypertension. Across all patients, many of whom had heart disease or hypertension, we did not see a reduction in blood pressure from pre-intervention to post-intervention. In this case, we took the average of all of the blood pressure scores in the six months prior to (pre-intervention) and subsequent to (post-intervention) the first education session. Across all patients who had scores in this time frame, blood pressure increased slightly from an average of 127/73 to an average of 127/74. However, when we extended the timeline to a longer duration, to include all the blood pressure scores from January 2019 to first session (extended pre-intervention) and first session to November 2023 (extended post-intervention), we did see a reduction in blood pressure in all patients in line with our goal: 130/74 (extended pre-intervention) to 125/73 (extended post-intervention). We also examined this within only the group with heart disease or hypertension. There were no significant changes from the six months prior to six months post for either those patients with heart disease/hypertension + diabetes (128/72 pre-intervention to 128/74 post-intervention) or for the patients with heart disease/hypertension only (125/75 to 125/75). Once again, when we extended all blood pressure scores, we did see decreases. For the group with heart disease/hypertension + diabetes, we saw reductions in line with our goals (132/74 extended pre-intervention to 125/72 post-intervention). For the group with heart disease/hypertension only, we also saw a reduction, but it was only slight (128/76 extended pre-intervention to 126/76 post-intervention). Regarding glycemic control, our goal was to decrease an individual's HbA1C by 0.5% points or more for those with pre-diabetes/diabetes. We were able to obtain averages for both pre-intervention and post-intervention measures in one group of our cohort: those with pre-diabetes/diabetes with heart disease or hypertension (n = 96). For this group of patients who had HbA1c scores during this time period, the average HbA1c went from 7.78% to 6.85%, a difference of .93% from pre-intervention measure to post-intervention measure, exceeding our goal of .5% change. Additionally, when we extended the timeline to a longer duration, to include all the HbA1c measures from January 2019 to the first education session (extended pre) and first session to November 2023 (extended post), we did see a reduction in HbA1c for the 96 pre-diabetes/diabetes patients who also had heart disease and/or hypertension that was in line with our goal: 7.94% (extended pre-intervention) to 7.26% (extended post-intervention), a difference of 0.68%.
Publications
|
Progress 09/01/21 to 08/31/22
Outputs
Target Audience:For this reporting period, the VeggieRx to HEAL program was made available to adult residents of Allen County with diagnoses of pre-diabetes or diabetes, cardiac diseases and at-risk pregnant women. Our program enrolled 174 participants at the beginning of the active phase of this cohort. Participants represented 19 zip codes in Allen County, with 46% of participants residing in the zip codes identified as one of the areas of greatest need in the areas of education, food insecurity, income, rent payments and insurance coverage. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?Participants in the VeggieRx to HEAL program are required to participate in four nutrition education sessions, led by the Parkview Community Outreach Dietitians. The nutrition education sessions include information on recommended daily intake of fruits and vegetables, the benefits of increased fruit and vegetable consumption, and demonstrations or tastings. The education sessions take place both in-person and virtually via Zoom. The in-person classes are held at Parkview Learning Kitchen and participants are able to interact with dietitians in a comfortable environment. How have the results been disseminated to communities of interest?Although our program is still underway, the data and results will be shared with our community ambassadors. The ambassador program will empower our alumni from the program to share its benefits with their friends, family members, and neighbors and encourage enrollment in VeggieRx to HEAL. The data will also be shared with providers, other healthcare staff, vendors, and community partners. What do you plan to do during the next reporting period to accomplish the goals?For our next program period, we will be making some modifications to the program operations to help us reach our goals: Moving to an electronic redemption platform to streamline redemption for our vendors and participants; We are engaging with more brick and mortar retailers to expand the produce season for redemption beyond the market season. The additional locations will offer our participants more flexibility in the hours and days they can redeem their incentives as well as variety in the produce that is offered; The nutrition education format may change based on the needs of the upcoming cohorts. We recognize that there are preferences among our participants to have the classes in person or virtually and are refining our curriculum to reflect these preferences.
Impacts
What was accomplished under these goals?
The VeggieRx to HEAL program is making an impact in Allen County by coming to the aid of our community's most vulnerable patients at risk for diet-related disease and food insecurity. Through the efforts of our providers, market partners, and program administrators, we have observed: Participants shopping at farm direct retailers that are new to them; Participants sharing stories about trying new produce items; Participants being excited to learn more about preparing produce; Participants interacting with vendors and learning more about the sources of local food; Participants have learned new modes of transportation to get to markets; Participants have increased knowledge and access to additional nutrition incentives such as Double Up, senior vouchers, and SNAP; Participants have self-reported improvements in energy levels, weight loss, overall health, and increased intake of fruits and vegetables during our education sessions and interactions with program staff; and Vendors have reported increased sales; Referring providers have reported additional screenings for food insecurity during office visits. Our data collection started during this program period will conclude during the next program period and will be reflected in our next progress report. Goal 1: Improve the amount of fresh produce that is available to adults identified as being food insecure and adults who are on Medicaid or uninsured with prediabetes, diabetes, have cardiac diseases or individuals with an at-risk pregnancy, in Allen County Our program continues to expand by adding more redemption points for participants, serving to increase the accessibility of produce in our county. Our first program year included partnerships with five farm direct sites and efforts are being made to expand to brick and mortar retail locations. Our farm direct vendors offer culturally appropriate produce items to reflect the diversity among our participants. It is our ongoing goal to have increased partnerships with brick and mortar and farm direct firms throughout the program area. Goal 2: Expand the Veggie Rx Program from 30 individuals in a 2019 pilot to serving 850 individuals in Allen County over the next three-year period During the first program year, 174 participants were enrolled in VeggieRx to HEAL. Our participants were referred to the program by 40 different clinics located throughout the program area. We continue to strengthen the relationships among our referral partners including the local FQHCs and will be enrolling over 400 participants in each of the next two program periods. Goal 3: Reduce urgent healthcare utilization and associated healthcare costs Our program has partnered with Indiana FSSA to collect the data to measure this outcome. Our data collection is ongoing and will be reported at the conclusion of the active period for this cohort. Goal 4: Reduce the prevalence of food insecurity and chronic health diseases in low-income individuals in Allen County Our data collection for this goal is ongoing and will be reported at the conclusion of the active period for this cohort. Program participants have shared that VeggieRx to HEAL is helping them supplement their diets with produce that they would not otherwise have been able to afford.
Publications
|