Recipient Organization
SCHA FOUNDATION INC
1000 CENTER POINT RD
COLUMBIA,SC 292105802
Performing Department
(N/A)
Non Technical Summary
The primary purpose of this grant is to demonstrate and evaluate the impact of the FoodShare Veggie Rx model on the improvement of dietary health through increased consumption of fruits and vegetables and the reduction of individual and household food insecurity. The Veggie Rx Clinical-Integration Model seeks to build a strong bridge between medical providers and a statewide food access network; FoodShare SC. Patients with a diagnosis of prediabetes or diabetes who reside in one of four target counties in SC will be offered an opportunity to participate in this project. A referral will be sent to the local county FoodShare hub who will provide the fresh food box to the patient twice per month. Patients will receive produce boxes at no cost for six months. Clinical labs will be taken at months one and six. A coordinator at each FoodShare hub will be responsible for communicating with patients and providers.As part of the SC Hospital Association (SCHA), the SCHA Foundation is well poised to lead this project based on expertise in leading statewide programs such as AccessHealth SC and Healthy People, Healthy Carolinas (see program descriptions in Project Narrative to show link with health care providers). The FoodShare member network will provide fresh food boxes for the initial project and will also be available to patients after the six-month intervention is complete. At project end, the SC team expects full implementation, as well as a documented and scalable model for delivering a produce prescription program.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Goals / Objectives
At the center of the FoodShare SC Veggie Rx-Clinical Integration model is a consistent product of high-quality produce accessible to SNAP families with limited income, provided by regional FoodShare SC hubs. These boxes are packed and distributed by a nonprofit located in the participant's local community using a hub and spoke model that both increases reach for transportation-limited community members and builds on existing local trust. The goal of this project is to improve food security and health of SNAP recipients with Prediabetes or Type 2 Diabetes by bridging the gap between health care and local food systems.
Project Methods
Outcomes and process evaluation will be conducted on the FoodShare SC Veggie RX program in accordance with requirements and guidance provided by the GusNIP NTAE Center. In direct alignment with the stated purposes of GusNIP Produce Prescription Projects, the first three objectives include does the FoodShare SC Veggie RX program: 1) improve dietary health through increased consumption of fruits and vegetables, 2) reduce individual and household food insecurity, and 3) reduce healthcare use and associated costs among participants? To answer these questions, we will administer the Produce Prescription Program Participant--Level Baseline Survey over the phone and enter the data into Qualtrics prior to a patient receiving their first FoodShare SC Veggie RX box and the Post Survey after 6 months with a sample of participating patients. Questions will be added to the surveys to collect a self-report of health care utilization. The project is scoped for approximately 1,600 patients. We will work with the Center to identify the sample size. We will provide deidentified matched patient data to the Center for analysis. For the added questions, we will share the deidentified data with the Center and analyze those responses to identify any changes in health care utilization and then apply nationally recognized calculations to estimate health care cost savings, including based on any reductions in related Emergency Department visits or an increase in appropriate care. Since the inclusion criteria of this project is patients with type 2 diabetes, we will also test HbA1c at baseline and 6 months post program enrollment as a fourth evaluation objective. When a provider refers a patient to FoodShare SC, they will enter BMI, BP, and lipid profile data into the portal. We will extract the data and match it with the pre- and post-survey data for each patient to also send deidentified to the Center. With a sample of patients (number based on guidance from the Center) who enroll during the first year of the project, we will conduct the Post Survey and collect biometrics data again at 12 months, with an incentive for another box.The next evaluation questions pertain to redemption rates of FoodShare SC Veggie RX boxes and long-term usage. These include: 1) What is the redemption rate of FoodShare SC Veggie RX prescriptions among participating patients? 2) Do redemption rates of FoodShare SC Veggie RX prescriptions differ among patients who are prescribed 6 months of free FoodShare SC Veggie RX boxes versus patients who are prescribed and referred to FoodShare to purchase their own boxes? and 3) Do patients who receive 6 months of free FoodShare SC Veggie RX boxes start purchasing boxes on their own after the 6 months are completed? When a patient enrolls in the program and is referred to the FoodShare SC hub in their geographic location, the hub tracks if they come to pick up their boxes in the FoodShare SC One Box software program. FoodShare SC One Box is a secure, password-protected system used to track customer orders. Patients will be denoted as participants of the Veggie RX program in the system and we will be able to pull reports to track how many weeks participants picked up boxes and if they start purchasing boxes on their own after the prescriptions ran out. Once the maximum number of patients have been enrolled in the program based on available funding, providers will continue to refer patients to FoodShare SC via the portal and encourage them to purchase boxes on their own. We will be able to determine and compare redemption rates between patients who receive a referral that includes free boxes versus those who do not. In addition to patient-based data collection, we will collect data for the Farm Direct and Clinic Core Metrics to share with the Center.We will also conduct a process evaluation to document the process, challenges, and successes of implementation and operations. Data will be collected with the 5 primary project stakeholder groups, (patients, health care partners, FoodShare SC organizations, and Unite Us developers). The participatory approach, journey mapping, will be used with a sample of patients to gain detailed input on the entirety of the produce prescription process. For the remaining stakeholder groups, quarterly group videoconferencing calls will be hosted by the SCHAF. These calls will allow sharing about their process, successes, and challenges. Real-time results of the patient journey maps will also be shared so that improvement opportunities can be implemented. There will be standard guiding questions and the sessions will be recorded and analyzed.This evaluation presents both opportunities and potential challenges. This evaluation design has been piloted as a part of partnerships between FoodShare SC hubs and health clinics in two separate counties. Through the pilot, slight changes to the referral system, processes, and the technology systems were made based on feedback from involved stakeholders including asking all survey questions over the phone, which will be incorporated into this evaluation plan.Challenges might still surface. Based on the sample size the Center recommends, we might not have the staff capacity to conduct all necessary phone surveys. If that occurs, we will recruit a graduate student. The evaluator has routinely served as a practicum advisor/intern supervisor for the past 13 years and has successfully recruited and trained students for data collection. Program retention among patients might also be a challenge, making it difficult to have a large enough sample to determine program outcomes. To help overcome this challenge, we are utilizing lessons learned from the pilot. After a participant does not pick up a box the first time, they will receive a call from FoodShareSC to troubleshoot (e.g., help figure out transportation). After missing two pick-ups, another patient will have the opportunity to enroll.The evaluator for this project, who will also serve as a co-project director, has 10 years of experience designing and conducting evaluations and research studies using both over the phone and in-person quantitative and qualitative methods. Studies include: a 6-month longitudinal study to understand if the FoodShare SC model is associated with changes in household food security and produce consumption among customers; a digit-dial survey with 2,000 SNAP participants to identify their experiences and environments to inform tailored SNAP-Ed programming; and a focus group study to understand transportation challenges and solutions.In addition to these methods, SCHA and BCBSSC have extensive experience capturing Emergency Department and Inpatient utilization in partnership with healthcare organizations and with the state's Revenue and Fiscal Affairs Office. Several project team members have previously or are currently working on other efforts that incorporate healthcare utilization and Medicaid data into their evaluation efforts. We will be able to learn from these existing structures and processes to leverage those data points into our GusNIP evaluation. As this project develops program infrastructure, data experts with experience in this facet of the work will be consulted to incorporate strategies to explore the relationship between program participants and clinical data.