Performing Department
(N/A)
Non Technical Summary
Farm to You Mobile is a Produce Prescription (PRx) program designed to improve community health and support local agriculture in the Eastern Panhandle of West Virginia (WV). Like many other regions of WV, our tri-county area suffers from interconnected problems of chronic disease, food insecurity, educational gaps, and socioeconomic barriers to healthy eating. Our local farmers are also struggling against low market prices and shrinking markets. University Healthcare Physicians recognizes the importance of community collaborations that improve health literacy and access to resources to improve the long-term health and personal agency of our community residents. Our current program, Farm to You, partners with local farmers to connect patients with fresh, local produce and nutrition/cooking education at no cost. We aim to expand this into a formal produce prescription program with a mobile "food truck" unit that delivers local produce to 8 clinical sites across the region at no cost to patients. The unit will be equipped for cooking demonstrations, interactive nutrition education, and electronic health record access to measure participation and impact on both individuals (health outcomes) and the health system (healthcare utilization patterns). Because of our extensive work in nutrition and cooking education with low-income communities, and our experience with Farm to You, we have a strong support network of knowledgeable staff and resources to manage this project. We plan to conduct a thorough program evaluation to analyze our impact on fruit/vegetable consumption, food insecurity, healthcare usage/costs, and physical health metrics for enrolled participants. We recognize that reducing barriers to healthy eating, including cost, transportation and knowledge, are crucial to reverse the worsening trends of chronic illness in our community. Farm to You Mobile aims to reduce these barriers and empower patients to make lasting investments to better their long-term health.
Animal Health Component
50%
Research Effort Categories
Basic
(N/A)
Applied
50%
Developmental
50%
Goals / Objectives
We seek to expand our current produce access and education program, Farm to You, to increase reach, educational programming, and clinical integration to a tri-county region in WV's Eastern Panhandle. The Farm to You Mobile PRx Program will employ a mobile teaching kitchen/distribution unit that expands access to healthy food and culturally appropriate cooking and nutrition education across our clinical sites in the Eastern Panhandle of West Virginia. We will also integrate PRx into the clinical encounter and electronic health record (EHR), and invest directly in local agriculture across our region.1) Expand Access to Fresh Produce: Launch Farm to You Mobile to reduce barriers to access among our eligible population by increasing the number of participating clinical access points across our counties.2) Expand Education: Use Farm to You Mobile to expand upon our teaching and nutrition education programming, and reduce barriers to healthy eating with a mobile teaching kitchen for our patients and community members. Develop programing tailored to specific populations including families, children, pregnancy, and the elderly.3) Integrate into EHR: Implement EHR-based provider prescription functionality for PRx integrated into clinical encounters and build upon the provider and staff incorporationof produce prescriptions and education into clinical care.4) Invest Locally: Invest in and market our local agricultural economy, and construct flexible procurement system that leverages assets and accommodates needs of local farmers.Objectives:For Goal 1:1a) Over 3 years, increase access tofresh, local, GusNIP-qualifying fruits and vegetables forlow-income consumers participating in Farm to You by prescribing up to 981 eligible patients biweekly access to financial incentives that completely subsidize the cost of the produce at point of purchase.1b) Provide information on community-wide resources for nutrition access, lifestyle health and food security such as local farmers' market nutrition incentive programs, cooking resources, community gardens, and emergency food organizations.For Goal 2:2a) At each distribution event, deliver practical and culturally appropriate nutrition and cooking education events tailored to the seasonal produce available onsite, with accompanying recipes and a reusable produce bag.For Goal 3:3a) Initiate the use of EHR-based PRx in the clinical encounter in at least 5 clinical sites in Year 1, with an additional increase of providers and sites in Years 2 and 3.For Goal 4:4a) Partner with a cooperative network of local farmers to fulfill at least 12,750 PRx of $20 value to eligible patients over 3 years of mobile outreach at 6-7 clinical sites per week, 26 weeks per year, with an average of 35 patients per site.4b) Increase direct-to-consumer marketing for local agricultural partners via coordinated social media efforts, community partnerships and coalitions, and match these marketing efforts to our expanded sites over the 3 years.
Project Methods
Primary programmatic efforts include:1. Expand Access to Fresh Produce2. Expand Nutrition/Cooking Education3. Integrate Produce Prescriptions into Clinical Care4. Invest in Local Agriculture5/ Improve Dietary Health and Social/Clinical Outcomes1: Expand Access to Fresh ProduceOver 3 years, we will increase access tofresh, local produce for our participants by prescribing up to 981 eligible patients biweekly access to produce prescriptions distributed via our mobile unit.We will also provide community-wide resource guides for healthy food access,lifestyle health and food security to improve overall access.Method: Based on medical/social eligibility criteria assessed by patient healthcare providers and project staff, participants will be enrolled in 1 of 3 intervention levels:Level 1 will include those who are eligible and enrolled in the PPR, and upon further discussion with their provider, have elected to participate in a more intensive intervention to improve their health. This includes 1) nutrition incentives twice monthly, 2) onsite nutrition/cooking education offered during events, 3) an online nutrition/cooking education course (with tracked attendance), and 4) quarterly provider check-ups to discuss their progress. Level 2 will include those who are eligible for and enrolled in the PPR program but have not elected the intensive option. They will receive 1) incentives twice monthly, and 2) onsite nutrition/cooking education offered during events.Level 3 will include those not eligible for the PPR program. Their once-monthly incentives will be covered by non-federal funding, and they will also be offered onsite nutrition/cooking education during events.Evaluation:The following metrics will be collected to evaluate access expansion over the project period: Number of patients who receive a produce prescription Number of patients in each intervention level (1, 2 or 3)Number of prescription redemptions Number of unique participants per siteNumber of eligible participants per clinical siteMonetary value of incentives issued and redeemed per siteAverage incentive value redeemed per recipientSurvey data on participant awareness of community-wide resources 2: Expand Nutrition/Cooking EducationAt each distribution event, we will deliver practical and culturally appropriate nutrition and cooking education events tailored to the seasonal produce available onsite, with accompanying recipes.The level of nutrition education provided will vary based on the intervention levels detailed above. Level 1 participants will receive the most in-depth nutrition/cooking education via an online course, while Level 2 and Level 3 participants will receive onsite nutrition/cooking education during distribution events.Evaluation: Nutrition education components of each distribution event will be tracked using RedCAP secure online software.The following metrics will be collected to evaluate education expansion via participant surveys:Level of nutritional knowledgeCooking and dietary self-efficacyKnowledge of cooking techniquesKnowledge of nutritional approaches to applicable diet-sensitive conditionsLevel 1 participants will be surveyed on their nutrition/cooking knowledge upon enrollment and at the conclusion of each project year.Level 2 and 3 participants will receive an adapted survey that redacts questions related to the online nutrition/cooking course offered to Level 1 participants.3: Integrate Produce Prescriptions into Clinical CareWe will initiate the use of EHR-based PRx in the clinical encounter in at least 5 clinical sites in Year 1, with an additional increase of providers and sites in Years 2 and 3.Evaluation:Program evaluation focuses on process-level and outcomes-level evaluation metrics. Part of the process evaluation will include a self-assessment on intervention development and implementation. Using USDAguidance, the intervention team will document information on the implementation process, challenges experienced, solutions to overcoming those challenges, and project implementation and operations successes. Using REDCap secure online software, the following project-specific data will be collected as well: number of redemption (clinical) sites; months/days/hours of operation of redemption sites; fruit and vegetable products offered at each site/event.We will also survey staff and providers on their experiences with clinical integration, measuring satisfaction levels with the implementation process and perceptions of program impact and effectiveness.4: Invest in Local AgricultureWe will partner with a cooperative network of local farmers to fulfill at least 12,750 PRx of $20 value to eligible patients over 3 years of mobile outreach at 6-7 clinical sites per week, 26 weeks per year, with an average of 35 patients per site. We will also increase direct-to-consumer marketing for local agricultural partners via coordinated social media efforts, community partnerships and coalitions, and match these marketing efforts to our expanded sites over the 3 years.Evaluation:Using REDCap secure online software, the following project-specific data will be collected to evaluate financial investments in local agriculture:expenses associated with the program; monetary value of incentives issues and redeemed per site;and average incentive value redeemed per recipient.We will also survey our farmer partners on their experiences with the cooperative network of procurement, measuring satisfaction levels with the implementation process and perceptions of program impact and effectiveness on their business operations. We will measure website traffic data on our various social media sites and community coalition sites promoting the program to evaluate marketing goals.5: Improve Dietary Health and Social/Clinical OutcomesWe aim to increase fruit and vegetable intake, decrease food insecurity, improve physical health outcomes and decrease healthcare usage/associated costs.Evaluation:Using REDCap secure online software and/or the Epic electronic health record, the following data will be collected: fruit and vegetable intake; food security focused questions; COVID-19 related questions; household characteristics. These metrics are outlined in detail in the pre-supplied pre/post survey questionnaires via USDA. From the Epic EHR, the following information will be collected: health profile, including indication of pre-diabetes, diabetes, gestational diabetes, high blood pressure, cardiovascular disease, pregnancy and obesity; sociodemographic data, including age, sex, race and ethnicity; vitals and laboratory values, including systolic and diastolic blood pressure, height, weight, body mass index, Hemoglobin A1c, and lipid panel [HDL, LDL, total cholesterol, triglycerides] as available. We anticipate collecting baseline data on patients, and with additional data collection at 6-month intervals throughout the duration of the program. WVU OHSR aims to work with project leadership and NTAE evaluation leadership in crafting specific, measurable, attainable, realistic, and time-based (SMART) goals for monitoring program success. These goals will be based, in large part, on baseline statistics among program participants.From the WV Medicaid claims data, the following information will be collected given appropriate approvals: supplemental health care usage and cost data on program participants. These variables will be defined in more detail with project leadership and any needed NTAE guidance. We will address all core program metrics as outlined in the "Participant-Level Core Metrics Toolkit for Produce Prescription Projects" documentation provided by USDA.