Progress 09/15/22 to 09/14/24
Outputs
Target Audience:OKFresh targets the underserved and primarily those who identify as food insecure in Comanche, Muskogee, and Ottawa counties. They are recruited by particpating clinics and screened for food insecurity. Changes/Problems:Market Utilization During 2022-2023, while enrollment continued to grow, program/market utilization remains low. With an average monthly market utilization rate of 39.15%, that tells us that we need to intervene with current members. Why are current members not utilizing their benefits monthly? In similar programs, incentive money is based on household size. This may be an important factor in benefit utilization - if people do not feel it is worth their time, are they really going to use it? During 2023-2024, program/market utilization remains low. In response to last year's reported market utilization rate, we conducted a text message survey asking participants why they had not utilized their benefits. 29% of people reported market hours as their reason for not utilizing benefits. 14% reported the market prices were too expensive. 13% reported transportation hindering their program utilization. 6% reported a combination of weather, transportation, and market prices hindered their program utilization. 38% responded "other," which includes illness, tired, location, forgetfulness, no time, planning to attend, etc. An additional factor to consider is how much produce the market has in stock. From time to time, participants have submitted complaints regarding the lack of selection of produce that have been offered at markets. We will consider this information when applying for future funding. Survey Questions As reported in the previous narrative, we added the household size question to the pre-survey. We also added healthcare utilization questions to learn more about how often our participants use healthcare services like the emergency room and regular doctor appointment visits. Capturing SDoHs in the EHR Few clinics are utilizing their EHR for food insecurity screenings and tracking. OFMQ will continue to train clinics on how to capture this as well as advocate for an EHR software that is capable of such functions. As a result of a 2025 CMS Quality Payment Reporting Requirement to capture SDoH data (food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety), many clinics will implement capturing SDoH data within their EHR. We will also continue teaching clinics their ability to bill for mild to moderate CPT codes for food insecurity screenings. Database Process Improvement Our current database is hosted on Smartsheet, and this program management system is cumbersome and could improve. Our database system in Smartsheet is not an automatic process, it is nearly all manual. This means that the OFMQ Project Coordinator must manually enroll participants, change participant balances, and capture market attendance according to clinic all individually. All the listed functions could potentially be in an automated system, inevitably making this project much more sustainable to continue and expand. Mobile Farm Truck Our partnering organization, Healthy Oklahomans' Nutrition Alliance (HONA), did not have a mobile farm truck after promising one for the winter market season. The OKFresh team pivoted from this issue and made the best of the situation. Two clinics in both Muskogee and Miami (Lawton has a year-round market and therefore does not participate in the Mobile Market) graciously offered their space to host the mobile market once a week for OKFresh participants as well as other marketgoers. This has been a beneficial pivot because it has involved the clinic in a new and creative way while generating more interest and recruiting more members while still being available to the general public. Facebook The Ottawa County Farmers Market Facebook page was hacked during the project in late 2023. Facebook is the main form of communication for the market to communicate with community members. Resources including healthy cooking demonstrations are pushed out using the Facebook page. When the page was hacked, we not only lost useful data, but the market had to regain a following of community members to effectively communicate with. What opportunities for training and professional development has the project provided?Program Training - Clinics OKFresh has provided many opportunities for development in a variety of areas. All our participating clinics are trained on the hunger vital signs and food insecurity screening workflow. In addition to a welcome on-boarding meeting to OKFresh, a welcome kit is provided, which includes: OKFresh website information, program FAQs, social media post examples, program recruitment brochures, posters, hunger vital sign questions and provider talking points, food insecurity screening tracker, t-shirt order forms, and Oklahoma food resources. Throughout the project, participating clinics were reminded of these resources and trained as needed. Program Training - Farmers Markets All participating farmers markets are trained on implementing the program and documenting in our database. ONIE completes all farmers market trainings, which includes token process for eligible food items, fresh produce items and how to capture weight after purchase. They ensure that all locations are knowledge about the specifics of the project. The farmers market is responsible for capturing member purchasing information in a Smartsheet form, which is shared with the OKFresh team. Clinics and farmers markets are knowledgeable and equipped to provide additional Oklahoma food resources. Professional Developments and Conferences OKFresh allows the OFMQ and ONIE teams to speak and educate on food insecurity at conferences and connect with others who are doing similar work or wish to establish their own project. OKFresh has expanded OFMQ's reach within the community to populations we normally would not have reached within our Healthcare IT work. Likewise, ONIE has expanded it's reach within the healthcare sector. OKFresh has presented opportunities for us both to connect outside of our expertise. For example, ONIE attended the OK Public Health Association and OFMQ attended the Mobile Market Summit. Both OFMQ and the ONIE Project stay relevant within their sectors by attending conferences and trainings relevant to our expertise. During 2022-2024, OFMQ attended the following healthcare annual conferences: Mobile Market Summit, PLICO Healthcare Summit, Oklahoma Hospital Association, Jackson County Wellness Symposium, Oklahoma Osteopathic Association, and the Oklahoma Rural Health Association. ONIE has attended the Oklahoma Local Agriculture Summit, Intents Farmers Market Conference, Oklahoma Public Health Association Conference, Hunger for Action: Oklahoma's Anti-Hunger Conference, ASNNA, the National Association of Farmers Market Nutrition Program Conference, and the Food and Nutrition Conference and Expo. As leaders in Oklahoma Produce Prescription Program initiatives, both OFMQ and ONIE are actively a part of the Oklahoma Food is Medicine Coalition and the Oklahoma State Obesity Plan. We provide information and resources on the OKFresh program when feasible for the program at the conferences and coalitions listed above. We always aim to learn and teach as much as we can about food insecurity screenings and other social drivers of health. How have the results been disseminated to communities of interest?Clinics receive regular program updates from the OFMQ Clinical Consultant. The farmers markets see the results in real-time, as they are serving members of our project; however, ONIE meets with them regularly to discuss the project's needs and impact. After the first programmatic year, an infographic was created to display our results and disseminate to our stakeholders and participating firms. We also shared this infographic on the OFMQ and ONIE websites as well as including it in the OFMQ Newsletter - using it as a tool to teach about our work. What do you plan to do during the next reporting period to accomplish the goals?The 2022-2024 GusNIP (NIFA) project cycle is complete. While we have not secured future funding, we are actively looking for opportunities. We will be submitting a proposal with a continued focus on intervening at a deeper level and increasing benefit-utilization. Additionally, we will continue to promote and help clinics develop their EHR over paper processes for food insecurity screenings and tracking. We will also continue to develop and implement a communication workflow to ease the burden of the different moving entities as well as continuing to encourage and support market managers to develop new relationships with produce vendors to regularly attend their market to provide shoppers with more options.
Impacts
What was accomplished under these goals?
1: Increase screening for FI (food insecurity) in high-risk communities (Significantly decrease the frequency of self-reported food insecurity among participating families)Through participation in the OKFresh programFI significantly decreased. OFMQ has increased FI screenings for clinics in Ottawa, Muskogeeand Comanche counties by training clinics to incorporate the hunger vital signs into the workflow. In the firstproject yr 1102 individuals were referred and the second yr 1285 individuals were referred to the program through a participating clinic. Comparing 22-23 pre- and post-survey datafor self-reported FI before the interventionthe prevalence of FS (food security) was 11.9% and following the intervention was 20.9%indicating a 9% increase in FS (p=0.0079). 23-24the prevalence of FI amongst participants prior to participation was 88.7%whereas the FI prevalence after at least 60 days of participation and potentially up to 18 mo of participation decreased to 66.1% (p<0.0001). FI score decreased from 3.2 to 2.7 (p<0.0001). 2: Expand access to fresh produce among FI and low-income populations (Significantly increase the average daily servings of fresh vegetables by the "enrolled" household member)During the first program yearthe frequency of eating vegetables other than salad, salsa and potatoes, 3-6 days/wk increased from 39.4% at baseline to 56.7% following 6 moof the intervention in a sample of 67 program participants with both pre- and post-surveys. This demonstrates program success and is a meaningful improvement in dietary quality. Increased access to fresh produce: the frequency of buying fruits and vegetables at a FM (farmers market) 1/mo, 2-3/mo, and 1/wk increased substantially. The frequency of buying fruits and veggies at a FM 1/mo increased from 16.4% at baseline to 26.9% following the 6 moof intervention. The frequency of buying fruits and vegetables at a FM 2-3/moincreased from 28.3% at baseline to 41.8% following 6 moof the intervention. The frequency of buying fruits and vegetables 1/wk increased from 13.4% at baseline to 14.9% following 6 moof the intervention. These increases would demonstrate substantial increase in FM shopping and revenue generation for local growers and farmers. For the second program year, there was a significant increase in fresh vegetable consumption. The number of days when vegetables are consumed in meals significantly increased from 3.4 days/wk to 4.4 days/wk (p=0.14). Specifically salad intake significantly increased (p=0.01). For example salad intake 3-6 days/wk increased from 26.3% to 33.7%. Non-potato vegetable intake increased significantly (p=0.01). For example daily non-potato vegetable increased from 14.9% to 21.5%. Increased access can also be evidenced by the significant (p<0.0001) increase in purchasing fruit and vegetables from FMs. The frequency of participants shopping 2-3 times/month nearly doubled from 23.8% to 45.2%. The frequency of shopping once/wk almost tripled from 6.0% to 17.2%. These increases would demonstrate substantial increase in FM shopping and revenue generation for local growers and farmers. From 2022-2024, OKFresh has given $101,517 worth of benefits to participants and an average of 46,856lbs of produce distributed. 3: Educate community members on the importance of nutrition and a healthy lifestyle.The OKFresh program provides nutrition education on every market day using recipe cards and booklets. ONIE has a SNAP-Ed -supported program called Harvest Highlight (HH) (program that features fresh market produce in Facebook (FB) live videos on the respective FM FB page). All 3 FMs participated in the HH program to host FB live market tours followed by a cooking demonstration that showcased healthy seasonal recipes and practical uses for market produce. Videos targeted low-income zip codes to help reach our target audience. ONIE coordinates and supports FB live cooking demonstrations for FM locations. From 2022-2024 ONIE coordinated and/or hosted 22 live cooking demonstrations and 40 live videos on FB within Miami, Muskogeeand Lawton (with the average reach of 3,765 unique individuals per live video). We used targeted communication to engage with all participants through 58 email and 418 text message campaigns during the project.Communications included seasonal produce promotion, healthy recipes, farmers market updates, special event information, and tips for using OKFresh benefits. Text messages included market reminders, other food access resources, healthy recipes, and gardening tips.Newsletters were developed and sent monthly and covered featured produce, food and nutrition facts, market event schedule, market details, healthy recipes, and how to use program tokens. Social media promotions on FM FB pages bridged the gap between members and their community markets, enhancing engagement and accessibility. Regular digital communications were frequently highlighted in interviews as useful and valued. Enroll up tothree hundred families, or 1,800 individuals, in the OKFresh program across Comanche, Muskogee, and Ottawa Counties by 9/30/24; Program participation or retention will meet or exceed 30% each year. Retention will be measured by the number of household members enrolled at the beginning of the program, and at the conclusion of each program year.9/2023OKFresh had 621 individuals enrolled. 342 participants have attended the FM to redeem their benefits at least 1x, which is a 55% retention rate and does meet our goal of meeting or exceeding 30%. The avg monthly market utilization rate is 39.15% across the 3 locations (Lawton = 34.28%; Muskogee = 41.16%; and Miami = 42.0%). 10/2023-9/2024, an additional 683 individuals enrolled in OKFresh. The avg household size for these participants is 2.3 individuals. Differing from the last reporting period, household size was added to the pre-survey. Using this avg the OKFresh program reached 1,582 individuals across Comanche, Muskogee and Ottawa counties during 10/2023-9/2024. We can assume a similar household size for the 2022-2023 yr indicating 1,428 individuals served in 22-23 (3010 total individuals served 2022-2024). We continue to meet and exceed our goal of a 30% retention rate with 713 participants have attended the FM to redeem their benefits at least 1x during 10/2023-9/2024. Using this number divided by total program participants (1078) is a 66% retention rate. The avg monthly market utilization rate is 26% across the three locations (Lawton = 19%; Muskogee = 25%; and Miami = 33%). Retention increased as individuals enrolled and utilized their benefits at least 1x. Market utilization decreased as more people enrolled and they did not consistently utilize their benefits. Significantly increase the number of self-reported positive health outcomes among program participants.From 22-23there was not a significant change in general health scores (range 1-5) from pre- (2.6) to post- (2.6) with the limited sample size available at this time. From 23-24there was a statistically significant (p=0.01) improvement in participants' self-reported general health prior to OKFresh participation and after participating in the program for at least 60 days. The prevalence of participant's reporting good to excellent general health increased from 45.2% to 56.3%. The overall score increased from 2.5 to 2.7 on a 5-point scale (p=0.002). At least 50% of participating healthcare providers will modify their workflow to incorporate screening for social determinants of health into their patient assessments.22-23 100% of participating clinics were actively recruiting for OKFresh and screening for food insecurity. 23-24 83% of participating clinics modified their workflow to include food insecurity screenings. 24 clinics were recruited and enrolled to prescribe OKFresh from 22-24. 2 clinics dropped out and 2 did not adopt SDoH screenings and did not actively recruit for OKFresh except for a few outliers.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2024
Citation:
Stephanie DeBerry, MS, RD, Meredith Scott, MS, Lindsey Wiley, MHA, Jayme Noble, BS, Michael Clark, MS, Susan B. Sisson, PhD, RD
OKFresh was made possible by funding from the Walmart Foundation & USDA GusNIP Produce Prescription Grant.
|
Progress 09/15/23 to 09/14/24
Outputs
Target Audience:OKFresh targetsthe underserved and primarily those who identify as food insecure in Comanche, Muskogee, and Ottawa counties. They are recruited by particpating clinics and screened for food insecurity. Changes/Problems:Market Utilization Program/market utilization remains low. In response to last year's reported market utilization rate, we conducted a text message survey asking participants why they had not utilized their benefits. 29% of people reported market hours as their reason for not utilizing benefits. 14% reported the market prices were too expensive. 13% reported transportation hindering their program utilization. 6% reported a combination of weather, transportation, and market prices hindered their program utilization. 38% responded "other," which includes illness, tired, location, forgetfulness, no time, planning to attend, etc. An additional factor to consider is how much produce the market has in stock. From time to time, participants have submitted complaints regarding the lack of selection of produce that has been offered at markets. Survey Questions As reported in the previous narrative, we added the household size question to the pre-survey. We also added healthcare utilization questions to learn more about how often our participants use healthcare services like the emergency room and regular doctor appointment visits. Capturing SDoHs in the EHR Few clinics are utilizing their EHR for food insecurity screenings and tracking. OFMQ will continue to train clinics on how to capture this as well as advocate for an EHR software that is capable of such functions. As a result of a 2025 CMS Quality Payment Reporting Requirement to capture SDoH data (food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety), many clinics will implement capturing SDoH data within their EHR. We will also continue teaching clinics their ability to bill for mild to moderate CPT codes for food insecurity screenings. Database Process Improvement Our current database is hosted on Smartsheet, and this program management system is cumbersome and could improve. Our database system in Smartsheet is not an automatic process, it is nearly all manual. This means that the OFMQ Project Coordinator must manually enroll participants, change participant balances, and capture market attendance according to clinic all individually. All the listed functions could potentially be in an automated system, inevitably making this project much more sustainable to continue and expand. Mobile Farm Truck Our partnering organization, Healthy Oklahomans' Nutrition Alliance (HONA), did not have a mobile farm truck after promising one for the winter market season. The OKFresh team pivoted from this issue and made the best of the situation. Two clinics in both Muskogee and Miami (Lawton has a year-round market and therefore does not participate in the Mobile Market) graciously offered their space to host the mobile market once a week for OKFresh participants as well as other marketgoers. This has been a beneficial pivot because it has involved the clinic in a new and creative way while generating more interest and recruiting more members while still being available to the general public. Facebook Like mentioned in the previous narrative, the Ottawa County Farmers Market Facebook page was hacked during the project in late 2023. Facebook is the main form of communication for the market to communicate with community members. Resources including healthy cooking demonstrations are pushed out using the Facebook page. When the page was hacked, we not only lost useful data, but the market had to regain a following of community members to effectively communicate with. What opportunities for training and professional development has the project provided?Program Training - Clinics OKFresh has provided many opportunities for development in a variety of areas. With the project in maintenance mode, participating clinics were reminded and trained, if needed, on the hunger vital signs and food insecurity screening workflow as well as OKFresh website information, program FAQs, program recruitment brochures, posters, and Oklahoma food resources. Program Training - Farmers Markets All participating farmers markets are trained on implementing the program and documenting in our database. ONIE completes all farmers market trainings, which includes token process for eligible food items, fresh produce items and how to capture weight after purchase. They ensure that all locations are knowledge about the specifics of the project. The farmers market is responsible for capturing member purchasing information in a Smartsheet form, which is shared with the OKFresh team. Clinics and farmers markets are knowledgeable and equipped to provide additional Oklahoma food resources. Professional Developments and Conferences OKFresh allows the OFMQ and ONIE teams to speak and teach at conferences and connect with others who are doing similar work or wish to do similar work one day. OKFresh has expanded OFMQ's reach within the community to populations we normally would not have reached within our Healthcare IT work. Likewise, ONIE has expanded it's reach within the healthcare sector. OKFresh has presented opportunities for us both to connect outside of our expertise. For example, ONIE attended the OK Public Health Association and OFMQ attended the Mobile Market Summit. Both OFMQ and the ONIE Project stay relevant within their sectors by attending conferences and trainings relevant to our expertise. In the past year, OFMQ has attended the following annual healthcare conferences: Mobile Market Summit, PLICO Healthcare Summit, Oklahoma Hospital Association, Jackson County Wellness Symposium, and the Oklahoma Rural Health Association. During the past year, ONIE has attended the Oklahoma Local Agriculture Summit, Hunger for Action: Oklahoma's Anti-Hunger Conference, Oklahoma Public Health Conference, ASNNA, and the National Association of Farmers Market Nutrition Program. As leaders in Oklahoma Produce Prescription Program initiatives, both OFMQ and ONIE are actively a part of the Oklahoma Food is Medicine Coalition and the Oklahoma State Obesity Plan. We provide information and resources on the OKFresh program when feasible for the program at the conferences and coalitions listed above. We always aim to learn and teach as much as we can about food insecurity screenings and other social drivers of health. How have the results been disseminated to communities of interest?After the first programmatic year, an infographic was created to display our results and disseminate to our stakeholders and participating firms. We also shared this infographic on the OFMQ and ONIE websites as well as including it in the OFMQ Newsletter - using it as a tool to teach about our work. Clinics receive regular program updates from the OFMQ Clinical Consultant. The farmers markets see the results in real-time, as they are serving members of our project; however, ONIE meets with them regularly to discuss the project's needs and impact. What do you plan to do during the next reporting period to accomplish the goals?The 2022-2024 GusNIP (NIFA) project cycle is complete. While we have not secured future funding, we are actively looking for opportunities. We will be submitting a proposal with a continued focus on intervening at a deeper level and increasing benefit-utilization. Additionally, we will continue to promote and help clinics develop their EHR over paper processes for food insecurity screenings and tracking. We will also continue to develop and implement a communication workflow to ease the burden of the different moving entities as well as continuing to encourage and support market managers to develop new relationships with produce vendors to regularly attend their market to provide shoppers with more options.
Impacts
What was accomplished under these goals?
Goal: Increase screening for food insecurity in high-risk communities. (Objective: Significantly decrease the frequency of self-reported food insecurity among participating families). OFMQ has increased food insecurity screenings for clinics in Ottawa, Muskogee, and Comanche counties. This was achieved by training clinics to incorporate the hunger vital signs into their patient-visit workflow. In the second project year, it was reported that approximately 1285 individuals were referred to the program through a participating clinic. Through participation in the OKFresh program, food insecurity significantly decreased. The prevalence of food insecurity amongst participants prior to participation was 88.7%, whereas the food insecurity prevalence after at least 60 days of participation and potentially up to 18 months of participation decreased to 66.1% (p<0.0001). Food insecurity score decreased from 3.2 to 2.7 (p<0.0001). Goal: Expand access to fresh produce among food insecure and low-income populations. (Objective: Significantly increase the average daily servings of fresh vegetables by the "enrolled" household member). After participating in the OKFresh Program, there has been a significant increase in fresh vegetable consumption. The number of days in which vegetables are consumed in meals significantly increased from 3.4 days/week to 4.4 days/week (p=0.14). Specifically, salad intake significantly increased (p=0.01). For example, salad intake 3-6 days/week increased from 26.3% to 33.7%. Non-potato vegetable intake increased significantly (p=0.01). For example, daily non-potato vegetable increased from 14.9% to 21.5%. While not a primary goal, daily fruit intake increased from 15.5% to 28.9% (p=0.002). Increased access can also be evidenced by the significant (p<0.0001) increase in purchasing fruit and vegetables from Farmers Markets. The frequency of participants shopping 2-3 times/month nearly doubled from 23.8% to 45.2%. The frequency of shopping once/week almost tripled from 6.0% to 17.2%. These increases would demonstrate substantial increase in Farmers Market shopping and revenue generation for local growers and farmers. OKFresh has given $85,004 worth of benefits to participants and distributed an average of 34,656 pounds of produce for the second program year. Goal: Educate community members on the importance of nutrition and a healthy lifestyle. OKFresh aimed to connect participants with their local food systems while promoting healthy eating through the promotion of seasonal produce. To achieve this, the OKFresh team engaged members through diverse initiatives designed to educate and engage participants to try using produce in new ways. The team coordinated 7 farmers market visits within the three participating markets between October 2023 - September 2024. During this same program year, ONIE coordinated and/or hosted 13 Facebook live cooking demonstrations and 28 live videos on Facebook within Miami, Muskogee and Lawton (with the average reach of 3,765 unique individuals per live video). We used targeted communication to engage with all participants through 30 email and 286 text message campaigns during October 2023 - September 2024. The purpose of the farmers market visits includes the re-launch of OKFresh programs, promotional activities, intercept interviews, and mobile market events in Lawton, Muskogee, and Miami. All three farmers markets participated in the Harvest Highlight to host Facebook live farmers market tours followed by another cooking demonstration that showcased healthy, seasonal recipes and practical uses for market produce. OKFresh expanded our reach by having regular communication with participants through text messaging and email campaigns. These communications included seasonal produce promotion, healthy recipes, farmers market updates, special event information, and tips for using OKFresh benefits. These initiatives successfully educated community members on the importance of nutrition and seasonal produce in Oklahoma. Social media promotions on farmers market Facebook pages bridged the gap between members and their community markets, enhancing engagement and accessibility. Regular digital communications were frequently highlighted in intercept interviews as both useful and valued by participants. Objective: Enroll up tothree hundred families, or 1,800 individuals, in the OKFresh program across Comanche, Muskogee, and Ottawa Counties by September 30, 2024.; Program participation or retention will meet or exceed 30% each year. Retention will be measured by the number of household members enrolled at the beginning of the program, and at the conclusion of each program year. October 2023 through September 2024, 683 individuals enrolled in OKFresh. The average household size for these participants is 2.3 individuals. Differing from the last reporting period, household size was added to the pre-survey. Using this average, the OKFresh program reached 1,582.4 individuals across Comanche, Muskogee, and Ottawa counties during October 2023 - September 2024. We continue to meet and exceed our goal of a 30% retention rate with 713 participants have attended the farmers' market to redeem their benefits at least once during October 2023 - September 2024. Using this number divided by total program participants (1078) is a 66% retention rate. The average monthly market utilization rate is 26% across the three locations (Lawton = 19%; Muskogee = 25%; and Miami = 33%). Objective: Significantly increase the number of self-reported positive health outcomes among program participants. There was a statistically significant (p=0.01) improvement in participants' self-reported general health prior to OKFresh participation and after participating in the program for at least 60 days. The prevalence of participant's reporting good to excellent general health increased from 45.2% to 56.3%. The overall score increased from 2.5 to 2.7 on a 5-point scale (p=0.002). Objective: At least 50% of participating healthcare providers will modify their workflow to incorporate screening for social determinants of health into their patient assessments. Baseline data was unable to be collected. During this project cycle, 83% of participating clinics modified their workflow to include food insecurity screenings. 24 clinics were recruited and enrolled to prescribe OKFresh throughout the project cycle. 2 clinics dropped out and 2 did not adopt SDoH screenings and did not actively recruit for OKFresh except for a few outliers.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2024
Citation:
Stephanie DeBerry, MS, RD, Meredith Scott, MS, Lindsey Wiley, MHA, Jayme Noble, BS, Michael Clark, MS, Susan B. Sisson, PhD, RD
OKFresh was made possible by funding from the Walmart Foundation & USDA GusNIP Produce Prescription Grant.
|
Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The primary population of focus for OKFresh is Oklahomans suffering from food insecurity. According to a study done by the Regional Food Bank of Oklahoma 55 counties contain food deserts, and 45 of our 77 counties have 50% or more of the population living in areas with low access to food. (1) OKFresh will cover various regions of the state to target food insecure communities and serve those most vulnerable including the elderly, ethnic and racial minorities, families with children, low-income and rural populations.(2) America's Health Ranking 2022annual report has Oklahoma ranked 49th for fruit and vegetable consumption, 47th foravoided care due to cost, and 48th for nutrition & physical activity. (3) OKFresh will train healthcare staff to screen for food insecurity, resolve gaps in care that have resulted from the COVID-19 pandemic, and provide tools to refer patients to healthcare and wellness services. OFMQ, in collaboration with the Oklahoma Nutrition Information and Education (ONIE) Program and other local partners, will expand and enhance the OKFresh Program. OKFresh is a partnership between healthcare providers, farmers market (FM), and other partners across Oklahoma to identify individuals suffering from food insecurity and connect them to affordable, local options for fresh fruits and vegetables through a produce prescription program. OFMQ and ONIEoperateOKFresh in Comanche County, Muskogee County, and Ottawa County in Oklahoma. The three target counties exhibit food insecurity rates greater than 15%. Changes/Problems:Market Utilization While enrollment continues to grow, program/market utilization remains low. With an average monthly market utilization rate of 39.15%, that tells us that we need to intervene with current members. Why are current members not utilizing their benefits monthly? In similar programs, incentive money is based on household size. This may be an important factor in benefit utilization - if people do not feel it is worth their time, are they really going to use it? Survey Questions After evaluating the year one pre-survey, we must add a household size assessment question to the survey. We could have learned much more about the participants with this metric as well as given more context to the other metrics measured. Our complete pre- to post- survey analysis has not been finished yet; however, we will be considering the relevance of our added questions (in addition to the required GusNIP questions) pertaining to food preparation and frequency of eating leftovers. We must go back to our goals to ensure that we are capturing the needed information and not wasting time and space with questions of little relevance. Participating Clinic Pre-Survey We chose not to complete the optional GusNIP clinic pre-survey in year one due to having 2 of the 3 counties as pilot project sites. Through the pilot project, we were able to capture baseline information. After consideration, this was not the correct choice given that we are measuring increased food insecurity screenings in clinics for this project year. So, we must survey the clinic each project year to obtain a baseline so we can accurately measure that. We could also use this as an opportunity to gather data on current EHR utilization and processes. In FY2024, we plan to assess screening based on recall and historical data if clinics had a system to collect food insecurity prior to participating in OKFresh. Capturing SDoHs in the EHR Not as many clinics as we would prefer are utilizing their EHR for food insecurity screenings and tracking. OFMQ will continue to train clinics on how to capture this as well as advocate for an EHR software that is capable of such functions. In 2024, many clinics will begin to capture SDoH data as it is a CMS Quality Payment Reporting requirement. We will also continue teaching clinics their ability to bill for mild to moderate CPT codes for food insecurity screenings. Database Process Improvement Our current database is hosted on Smartsheet, and this program management system is cumbersome and could improve. Our database system in Smartsheet is not an automatic process, it is nearly all manual. This means that the OFMQ Project Coordinator must manually enroll participants, change participant balances, and capture market attendance according to clinic all individually. A change from the pilot project is asking the market to record the referral clinic from each OKFresh participant so we can track what clinic the participant came from as this is a GusNIP requirement. This is not a big change, but adding an extra step in a workflow isn't always an easy transition. There were learning curves with this and could still be improved with an automated system. The manual process is a time-consuming process for someone who has other projects going on as well. All the listed functions could potentially be in an automated system, inevitably making this project much more sustainable to continue and expand, which is always the goal. Mobile Farm Truck Another major issue is our winter market Mobile Farm Truck. Our partnering organization, Healthy Oklahomans' Nutrition Alliance (HONA), did not have a mobile farm truck after promising one. The OKFresh team pivoted from this issue and made the best of the situation. Two clinics in both Muskogee and Miami (Lawton has a year-round market and therefore does not participate in the Mobile Market) graciously offered their space to host the mobile market once a week for OKFresh participants as well as other marketgoers. This has been a beneficial pivot because it has involved the clinic in a new and creative way while generating more interest and recruiting more members while still being available to the general public. What opportunities for training and professional development has the project provided?Program Training - Clinics OKFresh has provided many opportunities for development in a variety of areas. All our participating clinics are trained on the hunger vital signs and food insecurity screening workflow. In addition to a welcome on-boarding meeting to OKFresh, a welcome kit is provided, which includes: OKFresh website information, program FAQs, social media post examples, program recruitment brochures, posters, hunger vital sign questions and provider talking points, food insecurity screening tracker, t-shirt order forms, and Oklahoma food resources. Program Training - Farmers Markets All participating farmers markets are trained on implementing the program and documenting in our database. ONIE completes all farmers market trainings, which includes token process for eligible food items, fresh produce items and how to capture weight after purchase. They ensure that all locations are knowledge about the specifics of the project. The farmers market is responsible for capturing member purchasing information in a Smartsheet form, which is shared with the OKFresh team. Clinics and farmers markets are knowledgeable and equipped to provide additional Oklahoma food resources. Professional Developments and Conferences OKFresh allows the OFMQ and ONIE teams to speak and teach at conferences and connect with others who are doing similar work or wish to do similar work one day. OKFresh has expanded OFMQ's reach within the community to populations we normally would not have reached within our Healthcare IT work. Likewise, ONIE has expanded it's reach within the healthcare sector. It has presented opportunities for us both to connect outside of our expertise. A few examples would be the OK Rural Health Conference and the Hunger Free OK Conference, both of which OFMQ and ONIE attend. Both OFMQ and the ONIE Project stay relevant within their sectors by attending conferences and trainings relevant to our expertise. In the past year, OFMQ has attended the following healthcare annual conferences: PLICO Healthcare Summit, Oklahoma Hospital Association, Oklahoma Osteopathic Association, and the Oklahoma Rural Health Association. ONIE has attended Oklahoma Local Agriculture Summit, Intents Farmers Market Conference, Oklahoma Public Health Association, and the Food and Nutrition Conference and Expo. We always aim to learn and teach as much as we can about food insecurity screenings and other relevant topics. How have the results been disseminated to communities of interest?The OFMQ Clinical Consultant distributes monthly enrollment numbers to clinics. The participating clinics receive monthly emails with program enrollment numbers and statistics. The farmers markets see the results in real-time, as they are serving members of our project; however, ONIE meets with them regularly to discuss the project's needs and impact. After all metrics from our pre- and post-surveys are analyzed, we will create an infographic to display our results. We will share this with all our stakeholders and participating firms as well as display it on our websites and be used as a tool to teach about our work.? What do you plan to do during the next reporting period to accomplish the goals?The implementation phase of OKFresh has been completed, so we will be moving toward the maintenance phase. During this phase, we will focus on intervening at a deeper level and increasing benefit-utilization with our current members while still recruiting new members through our participating clinics. We have found that on-site trainings and education has been the most beneficial tool in program success for the participating clinics. We will continue to promote and help clinics develop their EHR over paper processes for food insecurity screenings and tracking. We will continue to develop and implement a communication workflow to ease the burden of the different moving entities. We will also create a regular revolving topic schedule for the OKFresh text messaging program to encourage a healthy lifestyle in addition to continuing to encourage and support market managers to develop new relationships with produce vendors to regularly attend their market to provide shoppers with more options.
Impacts
What was accomplished under these goals?
Goal: Increase screening for food insecurity in high-risk communities. (Objective: Significantly decrease the frequency of self-reported food insecurity among participating families). OFMQ has increased food insecurity screenings for clinics in Ottawa, Muskogee, and Comanche counties. This was achieved by training clinics to incorporate the hunger vital signs into their patient-visit workflow. This was tracked by a food insecurity screener as well as structured data fields in the EHR (if approved by participating site). Program referrals were reported to the OFMQ Clinical Consultant monthly by each participating clinic by pulling registry reports from the EHR or using the screening tracker form. if they chose not to utilize the EHR. In this first project year, it was reported that 1102 individuals were referred to the program through a participating clinic. We do not have a baseline for this metric but can infer the baseline is much smaller due to the conversations the OFMQ Clinical Consultant has had with clinics and capturing social determinants of health. Capturing SDoHs are more common in the community health center/health department sector due to the nature of the work of community health workers. This is less common and more of a change in workflow for small practice clinics. For self-reported food insecurity, comparing pre- and post-survey data, before the intervention, the prevalence of food security was 11.9% and following the intervention was 20.9% indicating a 9% increase in food security (p=0.0079). Goal: Expand access to fresh produce among food insecure and low-income populations. (Objective: Significantly increase the average daily servings of fresh vegetables by the "enrolled" household member). The frequency of eating vegetables other than salad, salsa, and potatoes, 3-6 days/week increased from 39.4% at baseline to 56.7% following 6 months of the OKFresh intervention in a survey sample of 67 program participants with both pre- and post-surveys. This increase demonstrates program success and is a meaningful improvement in dietary quality. While not a specifically stated outcome, frequency of eating fruit at least once per day increased from 10.6% at baseline to 19.4% following 6 months of the OKFresh intervention in a survey sample of 67 participants completing both pre- and post-surveys.The doubling in prevalence of eating fruit at least once per day is a meaningful change in improving dietary intake and demonstrates the project has been successful in meeting this goal. Regarding increased access to fresh produce, the frequency of buying fruits and vegetables at a Farmers Market once a month, 2-3 times/month, and once/week increased substantially. The frequency of buying fruits and vegetables at a farmers' market once per month increased from 16.4% at baseline to 26.9% following the 6 months of OKFresh intervention. The frequency of buying fruits and vegetables at a farmers' market 2-3 times per month increased from 28.3% at baseline to 41.8% following 6 months of the OKFresh intervention. The frequency of buying fruits and vegetables once per week increased from 13.4% at baseline to 14.9% following 6 months of the OKFresh intervention. These increases would demonstrate substantial increase in Farmer's Market shopping and revenue generation for local growers and farmers. OKFresh has given $16,513 worth of benefits to participants and an average of 12,200 pounds of produce distributed for the first program year. Goal: Educate community members on the importance of nutrition and a healthy lifestyle. ONIE performed 3 live cooking demonstrations at Lawton and Muskogee locations and offers recipe cards on each market day and nutrition label information at the farmers' markets. ONIE distributed a total of 52 text messages to all participants containing either healthy recipes or healthy living tips. Also, the ONIE Project website is always available with new recipes and instruction videos utilizing low-cost and healthy ingredients. The program also provides nutrition education, food tools and storage, and recipes on weekly market produce through text messages and emails. Our team provides weekly education to participants pertaining to seasonal produce with links to recipes and information about local community events. Objective: Enroll up tothree hundred families, or 1,800 individuals, in the OKFresh program across Comanche, Muskogee, and Ottawa Counties by September 30, 2024.; Program participation or retention will meet or exceed 30% each year. Retention will be measured by the number of household members enrolled at the beginning of the program, and at the conclusion of each program year. As of September 2023, OKFresh has 621 individuals enrolled. Since we did not capture household size, we cannot assume an average household for the individuals served. 342 participants have attended the farmers' market to redeem their benefits at least once, which is a 55% retention rate, which does meet our goal of meeting or exceeding 30%. The average monthly market utilization rate is 39.15% across the three locations (Lawton = 34.28%; Muskogee = 41.16%; and Miami = 42.0%). Objective: Significantly increase the number of self-reported positive health outcomes among program participants. There was not a significant change in general health scores (range 1-5) from pre- (2.6) to post- (2.6) with the limited sample size available at this time.In similar produce prescription programs with a goal of positive health outcomes, incentive dollars are based on family size, nutrition classes are a part of the program, and basic health metrics are measured pre- and post-intervention: blood pressure, blood sugar, height, and weight. It is difficult to prove improved health outcomes with $20 of incentives per month and no measure of health other than self-reported. Additionally, other programs had longer interventions, whereas OKFresh has been implemented for six months in Muskogee and Lawton, and only five months in Miami. So, we expected this to not be a significant change. Objective: At least 50% of participating healthcare providers will modify their workflow to incorporate screening for social determinants of health into their patient assessments. Baseline data was unable to be collected. In FY2024, we plan to assess screening based on recall and historical data if clinics had a system to collect food insecurity prior to participating in OKFresh. During this project cycle, 19/19 participating clinics are actively recruiting for OKFresh and screening for food insecurity.
Publications
|
|