Progress 09/15/23 to 09/14/24
Outputs
Target Audience:This reporting period included the end of the first cohort of the KC Fresh Rx program and five of the six months[DM1] of the second cohort of the program. For the first cohort, the target population was Medicaid patients who had experienced food insecurity in the prior year and who were pre-hypertensive and/or pre-diabetic. Twenty-two patients completed the KC Fresh Rx program in 2023. They were referred to the program from three different health clinics. The participant goal for this cohort was sixty. During the recruitment and referral process for the second cohort in early 2024, the target population for the KC Fresh Rx population was modified. The referring clinics, which included four clinics for the second cohort, provided the input that identifying patients who are pre-hypertensive and/or pre-diabetic through electronic medical records was difficult because those designations are not commonly noted in records where they can easily be queried. The decision was made to expand the target population for the program to patients who had been diagnosed with hypertension and/or diabetes as well. This change was approved by the Gus Schumacher Nutrition Incentive Program program officer and communicated to the National Nutrition Incentive Hub. Patients who are diabetic need to have their diabetes stabilized in order to participate. Fifty-two participants started the program for the second cohort in 2024. During the reporting period, three participants dropped from the program, leaving 49 participants. The goal for the second cohort was to have 60 participants engaged in the program. Changes/Problems:During the reporting period, goals for the program were to enroll 60 participants per year. Twenty-two participants completed the program in November 2023 and 52 were enrolled in April 2024, with 49 still enrolled by the end of the reporting period. Multiple strategies will be employed to reach the target of 180 participants in the final year. One strategy will be to expand the number of languages the program is translated into so that a wider range of participants can be referred to the program. Another strategy will be to offer assistance for participants who need transportation to the participating stores, the in-person nutrition education classes, and to their post program data collection appointments. Funding to support the translation into additional languages and to pay for transportation assistance comes from a Nutrition Incentive Hub's Capacity Building and Innovation Grant for use from August 2023-August 2024. Another challenge was related to the card and system used for incentives. Each participant received an amount based on the size of their household ($40 per month for the participant plus an additional $20 for each additional household member). At the end of cohort one in 2023, the development of the card was not finished. Participants and cashiers were given specific instructions that needed to be followed in order for the card to work correctly, such as separating fruits and vegetables from non-produce items and manually removing the tax. When these instructions were not followed, the card did not perform as intended. Non-produce items were purchased, and taxes were included in transactions covered by the KC Fresh Rx card. These issues also caused confusion for cashiers and participants. At the start of the 2024 cohort in April, card usage was delayed for 2 weeks as the technology was finalized in stores so that the card only allowed fresh fruits and vegetables and automatically removed taxes. The card generally worked as intended in grocery stores, but an issue was discovered around the programming of the card and sale items in the store. If an item was on sale, the card rejected the item and made the balance on the card appear to be $0. Again, cashiers and participants were confused by this issue. The issue was not resolved at the end of the reporting period time. Conversations have taken place with the staff at the grocery store company and a company that provides technology services for the stores to ensure that the remaining glitches related to the card would be addressed before the third cohort beings. What opportunities for training and professional development has the project provided?Collaborative members have participated in monthly produce prescription community of practice meetings hosted by partners involved with the National Nutrition Incentive Hub. During these meetings, members share lessons learned related to specific topics of interest. Collaborative members attended and participated in several of the Nutrition Incentive Hub's regular webinars and online courses including couple collaborative members also attended the Project Director meeting in December 2023 and had the opportunity to learn from other grantees implementing a produce prescription program. How have the results been disseminated to communities of interest?Results for the first cohort which October 2023 included in a KC Fresh Annual Report. This annual report has been share with collaborative members, funders, the grocer store chain working with the program, and other interested partners. Results have also been share through presentations with interested partners across Kansas and Missouri and other produce prescription programs. What do you plan to do during the next reporting period to accomplish the goals? Objective 1: Identify 180 Medicaid patients over three years who 1. Are pre-diabetic and or pre-hypertensive; and 2. Have experienced food insecurity in the 12 months prior to referral. To achieve the goal of 180 patients throughout the 3 years, the KC Fresh Rx collaborative decided to expand the criteria for potential participants to include people who have already been diagnosed as diabetic and hypertensive. In addition, the Nutrition Incentive Hub's Capacity Building and Innovation funding will allow all of the KC Fresh Rx materials to be translated into 3 additional languages, Arabic, Somali, and Vietnamese (materials are currently available in English and Spanish). These translated materials will allow clinics to refer a more diverse group of participants from the patients they serve. The funds will also be used to provide transportation for participants who do not have reliable transportation. The program will be able to assist with transportation to the required first and least sessions, as well nutrition education classes and trips to the grocery store. Being able to provide this assistance will help ensure that participants engage with the program as intended and complete the six-month program. Objective 2: Provide six monthly financial incentives to the eligible participants to purchase fresh vegetables and fruit from participating grocery stores. We will continue conversations with our grocery store partners to ensure any glitches are solved before the 2025 cohort begins and participants can use their incentive effectively. Objective 3: Provide nutrition education information and demonstrations during the six-month period when incentives for fresh produce are provided to participants. In addition to the already planned and developed demonstrations and education, materials will be translated, and new materials will be created to accommodate three additional languages: Somali, Arabic, and Vietnamese. Objective 4: Monitor and compare the health care utilization and associated costs for the participants before and during their participation in the produce prescription program. Efforts continue to collect healthcare utilization from patients that are self-reported as well as from the clinics and their electronic medical records.
Impacts
What was accomplished under these goals?
Core Operations Objective: Operationalize a collaborative to implement a produce prescription program including MARC, health care clinics, nutrition educators, and evaluators. The KC Fresh Rx collaborative continued to plan for and implement the program by completingactivities with the first cohort of participants, adjusting the program with lessons learned from the first cohort, and beginning program activities with a second cohort. Partners consist of representatives from MARC, four health care clinics (AdventHealth Clinic, Samuel U Rodgers Health Clinic, University of Kansas General and Geriatric Medicine, and the University of Kansas Family Medicine Clinic, which is a new partner), and researchers from the University of Kansas Medical Center, who provide nutrition education and evaluation services. Monthly meetings are held virtually to discuss program strengths and weaknesses and strategies for better program participation. Communication is done via email and through the secure SharePoint site. Objective 1: Identify 180 Medicaid patients over three years who 1. Are pre-diabetic and or pre-hypertensive; and 2. Have experienced food insecurity in the 12 months prior to referral. At the end of the first cohort 22 Medicaid patients completed the program. During the second year, 52 patients were identified and enrolled using expanded criteria to include patients diagnosed with hypertension and diabetes. During the reporting period three participants dropped from the program during the second cohort, leaving 49 people. A total of 71 participants have participated in the program across the two cohorts. Objective 2: Provide six monthly financial incentives to the eligible participants to purchase fresh vegetables and fruit from participating grocery stores. Participants have been provided with monthly financial incentives to purchase fresh fruits and vegetables at 25 participating grocery stores. Incentives were uploaded to reloadable gift cards. Incentive amounts were based on household sizes ($40 for the participants each month and $20 for each additional family member). During the final months of the first cohort in 2023, the program-specific gift card was still in development and some of the card capabilities were not in place. Participants were required to separate produce from other items and tax had to be manually removed from the transaction. During the 2nd cohort, the KC Fresh Rx card was programmed to automatically separate fresh produce from non-eligible items and remove the tax. Objective 3: Provide nutrition education information and demonstrations during the six-month period when incentives for fresh produce are provided to participants. Nutrition education opportunities and materials were provided to participants of the KC Fresh Rx program throughout each of the six months of the program. The participants were invited to attend a 1-hour nutrition education class each month. During the reporting period approximately 50 percent of the 2023-year one cohort participants came to these in-person nutrition education classes. During the year two cohort, approximately 40 percent came to the classes. Each month, a topic is discussed, such as shopping for and storing fresh fruits and vegetables, and a cooking demonstration is given, placing a particular focus on seasonal fruits and vegetables. Several recipe cards are given to the participants each month which also highlight seasonally available produce. A monthly handout is also provided to the participants, summarizing the topic covered in the in-person class, as well as providing fun facts about a highlighted produce item and suggestions for how participants can incorporate more movement into their lives. In addition to the in-person classes, weekly messages are sent out to participants via text and email to remind them to use their incentive dollars for fresh fruit and vegetables and encourage them to incorporate more fresh produce into their diet. The messages sent out during the week of the in-person classes include a brief recap of the information and a video version of the cooking demonstration presented during the classes. Throughout the program period, participants who have attended the classes have been increasingly more engaged, sharing their successes and challenges regarding the goal of eating more fruits and vegetables. Objective 4: Monitor and compare the health care utilization and associated costs for the participants before and during their participation in the produce prescription program. Health care utilization information is self-reported by participants, and verified from healthcare providers if possible, with additional information being added from clinic records if self reported data did not include allapplicable medical encounters. Data is collected for the six-month period before the participants startthe program and the six months during the program. Data from the two periods are compared and analyzed. The program is looking at the following health care utilization data: 1. # of well visits; # of missed appointments; # of hospitalizations; # of Emergency Room visits. During this reporting period, clinics provided data for the first cohort reflecting health care utilization during the six months the participants were engaged with the program. The clinics also provided health care utilization data for the second cohort participants, for the six-month period before they began the program. Results from the first cohort in 2023: $10,600 in incentives were distributed. Participants redeemed $9,475 in stores, for a redemption rate of 89%. Most participants used a combination of in person and virtual education, with 100% of participants using at least one of these methods. Based on pre- and post-program survey data, average fruit and vegetable consumption increased from 2.22 cups per day to 2.66. Participants experiencing low or very low food security in the 30 days prior to participating in the program were 70% and decreased to 57% by the end of the program. Participants also reported an increase in food literacy and knowledge related to cooking meals using healthy ingredients at home. A decrease was seen in average number of days of poor mental health and days that poor physical or mental health kept them from usual activities. Regarding hemoglobin A1c, eleven participants had an available HbA1c at baseline with ten of those in range for prediabetes. At the end of the program, eight participants who had a pre-program A1c measurement returned for a post measurement. Of these eight people, five saw a reduction in their A1c, with two of them no longer being in the pre-diabetic range. One person's A1c stayed the same and two saw increases. Of those that had increases to their A1c's, significant challenges prevented them from fully utilizing the card consistently. The average HbA1c value was 5.93% at baseline and 5.75% at the end of the study. In regard to blood pressure, eighteen individuals had baseline measurements and of those, 14 were in the range for prehypertension based on their systolic blood pressure (120-139 mmHg). Of the 10 people who had both baseline and end-of-program measurements for blood pressure, eight people had a reduction in their systolic pressure, with the other two seeing an increase. At baseline, 13 out of 18 participants were in the prehypertensive range based on diastolic blood pressure (80-89 mmHg). For the 10 individuals that had both baseline and end-of study measurements, five showed a reduction in diastolic blood pressure, three saw increases and two remained the same. During the reporting period, the second cohort in 2024 was not complete. Results for the second cohort will be included in the next report.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2024
Citation:
"Gibson, C. A., Mount, R., Valentine, H. Oral presentation at IAFOR International Conference on Education in Hawaii, "KC Fresh Rx: A Produce Prescription Program with Nutrition Education Among Medicaid Recipients." International Academic Forum, Honolulu, HI. (January 2024).
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2024
Citation:
Gibson, C.A., Mount, R., Valentine, H., Cunningham, A., Comfort, B., Martin, D. Oral presentation at Nutrition 2024. KC Fresh Rx: A Produce Prescription Program for Medicaid Recipients. American Society for Nutrition, Chicago, IL. (July 2024).
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:The KC Fresh Rx program worked with three health clinics in the Kansas City metro area to identify participants for the program's first cohort. The referring clinics were AdventHealth Medical Clinic, the University of Kansas Medical Center Geriatric and General Medicine Clinic, and Samuel U. Rodgers Health Clinic. The participants referred to the program by the three health clinics were Medicaid recipients who have experienced food insecurity in the year prior to being referred and who have been identified as pre-hypertensive and/or pre-diabetic. Twenty-two participants used the financial incentive provided by the program. (The goal for our first cohort was 60 participants. Efforts will be made during the next two years to increase the number of participants included in the program.) and about 45 percent of the participants responded to the weekly messages sent. Changes/Problems:First year goals for the program were to enroll 60 participants. Recruitment and referrals were delayed in part because the development of the SharePoint site used to securely share information and communicate between partners took more time than expected. In addition, not all the patients who were informed about the program by the clinics chose to participate in the program so in future years, the clinics may need to over recruit to meet our participant goals. Another challenge was related to the development of the card and system used for incentives. The original card developer we had spoken with during the time when we were writing our proposal was not able to create the type of card needed for this project ultimately. The staff at Balls Foods Stores connected us with another company that was able to create a card and work with the point-of-sale provider. The work however, to create the card took significantly longer than we had anticipated. At first, we delayed the start of the first class by one month, from April to May. Then the decision was made to start the cohort and offer each participant the choice of a gift card from one of the four different grocery banners owned by Balls Foods stores: Hen House stores, Balls Price Chopper stores, and Balls Sun Fresh stores. The gift cards were available in amounts from $40-$180 and each participant received an amount based on the size of their household ($40 per month for the participant plus and additional $20 for each additional household member). This alternative option was given to each participant for the first two months of the program. Distribution the first month was easier since the participants were all required to meet with program staff in person. However, to ensure that the cards would be used only for fresh fruit and vegetables, a bar code sticker was adhered to the cards. The cashiers were supposed to scan that bar code before the transaction and ring up the produce separately from the other items in the purchase. It took time for the cashiers and participants to get used to this process. For the second month, distribution was more difficult since not all the participants came to the in-person classes, so distribution took considerably more effort to make sure each participant received their card and get a signed form documenting that receipt. For the third month, the participants were given a KC Fresh Rx card. However, the development of the card was still not finished. The card was still allowing non-produce items to be purchased and tax to be charged. We have worked with the grocer to ensure that these issues have been caught and resolved for the future. Unfortunately, during the cohort, these issues caused confusion. What opportunities for training and professional development has the project provided? The KC Fresh Rx project director and coordinator attended the Nutrition Incentive Hub National Convening in Washington D.C. in June of 2023. At the Convening we attended workshops to learn more about technology solutions, reporting, evaluation, program sustainability and expansion strategies, while learning from other programs across the country. Collaborative members have participated in monthly produce prescription community of practice meetings hosted by partners involved with the National Nutrition Incentive Hub. During these meetings, members share lessons learned related to specific topics of interest. KC Fresh Rx collaborative partners also participated in webinars and online courses provided by the National Nutrition Incentive Hub including: GusNIP Farm Bill Update Webinar Nutrition Education + Nutrition Incentives Community of Practice GusNIP NTAE Nutrition Incentive Economic Impact Calculator Webinar How have the results been disseminated to communities of interest?Our first cohort was still in progress at the end of this reporting period (September 14th, 2023) so data from the program was still in the process of being collected. Reports describing the activities and data from the first cohort will be developed and disseminated to interested partners and stakeholders early in 2024. An evaluation report will also be prepared to share the findings of the surveys and assessments conducted during the first cohort. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period, we will finish the activities, data collection and analysis with the first cohort of participants. We will begin the recruitment process for the second cohort and their nutrition education classes and financial incentives will begin in April. Our goal is to recruit 80 participants from the three clinics for the next reporting period.
Impacts
What was accomplished under these goals?
Core Operations Objective: Operationalize a collaborative to implement a produce prescription program including MARC, health care clinics, nutrition educators, and evaluators. A collaborative of partners has met monthly to plan for and implement the KC Fresh Rx program, the produce prescription program supported by this award. Partners consist of representatives from MARC, three health care clinics, and the University of Kansas Medical Center, who provide nutrition education and evaluation services. The collaborative partners meet virtually and communicate via email and through a secure SharePoint site. Objective 1: Identify 180 Medicaid patients over three years who 1. Are pre-diabetic and or pre-hypertensive; and 2. Have experienced food insecurity in the 12 months prior to referral. In the first year, 23 Medicaid patients were identified and enrolled in the program. Of those, 22of the participants participated during the six months of the program. The Medicaid patients referred to the program are pre-diabetic and/or pre-hypertensive and have reported food insecurity in the year prior to referral. Objective 2: Provide six monthly financial incentives to the eligible participants to purchase fresh vegetables and fruit from participating grocery stores. Participants have been provided with monthly financial incentives to purchase fresh fruits and vegetables at 25 participating grocery stores. For the first two months, the KC Fresh Rx reloadable gift card being developed for this program with the grocery store company and their point of sale and gift card providers was not ready for implementation. The participants received normal grocery store gift cards and were able to choose a card for the brand of grocery store (Hen House, Balls Price Chopper, or Balls Sun Fresh) at which they were most likely to shop. The cards had a bar code which cashiers would scan to be able to pay for fruits and vegetables being purchased. When the KC Fresh Rx card was ready for implementation, incentives were uploaded to the participants' cards monthly. Incentive amounts were based on household sizes ($40 for the participants each month and $20 for each additional family member). Objective 3: Provide nutrition education information and demonstrations during the six-month period when incentives for fresh produce are provided to participants. Nutrition education opportunities and materials were provided to participants of the KC Fresh Rx program throughout each of the six months of the program. The participants were invited to attend a 1-hour nutrition education class each month. Approximately 50 percent of the participants came to these in-person nutrition education classes. Each month, a topic is discussed, such as shopping for or storing fresh fruits and vegetables, and a cooking demonstration is given, placing a particular focus on seasonal fruits and vegetables. Several recipe cards are given to the participants each month which also highlight seasonally available produce. A monthly handout is also provided to the participants each month, summarizing the topic covered in the in-person class, as well as providing fun facts about a highlighted produce item and suggestions for how participants can incorporate more movement into their lives. In addition to the in-person classes, weekly messages are sent out to participants via text and email to remind them to use their incentive dollars for fresh fruit and vegetables and encourage them to incorporate more fresh produce into their diet. The messages sent out during the week of the in-person classes include a brief recap of the information and a video version of the cooking demonstration presented during the classes. Throughout the program period, engagement has increased among those that attended classes resulting in shared successes and challenges between participants. Objective 4: Monitor and compare the health care utilization and associated costs for the participants before and during their participation in the produce prescription program. During this reporting period health care utilization information has been collected from participants, and verified from healthcare providers where possible, for a one-year period before the participants started the program. Information about health care utilization will be collected for the time the participants were involved with the program as well and the data from the two periods will be compared and analyzed. The program is looking at the following health care utilization data: 1. # of well visits; # of missed appointments; # of hospitalizations; # of Emergency Room visits.
Publications
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