Performing Department
(N/A)
Non Technical Summary
The overall vision of Food = Health is to provide compelling evidenceto key internal, local, state, and national stakeholders demonstrating that produce prescriptions are a cost-effective treatment plan option to create better health outcomes and a potentially better life for families in rural, underserved areas. This vital research is needed to demonstrate to stakeholders such as health systems, payers, and funders that a practical and executable intervention in a rural areais better access to fresh produce and nutrition education, especially when paired with a clinical treatment plan. The major goals of this program are to increase dietary health through increased consumption of fruits and vegetables, decrease household food insecurity, and reducehealthcare system utilization and costs through an equitable, sustainable, and community-oriented program.The program will accomplish these goals by providing fresh produce, nutrition education, and by working with clinical care teams to integrate these resources into a comprehensive treatment plan for patients with, or at risk for, diet-impacted chronic disease.Food = Health is designed for and by community members of Southeast Kansas and Northeast Oklahoma- an area known as the least healthy and poorest of their respective states. Congruent with the health, social, and economic state of the region, the food systems and resulting effects on hunger are equally poor. Despite these troubling trends, the Community Health Center of Southeast Kansas (CHC/SEK)--the region's largest Federally Qualified Health Center (FQHC), which has clinics in seven rural counties in southeastern Kansas, and one rural county in northeastern Oklahoma--has grown to be a major regional asset and a leader in realizing their vision, "healthcare the way it should be." CHC/SEK will partner with Building Health, Inc. (BHI) to incorporate successful partnerships, clinical expertise, and patient care experience into thisnew program to address food insecurity and poor health outcomes.Food = Healthwas developed over many months of engaging patients, clinicians, community partners, and researchers to design an equitable, and sustainable produce prescription program. Enrollment into the program will provide a comprehensive look at the strengths and opportunities of the participant and their household's health while integrating a prescription for high-quality fresh fruits and vegetables as a treatment option for diet-impacted chronic diseases. In the 12-month program, participants will be given prescriptions for $25 of produce every other week. Produce prescriptions will be provided in two ways--prescription vouchers to be used at local farmers markets or prescriptions for produce boxes prepared by Martinous Produce Co., a local produce distributor.As part of the intake process, CHC/SEK community health workers (CHWs) will assess unique barriers a household may have, such as inadequate kitchen supplies or dietary restrictions and work to address those on an individual level. While enrolled in Food=Health, participants will have access to nutrition education, cooking skills education, and clinical services. CHWs will work closely with participants throughout the program and will help with enrollment for food assistance programs, and for other social service programs, including rent, utility, and prescription assistance and SNAP-Ed classes with Kansas State Research and Extension.Data will be collected throughout the project utilizing CHC/SEK's electronic health record; CHC/SEK's Accountable Care Organization (ACO) claims database; a secure, electronic survey vendor called Alchemer; SNAP-Ed course attendance records; and Martinous Produce Co. Receipt data for participants. As these data are collected, they will be analyzed by members of the project team, including the Learning Tree Institute (LTI), the evaluation partner of Food = Health. The final project evaluation and results will be summarized and prepared for presentation to key stakeholders in order to contribute to best practices for produce prescription programs integrated with primary care teams in rural areas.
Animal Health Component
60%
Research Effort Categories
Basic
10%
Applied
60%
Developmental
30%
Goals / Objectives
The overall vision of Food = Health is to provide evidenceto key internal, local, state, and national stakeholders demonstrating that produce prescriptions are a cost-effective treatment plan option to create better health outcomes and a potentially better life for families in rural, underserved areas. The major goals of this program are to increase dietary health through increased consumption of fruits and vegetables, decrease household food insecurity, and reducehealthcare system utilization and costs through an equitable, sustainable, and community-oriented program.The program will accomplish these goals by providing fresh produce, nutrition education, and by working with CHC/SEK care teams to integrate these resources into a comprehensive treatment plan for patients with, or at risk for, chronic disease. Specific objectives are listed for each goal below.Goal 1: Improve participants' dietary health through increased consumption of fruits and vegetablesObjectives:At least 300 CHC/SEK eligible patients enroll into Food = Health, as measured by electronic health record (EHR) data from CHC/SEK, and receive a maximum of 26 bi-weekly produce prescriptions50% of Food = Health participants complete a 4-6 class K-State Research and Extension (KSRE) SNAP-Ed course as measured by KRSE attendance data within the participant's enrollment period90% of participants attend at least 3 nutrition education opportunities30% of participants self-report that their household consumed "most" or "all" of their produce over the last 30 days as measured by a survey conducted by a community health worker (CHW) at least 90-days post-enrollment30% of participants increase their fruit and vegetable consumption as measured by the Dietary Screener Questionnaire (DSQ-10) compared to their baseline score90% of enrolled participants receive at least 9 produce boxes or voucher distributions within 6 months of program enrollment75% of enrolled participants receive at least 18 produce boxes or voucher distributions within 12 months of program enrollmentGoal 2: Reduce individual and household food insecurityObjectives:Decreased food insecurity for 30% of participants as measured by scores on the USDA Food Security Survey six-item short form by the end of their program participation40% of participants receive at least one referral or complete at least one enrollment to a community resource related to food insecurity80% of participants self-report that their kitchen kit had a "moderate effect" or "major effect" on their ability to utilize their produce prescription as measured by a CHW at least 90-days post-enrollment?Goal 3: Reduce healthcare system utilization and associated costsObjectives:40% of participants complete a well-visit during their program as measured by CHC/SEK EHR visit data5% of participants decrease the number of emergency department (ED) and non-emergent ED visits as measured by Accountable Care Organization (ACO) data, when feasible, or by self-report when claims data is not available, when compared to the previous yearDecreased total healthcare system charges for 5% of program participants as measured by ACO data, when feasible, or by self-report when claims data is not available, when compared to the previous yearDecreased number of participants with an HgA1C value of 5.7% or greater, by 20% when compared to baseline data, as measured by lab results in CHC/SEK's EHRDecreased number of participants with a high blood pressure as defined by a value of 140/90 or greater, by 20% when compared to baseline data, as measured by vitals in CHC/SEK's EHRDecreased number of participants with a BMI defined as obese as defined by a value of 30 or greater, by 5% when compared to baseline data, as measured by vitals in CHC/SEK's EHRDecreased number of low-birth-weight babies as defined by CHC/SEK's HRSA UDS report from 6.9% in 2021 to 6.0% or less in subsequent years as measured by CHC/SEK UDS reportingDecreased number of participants with a high PHQ-9 score as defined by a value of 9 or greater, by 10% when compared to baseline data, as measured by assessment results in CHC/SEK's EHRGoal 4: Create community, systems, and financial sustainability Objectives:Increased enrollment of CHC/SEK care coordination programs by 10% within 2 yearsAt least 3 SNAP-Ed courses conducted in each county during the 26 months produce prescription phaseMedia and promotional campaign developed within the first 4 months of program planningFood = Health template treatment plans inclusive of CHC/SEK ACO and Quality metrics developed within the first 4 months of planningAll listed partners maintained throughout the programPlan for dissemination of results created within the first 4 months of program planning90% of CHC/SEK clinical care team members complete the quarterly structured surveyGoal 5: Create an equitable, community-oriented program:Objectives:75% of advisory committee members attend at least 3 meetings during their 12-month program enrollment period100% of patient educational materials made available in Spanish, and other languages if needed, within the first 3 months of program startWhen surveyed, 80% of advisory committee members respond "Almost Always" or "Always" to "My feedback is incorporated into the Food = Health program."Monthly program dashboard inclusive of important program outputs and outcomes created within the first 4 months of planning phase90% of community stakeholders complete the quarterly structured survey90% of program participants complete at least 1 monthly structured survey within their 12 month produce prescription periodThe feedback team will meet at least once per month during the 26 month produce prescription phase80% of surveyed stakeholders and advisory committee members respond "Very Satisfied" or "Satisfied" to "Are you satisfied with how your feedback or recommendations are implemented into the Food=Health Program?"
Project Methods
The Food=Health evaluation will be conducted as an impact evaluation with a correlational and a continuous quality improvement design. The overall goal of theevaluationis to contribute to the available practice-based evidence by demonstrating achievement in each goal.It will include outcome assessments to evaluate the intervention, and process assessments to evaluate the design and implementation of the program.The main intervention of Food=Health is to integrate a prescription for high-quality fresh fruits and vegetables as a treatment option for diet-impacted chronic diseases. This will be a 12-month program, and participants will be given prescriptions for $25 of produce every other week, totaling $650 over the length of the program. If transportation is a barrier for any participant, the local Community Health Worker (CHW) will deliver the boxes to the participant's household. While enrolled in this program, participants will have access to nutrition and cooking skills education, and clinical services. CHWs will work closely with participants to complete applicableenrollments for food assistance and other social service programs. As part of the intake process, the CHW will assess unique barriers a household may have, such as inadequate kitchen supplies or dietary restrictions and work to address those on an individual level utilizing Community Health Center of Southeast Kansas (CHC/SEK), Building Health Inc. (BHI), and other community resources.Data will be collected throughout the project utilizing CHC/SEK's electronic health record; CHC/SEK's Accountable Care Organization (ACO) claims database; a secure, electronic survey vendor called Alchemer; SNAP-Ed course attendance records; and Martinous Produce Co. Receipt data for participants. As these data are collected, they will be analyzed by members of the project team, including the Learning Tree Institute (LTI), the evaluation partner of Food=Health.To document the intervention's effectiveness in improving dietary health through increased consumption of fruits and vegetables, reducing individual and household food insecurity, and reducing healthcare use and associated costs among eligible participants, the evaluation will include an outcome assessment.The outcome assessment will include at least the minimum of collecting the core 19 firm-level and participant-level metrics and will cooperate with, and contribute core data to the NTAE center or delegate. Outcome assessment will consist primarily of participant-level metrics including utilization metrics and health and participant experience metrics. Participant-level metrics will be collected using the annual participant-level core metrics pre/post survey and additional participant satisfaction survey measures as provided. Surveys will be administered using the Alchemer online survey platform managed by LTI, the contracted evaluation partner. Surveys will be administered by BHI and CHC/SEK. Data collected through Alchemer will be analyzed and reported by LTI. Utilization metrics will include # of participant hospitalizations, # of non-emergent emergency department (ED) visits, # of ED visits, and # of participant well-visits. Health metrics include HbA1c, BMI, PHQ9, BP, birth weights, and 6-Item Short Form USDA-FSSM (to detect longitudinal change). Aledade, CHC/SEK's Accountable Care Organization (ACO) will provide additional health outcome data including claims information, which will include health system utilization outside of CHC/SEK.Health metrics will be collected by CHC/SEK and provided to LTI without identifying participant information. The analysis provided will be disseminated to stakeholders by the Project Director as is deemed appropriate by project staff. BHI and LTI will participate in the required national comparative analysis in order to integrate results across sites and approaches to look for best practices.Food=Health will have monthly partner and participant advisory committee meetings throughout the project to assist with program promotion, to receive feedback, and to inform program improvements. With long-term sustainability in mind, BHI will conduct interviews with clinical team members including the CHWs at CHC/SEK by joining their existing meetings to seek feedback on the program and make adjustments to the operational workflows, as needed. Food=Health will create a "feedback team" of subject matter experts to review each month's feedback, create recommendations, and create an implementation plan to incorporate the recommendations. The summary of the recommendations and proposed improvements will be presented back to stakeholders and the participant advisory committee at the next available meeting with those groups.Partners, staff, and participant advisory committee members will be surveyed quarterly ?to assess the process, challenges, and success of implementation and operations as part of the evaluation. Other process assessments will consist of firm level metrics including operating hours, characteristics of program operations, description of program collaborations, number of advisory meetings, number of partner meetings, the dollar value of incentives issued and redeemed, the amount and frequency of produce distribution, the number of community events and/or educational opportunities offered, the number of eligible participants, the number of enrolled participants, the number of participants discontinuing or completing the program, the number of outreach materials developed and/or distributed, and the estimated reach of outreach materials. Firm-level metrics will be collected by BHI and analyzed by LTI. Data analysis will also be used to make needed adjustments in programming. Program process assessment results will be provided to the NTAE center annually, or as requested.BHI and LTI will participate in all required technical assistance to support consistent implementation of evaluation protocols. BHI and LTI will cooperate with the NTAE center, or delegate, by supporting implementation of evaluation requirements; meeting periodically with staff, and other grantees to review plans, evaluation methods, data collection and reporting, and analysis and reporting of results; facilitate access to or provide documentation of implementation, operations, costs, and outcomes; and facilitate site visits and interviews with staff and program participants, as needed. Survey methodology including processes for data collection, data interpretation, validity, reliability, and limitations will be available and consulted throughout the IRB process. The Southeast Kansas Education Service Center conducts all Institutional Review Board (IRB) approvals on behalf of LTI and is charged with overseeing all LTI institutional research involving human subjects. The rights and privacy of program participants will be protected at all times, especially in accordance with HIPAA. Annual human subject's assurance statements will be reviewed and approved by the IRB, specifically for the outcome evaluation for this program. Informed consent will be collected from participants at program enrollment by CHC/SEK and BHI staff. Informed consent forms will be collected and stored in CHC/SEK's electronic health record, eClinicalWorks. Participants enrolled will include adults and children. Children will require an informed consent (assent) from the participant and parent or guardian. Data Use Agreements or MOUs will be generated with collaborators as needed.BHI, CHC/SEK, and listed partners have agreed to comply with any and all evaluation requirements. All partners and leading agencies agree to share information and core data per grant requirements. The final project evaluation and results will be summarized and prepared for presentation to key stakeholders in order to contribute to best practices for produce prescription programs integrated with primary care teams in rural areas.