Recipient Organization
KAHUKU MEDICAL CENTER
56-117 PUALALEA ST
KAHUKU,HI 96731
Performing Department
(N/A)
Non Technical Summary
Kahuku Medical Center (KMC) is located in the heart of North Shore, Oahu. KMC services a patient population that spans the North Shore and Ko'olauloa regions, home to approximately 35,000 residents and destination to over a million visitors annually. As the only hospital for more than 30 miles in either direction, KMC is the emergency safety net during a health crisis and the leading provider of primary care services in the area. Community members have described KMC as a medical hale (home), relating the facility's comfortable atmosphere to that of a loved one's home. The mottoFriends and Family Taking Care of Friends and Familywas chosen to celebrate this sentiment, along with the many community members on staff who often find themselves providing medical care for those they know and love. The KMC ohana (family) is a true reflection of the surrounding communities: culturally diverse, refreshingly personal, and the embodiment of the aloha spirit.KMC's patient catchment area ranks among the most beautiful regions in the world. Sadly, beneath the lush and beautiful surface lies disturbing disparities in health and socioeconomic status. The rates of poverty, food insecurity, poor health outcomes, and insufficient housing are all rising at an alarming rate. The current trajectory of chronic disease poses a genuine threat to the future generations of our community.The high cost of food coupled with the high cost of living has led to an increasing number of displaced community members who are unable to adequately feed their families. Consuming enough fruits and vegetables is crucial to improving health outcomes and preventing chronic disease, yet only 17% of local adults currently meet intake goals. Equitable access to healthy food is a critical need that remains unmet in Hawai'i. Programs like Produce Rx are vital to achieving a healthier, more resilient population. Not only do they alleviate food insecurity, they also stimulate the local economy and support the growth of agricultural infrastructure. The call to action for Kahuku Medical Center is undeniable. In joining other community stakeholders engaging in innovative systems of change, KMC can participate in efforts to alleviate the dual burden of food insecurity and chronic disease.
Animal Health Component
33%
Research Effort Categories
Basic
33%
Applied
33%
Developmental
34%
Goals / Objectives
KMC's Produce Prescription Program aims to fill the gap in accessibility and affordability of nutritious, locally grown fruits and vegetables for low-income individuals at risk for, or diagnosed with, a nutrition-related chronic condition. This project will use a collaborative approach to improve health outcomes among those at greatest risk while expanding local food producers' economic opportunities and agricultural infrastructure. The goals and objectives outlined below help form a roadmap to ensure meaningful deployment of the first Kahuku Medical Center Produce Prescriptions Program, serving the North Shore and Ko'olauloa regions of Oahu.Goal 1:Improve health outcomes through the increased consumption of fruits and vegetables.Objective:Provide 36 customized, culturally relevant educational resources supporting knowledge acquisitionon nutrition and healthy eating principles, the impact of dietary habits on chronic disease prevention or management, and nutritious recipes that honor traditional food preparation methods.Goal 2:Alleviate individual and household food insecurity.Objective:Maximize incentive benefit for each participant by achieving 75-90% of goal enrollment by incentive month 6.Goal 3:Reduce healthcare utilization and associated costs among program participants.Objective:Mandate regular follow-up appointments with Produce Rx prescribing providers to support primary care as the appropriate venue for managing health conditions, as opposed to current trends in utilization that reflect a growing reliance onemergency care for addressing routine needs.
Project Methods
In accordance with the primary goals of the GusNIP grants program, KMC's Produce Prescription Program aims to fill the gap in accessibility and affordability of nutritious, locally grown fruits and vegetables. KMC's Produce Rx Program will provide a reproducible, standardized process by which high-risk community members and existing SNAP and Medicaid beneficiaries can increase their purchasing power for healthy foods. This will be achieved through an incentive-based program offering produce delivery from project partner Farm Link Hawai?i (FLH). FLH improves access to nutritious foods through an innovative online marketplace, connecting local growers and food producers across the islands with their buyers. Farm Link Hawai'i is an active SNAP-EBT vendor and recipient of Double Bucks funding. Participants will receive up to 36 bi-weekly deliveries containing a Farmer's Choice produce box, valued at $30 each, for up to $1080 in Produce Rx incentives per participant. Each delivery will also include a customized, culturally relevant resource to provide education on basic nutrition concepts and healthy eating. Important takeaways will be identified in each resource to maximize value and knowledge retention.KMC's Produce Rx Program anticipates enrolling 150 eligible participants over a 2-year incentive period. Enrollment eligibility will focus on the following measurements:1. Adults (18 years and older)2. SNAP Benefit Recipient or Medicaid Beneficiary3. Housing Status (houseless, low-income single-family or multigenerational home)4. Increased risk or current diagnosis of a nutrition-related chronic health condition (including diabetes, hypertension, cardiovascular disease)Eligibility screening will be performed by KMC's Produce Rx Program team, KMC medical providers and their support staff, or digital and paper self-assessment tools.Once eligibility is confirmed, each participant will be issued a Welcome Packet containing important program documents, including informed consent and terms of participation, photo/video release, HIPAA, and any additional forms required by GusNIP NTAE. Participants will then be issued a unique Farm Link Hawai'i account through a novel approach designed to eliminate redundancies in workflow and potential barriers to participation. FLH account registration typically requires a credit card and personal email address. KMC's Produce Rx Program created a google mail (Gmail) account that will serve as the base email, and sole inbox, for all FLH account registrants. This will be accomplished through the Gmail Plus feature, which enables multiple email addresses to arrive in the same inbox by adding a unique extension after "+" as simulated in kmcfarmlink+participant1@gmail.com. FLH participant accounts will all utilize KMC's designated produce payment method. This enables auto-ship deliveries, eliminates a separate invoicing process for FLH, eliminates time spent cross-referencing incentive eligibility lists, and facilitates incentive tracking. Participants will also be encouraged to sign up for a personal, SNAP-designated FLH account to benefit from the Double Bucks incentive program. Instructions and registration support will be provided as indicated.KMC's Produce Rx Program will utilize a mixed-methods approach to data collection and evaluation, ensuring all the required participant and firm-level core metrics are accounted for. Any data relevant to KMC's determination of eligibility or intended project outcomes that is not part of the GusNIP NTAE reporting requirements will also be included. KMC's third-party evaluator, Dr. Monica Esquivel of UH Manoa, has extensive research experience in food access and food security. She currently serves as the third-party evaluator for a well-established Produce Rx Program based on Oahu. Her knowledge and background will strengthen KMC's reporting and evaluation processes, ensuring adequate measurement of program impact. Data collection will include pre and post-program assessments and participant biometrics such as DSQ scale, 6-Item Short Form Food Security Survey, Healthcare Cost Savings Estimator Tool, socioeconomic and demographic information; qualitative data (observation/conversation logs, program satisfaction), body composition, lab work (blood lipids, A1c), and blood pressure. Body composition will be obtained using the Tanita MC-980 Plus, a gold-standard, FDA-cleared body composition analyzer. Special attention will be paid to measurements of total body weight, fat mass, lean mass, and visceral fat score. The Healthcare Cost Savings Estimator Tool is a validated tool used to quantify the financial impact of wellness programs on healthcare utilization and associated costs. This is accomplished, in part, by measuring averted emergency room visits and hospitalizations among program participants.The following program implementation schedule provides a snapshot of action items within each project phase.Program Design and Development (October 2022 - December 2022): take stock of existing assets, perform a logistics assessment of implementation site; recruit and hire program staff; develop program website landing page, digital self-screening tool; create custom EMR alerts and referral orders; evaluate criteria of applicable state and federal assistance programs including Medicaid, SNAP, WIC, and Farmer's Market Nutrition Coupons (FMNP & SFMNP); design/create culturally relevant program materials including outreach and marketing supplies, educational resources, produce prescription prescriber pads; confer with KMC's third-party evaluator on selected program metrics and reporting tools, ensure GusNIP NTAE program compliance.Stakeholder Engagement, Program Promotion, Community Outreach (January 2023 - May 2023): collaborate with medical support staff on workflow modification related to program roll-out; educate medical providers and support staff on the function of their roles in screening, recruitment, and engagement; educate all KMC employees and community partners on program features, eligibility criteria, incentives, and ways they can support success; initiate outreach to educate, screen, and recruit eligible participants; display posters, informational flyers, and printed self-screening forms, in designated areas; package and distribute print materials as a marketing kit for nearby businesses.Screening, Recruitment, Eligibility Verification, Program Enrollment (May 2023 - August 2024): activate custom EMR alert/screening prompt for medical providers and support staff; medical providers will screen patients during visits as part of routine care or initiate screening orders for Produce Rx team follow-up; medical providers will initiate program participation order for eligible participants, Produce Rx team will enroll; activate digital marketing efforts and inbound linking from partner websites to promote program landing page for digital self-screening; distribute paper self-screening forms and program pamphlets at relevant community events, such as the monthly Hawaii Food Bank held on KMC's campus; field participant leads from referral orders and contact forms submitted through the program landing, make 3 attempts at contact before archiving for future reference; initiate enrollment activities for those with confirmed eligibility: participant forms reviewed/signed, assessment/survey data collection, biometric data collection, FLH account registration.Sustainability and Continued Feasibility (March 2025 - July 2025): The evaluation results and other important information gathered throughout the incentive period will be studied to determine how the post-project incentive program will be offered, improved upon, and evaluated. Special consideration will be given to the program's expansion through additional partners and funding sources.