Abstract
Electronic medical record (EMR) based referrals for food insecure patients to community assistance
Kurt Hager1 and Diana Cutts, MD2
(1)Second Harvest Heartland, St. Paul, MN, (2)Hennepin County Medical Center, Minneapolis, MN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
INTRODUCTION
Food insecurity affects 14% of US households and is a recognized social determinant of health. Despite new recommendations to incorporate food insecurity screening into patient care, few US hospitals have standardized screening for food insecurity, and even fewer have an action plan to assist those families.
APPROACH
We created a referral order for food assistance which was integrated into the electronic medical record in January 2015. After obtaining patient consent, contact information is auto-faxed to a partner food bank's trained outreach team. Food bank staff provide over the phone application assistance for SNAP and CSFP, and geographically individualized information about WIC, neighborhood food shelves, produce distributions, summer feeding sites and community meals.
RESULTS
In 2015, 1,003 patient EMR-based referrals for food assistance were generated. After three call attempts, 64 % of all patient referrals were contacted. Of those reached, 82% were connected with at least one new form of food assistance. Of persons contacted and not currently enrolled in SNAP, applications were completed for 67%, 26% were found to be ineligible, and 7 % declined to apply.
DISCUSSION
This innovative EMR-based intervention is an effective model of addressing food insecurity within a hospital and clinic setting. It leverages the EMR as a HIPPA compliant communication tool for the benefit of patients, plus it provides valuable collection of food insecurity data within a patient population. To maximize sustainability and impact, work flow would ideally be standardized systemically and accompanied by food insecurity screening at intake.
Implementation of health education strategies, interventions and programs
Abstract
An innovative prescription program's impact on child weight status and fruit and vegetable consumption
Ronit Ridberg, PhD, MS1, Janice Bell, PhD, MPH, MN2, Alan Hunt, PhD3, Ashley Fitch, MA3 and Catherine Luu3
(1)UC-Davis Center for Healthcare Policy and Research, Sacramento, CA, (2)UC Davis Betty Irene Moore School of Nursing, Sacramento, CA, (3)Wholesome Wave, Bridgeport, CT
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Fruit and vegetable (FV) prescription programs combine nutrition education and financial incentives to increase FV consumption in low-income families at risk for diet-related disease. Early research demonstrates that nutrition assistance incentive programs can impact purchasing and consumption; however, few studies have assessed FV prescription programs and none measure pediatric outcomes.
Methods: We examined change in body mass index (BMI) z-score, and change in FV consumption among obese and overweight children ages 2-18 (n=747) participating in a prescription program (2012-2014). Paired t-tests and chi-square tests were used to assess change in weight status, BMI z-score and FV consumption from baseline to last clinic visit. Multiple regression was used to model these outcomes as functions of program specific variables (e.g., # clinic visits, voucher redemption values) and important sociodemographic covariates.
Results: More than half the sample decreased their BMI z-score (54%; p<0.01) and increased FV consumption (52%; p<0.01) from baseline to last visit. In the fully adjusted models, higher FV voucher redemption values and greater numbers of clinic visits positively and independently increased the odds of increased FV consumption (ORs from 2-5) in approximate dose-response relationships.
Discussion: The clinical intervention of FV prescription programming can promote healthy dietary behavior change for children, an effect that is independent of the number of clinic visits. Specifically, additional clinic visits and higher financial incentives to purchase FV increased the odds of children meeting USDA dietary guidelines for FV consumption. Further research is warranted with a control group and long-term follow up of patients.
Administer health education strategies, interventions and programs Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Public health or related public policy Public health or related research
Abstract
Improving Hospital Food Environments in Los Angeles County: A Case Study of Four Public Hospitals
Michelle Wood, MPP1, Allison Kwan, MPP1, Brenda Robles, PhD, MPH1, Ranjana N. Wickramasekaran, MPH1 and Tony Kuo, MD, MSHS2
(1)Los Angeles County Department of Public Health, Los Angeles, CA, (2)University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: In 2014, the Los Angeles County Department of Public Health (DPH) launched efforts to improve food environments in the County's public hospitals which serve populations disproportionately impacted by obesity and chronic disease. Hospitals play an important role in providing access to healthy food, as they are large food purchasers. DPH partnered with the Department of Health Services (DHS) to solicit a new vendor and contract for hospital concession operations. Nutrition standards recommended by DPH were included in the food contract and require that 50% of all food and beverages must meet nutrition limits.
Approach: This presentation will describe a framework for how DPH launched its efforts to improve food offerings in public hospitals. The framework identifies four key components: (1) conducting environmental assessments of concessions, (2) utilizing assessments to inform the development of nutrition standards, (3) engaging key stakeholders and (4) providing technical assistance on implementation and evaluation.
Results: There is an unprecedented opportunity to improve the nutrition of 1.4 million meals served per year in County hospitals. DHS employs thousands of hospital employees who access on-site cafeterias; LAC+USC Medical Center, for example, employs 9000 employees. Building partnerships with hospital administrators, training vendors on nutrition changes and developing an implementation plan are all important factors to DPH's approach. Lessons learned with implementation and shifts in hospital food procurement norms will be discussed.
Discussion: Lessons learned with implementing healthier food offerings in public hospitals can serve as a model for other hospitals nationally looking to implement similar food purchasing guidelines.
Program planning Public health or related organizational policy, standards, or other guidelines Public health or related public policy
Abstract
Farm to Health Center Initiative: Comprehensive review of a food Insecurity initiative at community health center
Elizabeth Rosen, BA1, Blair Robinson, BA1 and Melanie Gnazzo, M.D.2
(1)University of Massachusetts Medical School, Worcester, MA, (2)Family Health Center of Worcester, Worcester, MA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
introduction: A Worcester, MA federally qualified community health center (FQHC) serving 98% of patients below 200% FPL is increasing access to fresh vegetables via a program providing 8 weeks of farm-fresh vegetables to patients with Food Insecurity (FI), The Farm-to-Health Center initiative also aims to promote provider-patient conversations about FI and educating patients about nutrition and cooking.
approach: The program is a medical student-initiated partnership between the FQHC (Family Health Center of Worcester) and a farm (Community Harvest Project). Medical students screened FQHC patients for FI during regularly scheduled medical visits, enrolling qualifying patients in the program. In 2015, we distributed 13,466 lbs of vegetables (919- 1,967 lbs/week to 105-167 households/week) to enrolled patients. Patients sampled recipes made with the produce and received recipe and nutrition booklets. Program efficacy and patient satisfaction was assessed using pre- and post-surveys.
results: Only 21% of patients surveyed reported that their provider ever asked about FI. 67% of enrolled patients attended at least one distribution. After receiving vegetables, 72.7% tried a new vegetable and 65.8% learned a new recipe. 93.5% of participants reported satisfaction with the program.
discussion: FQHCs can play a key role identifying FI and connecting patients to local resources, though their role in direct provision of resources is unclear. Provider-patient discussion could identify FI and increase access to resources. Patients show willingness to incorporate vegetables into their diets. Among programs that address FI, systematic assessment of program efficacy and subsequent program revision is necessary.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs