IntroductionFood insecurity is a significant issue in the United States and is prevalent in emergency department (ED) patients. The purpose of this study was to report the novel use of an integrated electronic medical record (EMR) order for food resources, and to describe our initial institutional referral patterns after focused education and implementation of the order.MethodsThis was a retrospective, observational study, describing food-bank referral patterns before and after the implementation of dedicated ED education on the novel EMR order for food resources.ResultsIn 2015, prior to formal education a total of 1,003 referrals were made to the regional food bank, Second Harvest Heartland. Five referrals were made from the ED. In 2016, after the educational interventions regarding the referral, there were 1,519 referrals hospital-wide, and 55 referrals were made from the ED. Of the 1,519 referrals 1,129 (74%) were successfully contacted by Second Harvest Heartland, and 954 (63%) accepted and received assistance.ConclusionUse of the EMR as a tool to refer patients to partner organizations for food resources is plausible and may result in an increase in ED referrals for food resources. Appropriate education is crucial for application of this novel ED process.

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OBJECTIVE Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes. RESEARCH DESIGN AND METHODS Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar controls from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time. RESULTS At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI −0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; −0.12, 7.82), DBP (−0.82 mmHg; −2.42, 0.79), or BMI (−0.22 kg/m2; −1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively. CONCLUSIONS A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control.

Food Is Medicine" interventions are of rapidly growing interest to health care systems, payers, patients, and policy makers (1). Such programs can be defined as integrating payment for healthy food or direct provision of it to patients, as part of a health care intervention, in order to improve diet-related health outcomes. Major examples include produce prescriptions (Produce-Rx) and medically tailored meals (MTMs). Produce-Rx generally offer free or discounted produce to ambulatory patients based on a range of eligibility criteria, whereas MTMs provide home-delivered, nutritionally tailored meals to outpatients with severe chronic conditions and limitations in activities of daily living. Such programs hold great promise as potentially low-cost strategies to improve nutrition, food security, health, and quality of life.In this issue of The Journal of Nutrition, Veldheer et al.(2) report a systematic scoping review of characteristics, populations, and outcomes of health care-based interventions aiming to increase access to fruits and vegetables (F&V). They included outpatient interventions performed by or in partnership with health care organizations, excluding purely community-based or government nutrition assistance programs. Understanding the impact of Food Is Medicine strategies nested within the health care system is critical because health care is where most government and business dollars are invested for improving health.The authors identified 27 studies-26 Produce-Rx, 1 MTM-evaluating effects of F&V health care interventions on dietary and/or biometric health outcomes. A salient finding was high variability across studies, including in targeted populations, incentive designs, additional intervention components, and outcomes. For example, although most studies targeted certain health conditions, these could include diabetes, overweight/obesity, hypertension, pregnancy, cancer,

ImportanceMedically tailored meals (MTMs) are associated with lower health care utilization among patients with complex diet-related diseases but are not a covered benefit in Medicare or Medicaid. The potential impact of extending insurance coverage for MTMs nationally remains unknown.ObjectiveTo estimate 1- and 10-year potential changes in annual hospitalizations, potential changes in annual health care expenditures, and overall policy cost-effectiveness associated with national MTM coverage for US patients with diet-related disease and limited instrumental activities of daily living who have Medicaid, Medicare, or private insurance.Design, Setting, and ParticipantsIn this economic evaluation, conducted from January 2021 to February 2022, a nationally representative sample from the 2019 Medical Expenditure Panel Survey was used to create a population-level cohort policy simulation model that estimated changes in annual hospitalizations and health care expenditures associated with coverage of MTMs. Participants were 6 309 998 US adults aged 18 years or older who had Medicare, Medicaid, or private payer insurance and at least 1 diet-sensitive condition and 1 limitation in instrumental activities of daily living.InterventionsTen nutritionally tailored MTMs per week for a mean of 8 months in each year of intervention.Main Outcomes and MeasuresThe main outcomes were total hospitalizations, program costs, health care expenditures, and net policy costs. One thousand Monte Carlo simulations for each of 10 years (2019-2028) jointly incorporated uncertainty in model inputs for effect sizes, hospitalizations, health care expenditures, and program costs.ResultsAt the 2019 baseline, an estimated 6 309 998 US adults were eligible to receive MTMs. Mean (SD) age was 68.1 (16.6) years; most were female (63.4%), were non-Hispanic White (66.7%), and had Medicare and/or Medicaid (76.5%). The most common eligibility diagnoses were cardiovascular diseases (70.6%), diabetes (44.9%), and cancer (37.2%). If all eligible individuals received MTMs, an estimated 1 594 000 hospitalizations (95% uncertainty interval [UI], 1 297 000-1 912 000) and $38.7 billion (95% UI, $24.9 billion to $53.9 billion) in health care expenditures could potentially be averted in 1 year. Program costs were $24.8 billion (95% UI, $23.1 billion to $26.8 billion), for an associated net savings of $13.6 billion (95% UI, $0.2 billion to $28.5 billion) from a health care perspective. In 2019 dollars, 10 years of the MTM intervention was anticipated to cost $298.7 billion (95% UI, $279.7 billion to $317.4 billion) and to potentially be associated with 18 257 000 averted hospitalizations (95% UI, 14 690 000-22 109 000) and reductions in health care expenditures of $484.5 billion (95% UI, $310.2 billion to $678.4 billion), for net savings of $185.1 billion (95% UI, $12.9 billion to $377.8 billion). Findings were robust in multiple sensitivity analyses.Conclusions and RelevanceThe findings suggest that national implementation of MTMs for patients with diet-sensitive conditions and activity limitations could potentially be associated with approximately 1.6 million averted hospitalizations and net cost savings of $13.6 billion annually. The results may inform US state, federal, and private-payer interest in expanding insurance coverage for MTMs among patients with diet-related chronic illness.