A community partnership to evaluate the feasibility of addressing food insecurity among adult patients in an urban healthcare system

Abstract

Background Food insecurity (FI) is a significant public health problem. Possible sequelae of prolonged food insecurity include kidney disease, obesity, and diabetes. Our objective was to assess the feasibility of a partnership between Henry Ford Health System (HFHS) and Gleaners Community Foodbank of Southeastern Michigan to implement and evaluate a food supplementation intervention initiated in a hospital outpatient clinic setting. Methods We established a protocol for using the Hunger Vital Signs to screen HFHS internal medicine patients for food insecurity and established the data sharing infrastructure and agreements necessary for an HFHS-Gleaners partnership that would allow home delivery of food to consenting patients. We evaluated the food supplementation program using a quasi-experimental design and constructing a historical comparison group using the electronic medical record. Patients identified as food insecure through screening were enrolled in the program and received food supplementation twice per month for a total of 12 months, mostly by home delivery. The feasibility outcomes included successful clinic-based screening and enrollment and successful food delivery to consenting patients. Our evaluation compared healthcare utilization between the intervention and historical comparison group during a 12-month observation period using a difference-in-differences (DID) analysis. Results Of 1691 patients screened, 353 patients (20.9%) met the criteria for FI, of which 340/353 (96.3%) consented, and 256/340 (75.3%) were matched and had data sufficient for analysis. Food deliveries were successfully made to 89.9% of participant households. At follow-up, the intervention group showed greater reductions in emergency department visits than the comparison group, −41.5% and −25.3% reduction, respectively. Similar results were observed for hospitalizations, −55.9% and −17.6% reduction for intervention and control groups, respectively. DID regression analysis also showed lower trends in ED visits and hospitalizations for the intervention group compared to the comparison group. Conclusions Results suggest that community-health system partnerships to address patient-reported food insecurity are feasible and potentially could reduce healthcare utilization in these patients. A larger, randomized trial may be the next step in fully evaluating this intervention, perhaps with more outcomes (e.g., medication adherence), and additional covariates (e.g., housing insecurity and financial strain).

A Systematic Review of Interventions That Address Food Insecurity for Persons With Prediabetes or Diabetes Using the RE-AIM Framework

“…58 Additionally, a community partnership between an urban health care system and a food bank to deliver medically tailored meals to participants with chronic illness (including T2DM) demonstrated significant decreases in health care utilization compared to a historical control group. 59…”

“…58 Additionally, a community partnership between an urban health care system and a food bank to deliver medically tailored meals to participants with chronic illness (including T2DM) demonstrated significant decreases in health care utilization compared to a historical control group. 59 Future evaluations could include a tailored approach to Food Is Medicine interventions to determine which resource (eg, SNAP benefits, food banks, or medically tailored meals) would best meet the need of individuals/ families. An ongoing RCT is evaluating the individual and combined effectiveness of food vouchers and food boxes, with and without diabetes education, specifically for Black adults with T2DM.…”

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

“…Many studies of food insecurity interventions use a quasiexperimental "effectiveness" design, evaluating the change in outcomes in a single population before versus after a food insecurity intervention, without a separate control group. [153][154][155][156][157][158][159][160] Randomized, controlled social interventions are difficult to design and conduct; however, researchers have previously demonstrated the feasibility and efficacy of testing various interventions to address food insecurity. 161,162 However, well-designed quasiexperimental studies, comparative effectiveness studies, investigation of heterogeneous treatment effects, and ethically designed randomized control trials that specifically focus on the impact of interventions will help guide important questions: "which works better?, for whom?, and why?"…”