Addressing food insecurity and its association with chronic disease and higher health care costs has as much to do with what’s happening to a patient outside the health care system as it does within the system, according to Elena Byhoff, MD, MSc, associate professor of medicine. Dr. Byhoff is principal investigator on a hybrid effectiveness-implementation study in a clinical-community partnership to understand health impacts of food insecurity intervention, a $2.8 million, five-year grant from the National Institute of Nursing Research.
The study’s partnership with Greater Lawrence Family Health Center, a federally qualified health center (FQHC); Project Bread, a nonprofit nutrition-focused community organization; Community Care Cooperative, an accountable care organization in Massachusetts founded and governed by FQHCs; and UMass Chan Medical School builds on a Massachusetts Medicaid (commonly known as MassHealth) 1115 waiver demonstration to identify and address food insecurity as part of value-based care.
“Organizations are providing nutrition resources in different communities, and it’s really hard to think about the cause and effect on individuals receiving services because there is so much difference from community to community and from organization to organization,” said Byhoff.
So, rather than evaluating just one or two types of interventions such as medically tailored meals or prescriptions for fruits and vegetables, partners in the study put together a suite of services to meet a variety of needs. Researchers aim to identify which services work best for different patients.
The study is designed to improve patient-centered choices to meet individual needs.
“Often, when you face food insecurity as an individual or family, it’s not because of one thing,” Byhoff said. “It’s often a complex series of issues, and your needs are more complex than just having diabetic-friendly food delivered every week.”
Participants offered the interventions are Medicaid enrollees with diabetes, hypertension, obesity or depression, who receive care at Greater Lawrence Family Health Center and are screened for food insecurity.
Food interventions offered by Project Bread for adults and children have six components: kitchen supplies, SNAP enrollment assistance, monthly $100 food vouchers, care management services, cooking classes and dietary counseling. Patients can opt for some or all of these services.
Researchers will evaluate health outcomes and impacts on cost and health care utilization (emergency department visits and inpatient hospitalization days). They will compare multicomponent interventions with similar populations at the same health center who were not screened for food insecurity and another matched population group at UMass Memorial Health who were not offered interventions from Project Bread.
The study also plans to identify determinants of a pragmatic food intervention for scaling and sustainability to be adapted in other settings.
“If we can start understanding who needs what, we can be more thoughtful and efficient in the way we address food insecurity and think about applications of this in the future,” said Byhoff.
