Scher Katherine, Sohaki Aaron, Tang Amy, Plum Alexander, Taylor Mackenzie, Joseph Christine
Population Health Management and Clinical Coordination, Henry Ford Health System, Detroit, USA.
Population Health Management, Henry Ford Health System, Detroit, USA.
Pilot Feasibility Stud. 2022 Mar 9;8(1):59. doi: 10.1186/s40814-022-01013-3.
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.
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.
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.
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).
粮食不安全是一个重大的公共卫生问题。长期粮食不安全可能产生的后遗症包括肾脏疾病、肥胖症和糖尿病。我们的目标是评估亨利·福特医疗系统（HFHS）与密歇根东南部粮食收集者社区食品库之间建立伙伴关系的可行性，以实施和评估在医院门诊环境中启动的食品补充干预措施。
我们制定了一项协议，使用饥饿生命体征对HFHS内科患者进行粮食不安全筛查，并建立了HFHS与粮食收集者伙伴关系所需的数据共享基础设施和协议，以便为同意接受的患者提供上门送餐服务。我们采用准实验设计评估食品补充计划，并利用电子病历构建历史对照组。通过筛查确定为粮食不安全的患者被纳入该计划，每月接受两次食品补充，共12个月，大部分通过上门送餐。可行性结果包括在诊所成功进行筛查和登记，以及成功为同意接受的患者送餐。我们的评估使用差异分析（DID）比较了干预组和历史对照组在12个月观察期内的医疗服务利用情况。
在1691名接受筛查的患者中，353名患者（20.9%）符合粮食不安全标准，其中340/353（96.3%）同意参与，256/340（75.3%）匹配且有足够数据进行分析。89.9%的参与家庭成功收到了送餐服务。在随访中，干预组的急诊就诊次数减少幅度大于对照组，分别减少了41.5%和25.3%。住院情况也观察到类似结果，干预组和对照组分别减少了55.9%和17.6%。DID回归分析还显示，干预组的急诊就诊和住院趋势低于对照组。
结果表明，社区与卫生系统建立伙伴关系以解决患者报告的粮食不安全问题是可行的，并且可能会减少这些患者的医疗服务利用。下一步可能是进行更大规模的随机试验，以全面评估这种干预措施，或许可以增加更多结局指标（如药物依从性）和额外的协变量（如住房不安全和经济压力）。
