At ChristianaCare, we understand the importance of involving our community and partnering with the neighbors we serve to help steer the direction and execution of our research efforts. Community engagement is an integral component in several of our projects. In some of our largest and most ambitious projects, the community is not only a key component – it is our fulcrum. Community members play a vital, active role in many ChristianaCare patient-centered, population-health initiatives.
Managing Blood Pressure in the Barbershop
The Value Institute is leading the development of a new community initiative to reduce uncontrolled high blood pressure rates in African American men through collaboration with barbershops in Wilmington, Delaware. According to the American Heart Association, black men have the highest rate of hypertension-related death of any group in the United States, partly because high blood pressure goes untreated in so many African Americans. Hypertension is called the “silent killer” because most patients do not have symptoms to alert them of the elevated pressure. Over time, high blood pressure increases the risk of serious problems such as stroke, congestive heart failure, heart attack, and kidney failure. The Value Institute will work with the community to train licensed barbers and other community members to accurately check the blood pressures of barbershop clientele, as well as encourage them to live healthier lives and seek additional care from a healthcare provider. This initiative is set to go live in Spring 2020.
Validation of 2-Item Food Insecurity Screen Among General Medicine Outpatients
Food Insecurity occurs in 12.7% of the U.S. population with higher prevalence among racial minorities, low income households, and individuals with chronic disease. A 2-item screening tool derived from the USDA Household Food Insecurity Scale (HFSS) has been validated among parents of pediatric patients. However, this screen has been used widely without validation in adult general medicine patients. We aim to validate this 2-item screen in ChristianaCare adult general medicine outpatients. By understanding the burden of food insecurity in our community, we can better provide services to address this social determinant of health.
A Home Delivery Meal (HDM) Program to At-Risk Adults During the 30-Day Post-Hospital Discharge Period
Many low-income individuals who have been diagnosed with a chronic disease experience worse outcomes because they often face the “treat or eat” dilemma: having to choose between spending money on medical needs or for food and other essentials like housing and utilities. The weeks following hospital discharge represent a particularly high-risk period for low-income patients who can face even greater challenges accessing the nutritious foods necessary for recovery. These challenges include managing the symptoms and other complications of their illness while coping with complex social situations, competing priorities, and multiple interacting social determinants of health. Thus there is a critical need to develop a nutrition-based post-discharge interventions that specifically addresses the needs and challenges faced by low-income patients.
The Value Institute in collaboration with ChristianaCare’s Community Health and Engagement, and Full Circle Foods, is conducting a study that is taking a home-delivered meal (HDM) approach to overcome the barriers and challenges patients with chronic conditions face during the post hospital discharge period. HDM programs have existed under the Title IIIC of the Older American Act for over a decade and these programs are associated with significant improvements in food insecurity, nutritional risk, weight, blood pressure, cholesterol, and HbA1c-levels. HDM recipients also had significantly lower health care utilization and medical spending relative to their non-HDM peers.
Despite these encouraging findings, there remains a gap in knowledge as to whether the HDM approach can be translated to younger, low-income, patients with chronic conditions. The objective of the proposed research is to test the feasibility of a hospital-based HDM intervention for recently discharged at-risk adults between the ages of 18-59. Full Circle Foods will deliver 12 customized, nutritionally tailored per-made meals per-week, for four weeks, to each participant AND member of their family.
At the completion of the proposed research, we expect to identify the steps necessary to successfully implement a post-discharge HDM intervention. We also expect to get a better understanding of the complex dietary challenges facing low-income adults with chronic conditions and identify potential solutions for behavior change. These results will have an important public health impact because they will provide a strong foundation for implementing systemic changes in hospitals’ discharge care routines and inform safety net programs on ways to improve their nutrition-based programs.