Dissertation/Thesis Abstract

Developing a Framework to Assess Outcomes and Impacts of Medically-Tailored Food and Nutrition Services Offered by the Metropolitan Area Neighborhood Nutrition Alliance (MANNA)
by Henstenburg, Jule Anne D., Ph.D., University of the Sciences in Philadelphia, 2018, 189; 10904832
Abstract (Summary)

Food is Medicine is a healthcare initiative whereby medically tailored food and nutrition services are provided to clients with acute and chronic illness. MANNA is a Food is Medicine organization in Philadelphia, PA with the philanthropic mission of providing short-term support of acute stages of life-threatening illness such as cancer, renal disease, diabetes, and others. The goal of MANNA is to expand the number of patients it can serve through health insurance reimbursement of its food and nutrition services. To achieve this goal, MANNA needs to show that its services are effective and cost-saving. To date, MANNA has one peer-reviewed study demonstrating an association between its services and decreased healthcare costs. However, apart from client satisfaction, there is no system in place to routinely collect client outcome data and compare it with program inputs. Therefore, the goal of this research was to begin the process of building a robust and sustainable evaluation framework for MANNA and perhaps for other food/nutrition service settings.

The study used several sources of data to construct the framework. To begin, the researcher examined a sample of MANNA client chart data as well as client satisfaction surveys. This provided a snapshot of client characteristics, health outcomes, and perceptions of care and related services. Then, focus groups were organized with key MANNA stakeholders, staff, and Board of Directors to obtain program provider perceptions of client services and of the most important outcomes to study.

Client medical records, client satisfaction surveys, and stakeholder interviews, provide the basis for an evaluation framework that MANNA may use going forward to measure medical, psychological, social, and economic impact of a program. Impact information can help estimate the success of a program of geographic expansion that MANNA is planning and identify the resources that will be necessary to achieve that success.

Based on anecdotal stories of client progress, program stakeholders perceive that MANNA clients improve physically and emotionally. These outcomes were not objectively substantiated in the sample chart data, in some cases due to inadequate reporting. One regularly reported health outcome in client charts was body weight, which allowed for a calculated body mass index (BMI) based on reported height. Since most MANNA clients have wasting diseases that would result in a decrease in BMI, it is important to emphasize the lack of significant BMI change over the six-month sample period, i.e., receiving services from MANNA is associated with maintaining body weight. A second finding was the reduction of reported recent hospitalization over the course of the study (p=0.0077). There were no other significant findings in an analysis of chart data.

The researcher suggests that MANNA use the National Institutes of Health-sponsored Patient Reported Outcomes Measurement Information System (POMIS) as a starting point for a new evaluation framework. These validated outcomes measures should help clarify the health impact of MANNA food and nutrition services and be consistent with quality measures used by multiple healthcare systems. It is also suggested that MANNA collect additional qualitative and quantitative data within its evaluation framework including client narratives, dietary intake data, select health measures, and demographic variables associated with health outcomes.

Indexing (document details)
School: University of the Sciences in Philadelphia
Department: Health Policy
School Location: United States -- Pennsylvania
Source: DAI-B 79/12(E), Dissertation Abstracts International
Subjects: Medicine, Nutrition, Public policy
Keywords: Body mass index, Food is medicine, Health outcomes, Medical nutrition therapy, Medically-tailored meals, Therapeutic diet
Publication Number: 10904832
ISBN: 978-0-438-15736-1
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