63 - Learnings from the field: Justification for developing the Nutrition Support Assessment Tool

Abstract Information: The Center for Medicare and Medicaid Services has emphasized the critical importance of assessing and addressing Health-Related Social Needs (HRSN), including food insecurity, to improve patient outcomes and quality of life and reduce healthcare disparities. With a growing focus at the national level on addressing hunger, nutrition, and health, data and strategies are needed to understand and address the complex and interrelated drivers of food insecurity. However, existing measurement and evaluation tools to assess food insecurity and malnutrition are limited in their consideration of both social and medical factors that contribute to these issues. As efforts to address HRSN like food insecurity increase, there is a critical need to facilitate efficient and effective screening and referral of patients to the “right level” of services. This work uses rigorous engagement and evaluation methods to address a critical gap in tools to assess and address hunger, nutrition, and health needs. First, our team conducted a review of existing food insecurity and malnutrition assessment tools, facilitated discussions with community-based organizations providing food/nutrition services, and collated feedback from patients participating in food-related research studies to inform the development of a new nutrition screening tool. The draft tool was iteratively refined through cognitive interviews with patients experiencing HRSN and interviews with providers involved with screening and referring patients for nutrition needs. The Nutrition Support Assessment Tool (NSAT) is a brief tool to assess individual patient’s underlying drivers of nutrition needs (e.g., unable to afford food, unable to prepare food, no access to working cooking equipment) to inform appropriate targets of intervention (e.g., food vouchers, delivered groceries, prepared meals). 13 patient cognitive interviews resulted in significant refinement of the NSAT, as interviewers observed that disclosure of nutrition needs was prompted much more successfully through open-ended probes. Changes focused on making the NSAT questions more direct to ensure appropriate capture of the drivers of nutrition needs. Feedback from provider interviews confirmed that the NSAT is assessing the appropriate drivers of nutrition need and fills an existing gap for more efficient referral identification and processes. The refined NSAT tool is composed of 11 questions: seven assessing social factors, two regarding the home environment, one regarding patient insurance and benefit status, and one regarding willingness to receive prepared meals if eligible. Next, the research team will evaluate the NSAT as part of an implementation trial to assess patient reported acceptability and usability of the tool, refine referral pathways, and assess patient outcomes. Use of the NSAT across the healthcare system has potential to provide a systematic approach to delivering more patient-centered, individualized care, thus improving patient’s health and wellbeing. In addition, along with informing nutrition referrals, the NSAT will facilitate identification of the root causes of patients’ unmet nutrition needs (e.g., lack of cooking knowledge, lack of working kitchen equipment), thus generating important information regarding the underlying structural causes of each individual and the overall population being served. This work highlights how patient-engaged evaluation improves tool development and presents a novel evaluation tool to assess drivers of nutrition need.