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Oncology Equity Alliance at Boston Medical Center: Addressing food insecurity through sustainable multi-model engagement
April 1, 2024
BMC's Rooftop Farm provides fresh produce to the hospital’s cafeteria, patients and Teaching Kitchen.
Food insecurity is a pressing but long-standing issue that affects Boston’s most vulnerable residents. Compounded by rising costs of living and the aftermath of COVID-19, there has been an unprecedented demand for food assistance across the city, with the need for food and limited access to food disproportionately felt by households with children; Black, indigenous and other people of color (BIPOC) and LGBTQ+ individuals.
Furthermore, the idea that access to food is an inseparable part of health and health care is supported by robust evidence linking food insecurity with chronic health
As the largest safety-net hospital in New England, Boston Medical Center (BMC) has been working to address health disparities with the guiding principle of food as medicine. To this end, the hospital has established innovative resources to address food insecurity, including the Preventative Food Pantry, Teaching Kitchen and Rooftop Farm. As an example, the fresh produce grown on the Rooftop Farm is provided to the hospital’s cafeteria, patients and Teaching Kitchen, as well as to an in-house farmers market.
Addressing food insecurity in a hospital setting starts with identifying unmet social needs that can impact health. Therefore, a standardized approach to screening and access to resources that address these unmet social needs are key.
The Oncology Equity Alliance (OEA) – supported by a $20M Merck-funded initiative – is the first BMC program of its kind; it works to improve access to patient navigation services and connect patients to resources to meet social needs – including food scarcity or food insecurity – during their cancer care journey. The interventions driven by the OEA act at three distinct levels (patient, clinician and health system) to address both bottom-up and top-down hospital processes and aim to create a streamlined and standardized screening process for social drivers of health (SDOH) across the BMC Cancer Center with consistent collaboration between patients, clinicians, patient navigators and operations leaders.
SDOH screening at BMC currently utilizes a standardized tool called THRIVE. This multi-question assessment aims to identify several different social drivers of health, including, but not limited to, transportation, food, housing and childcare. THRIVE is accessed by navigators through BMC’s electronic health record system, EPIC, where both barriers and referrals to resources can be documented and tracked over time.
The OEA identified food insecurity as a top social driver through data monitoring and discussions with navigators. Through effective advocacy and stakeholder engagement, the OEA team aims to achieve increased awareness of available food assistance services and ensure patients in need are accessing these services at earlier time points in their cancer care journey. Once a barrier is identified, a patient navigator and clinical care teams can provide appropriate resources to the patient.
In the context of food assistance, the OEA team began by intervening at the patient level by providing grocery gift cards that patient navigators distribute to patients in need of food assistance. Patient navigators also refer patients to BMC’s Food Pantry and assist them with signing up for regional or federal food assistance programs.
At the clinician level, the OEA team created “navigator info cards” that are distributed across the clinical sites. These cards promote the patient navigator's role in the care team and serve as a reminder about food resources, in addition to transportation services, that clinicians can share with patients during their appointments.
At the health systems level, the OEA team has been collaborating with patient navigators, operations leadership and clinicians to develop a central SDOH screening policy for the Cancer Center. This policy will standardize patient navigation workflows across departments to improve the identification and referral processes for SDOH needs. Thus, the OEA has embodied a sustainable position by utilizing a multi-model approach to enhance cancer patients' access to these unique food resources developed by BMC.
The OEA’s partnership with the Alliance for Equity in Cancer Care has provided both opportunity and resources for the team to connect and collaborate with various stakeholders at all levels of the patient journey. These critical collaborations ensure timely identification of unmet social needs that impact timely access to cancer care. Importantly, this partnership has also fostered the development of a space to share implementation successes and challenges with other Alliance sites.
Through engaging key stakeholders from patients to clinicians to operational leaders, the OEA has been able to successfully pilot a standardized approach to SDOH screening in cancer care and seamlessly connect this screening process to existing resources. This model illustrates that patient navigation is neither a siloed activity nor conducted by a single individual. Rather, every member of the care team is responsible for identifying and addressing unmet social needs that impact health and providing both clinical and non-clinical resources that can help alleviate these barriers to improve health outcomes.
Written by: Deborah Amburgey, Boston Medical Center