Impact of food insecurity resource navigation for primary care patients with diabetes and hypertension: A matched cohort study

BACKGROUND: Food insecurity contributes to poor health and increased healthcare costs among patients with chronic diseases. Resource navigators can facilitate community-based resource connections, addressing food insecurity, but the impact on healthcare costs and quality of life remains unclear. 

OBJECTIVE: To examine whether food insecurity resource navigation improves clinical outcomes, healthcare charges, and quality of life for patients with diabetes and/or hypertension. 

DESIGN: Matched-control quasi-experimental study. 

PATIENTS: Patients underwent screening for food insecurity from July 12, 2021, to December 31, 2022, in South Carolina's largest health system. Eligible patients (18 + years, having food insecurity, and diabetes and/or hypertension) enrolled for resource navigation in three primary care practices. Of 7592 screened patients, 371 (4.89%) were eligible and 236 (3.11%) consented to participation. A propensity-score matched cohort was obtained from practices without the navigator program. Each group included 219 patients, 20 (9.13%) with diabetes, 110 (50.2%) with hypertension, and 89 (40.6%) both. 

INTERVENTION: Resource navigator facilitated food-related community resource connections with 6-month follow-up. 

MAIN MEASURES: Difference-in-difference specifications were used to examine 6-month differences in clinical outcomes (BMI, blood pressure, HbA1c) and healthcare charges (primary, inpatient, emergency department) between patients with and without navigation support. Quality of life changes were assessed for navigator group patients. 

KEY RESULTS: Among patients with any primary care charges, those in the navigator group had 54.5% (SE = 0.099; p = 0.000) greater increase in 6-month charges than controls. Navigator group patients also had improved quality of life (0.345 quality-adjusted life years gained; p = 0.014) over 6 months. Emergency department, inpatient charges, and clinical outcomes did not differ between groups. 

CONCLUSIONS: Food insecurity resource navigation was associated with increased primary care charges and improved quality of life in patients with chronic diseases, highlighting its value in improving patient care. Studies with larger cohorts and extended follow-ups may reveal substantial effects on other patient outcomes.