The realities of data derived from electronic health records to evaluate health outcomes, utilization, and cost of produce prescription programs: A multiple case study evaluation

BACKGROUND: Produce prescription projects (PPRs) allow healthcare professionals to "prescribe" fruits and vegetables for patients experiencing food insecurity and a diet-related chronic disease. Evaluation of healthcare outcomes, utilization, and costs data is prudent to understand the impact of PPRs. However, substantial challenges exist. The objective of this study is to understand facilitators, barriers, lessons learned, and emergent best practices for data derived from electronic health records (EHR) among PPRs. 

DESIGN AND METHODS: A multiple methods case study including four PPRs funded through a pilot grant to use EHR-derived data to measure healthcare outcomes, utilization, and costs of health care. Data sources included grant applications (n = 4), data use agreements (DUA; n = 4), memoranda of understandings (n = 4), pre/post healthcare outcomes and utilization data, and qualitative interviews/focus groups (n = 10). For analysis we used: descriptive statistics; paired t-tests for changes in values pre/post PPR; and thematic qualitative analysis to construct themes. 

RESULTS: The four cases shared varied healthcare outcomes and utilization measures and submitted less data than was outlined in their respective DUA. Three salient themes emerged: PPR projects need: (1) sufficient time and resources to develop procedures to collect and share healthcare data; (2) tailored healthcare outcome measures to PPR design, outcomes of interest, and EHR capabilities; (3) technical support related to technology, data security and sharing. 

CONCLUSIONS: EHR data can provide insight on the impact of PPRs and related healthcare interventions on health outcomes and cost-effectiveness. Evaluation efforts must consider project capacity and ensure adequate resources to collect and securely share healthcare data.