Table 3

Non-Process Outcomes of Interventions to Address Food Insecurity in Health Care Settings (n = 11)

Study	Design	Population	Sample	Intervention or Experimental Condition	Outcomes	Effect Size: SMD, (95% CI), variance^a
Intervention type: referrals
Hassan,³⁷ 2015	Prospective observational	Patients aged 15-25 years at an urban adolescent/young adult clinic	401 youth	Web-based screening and referral tool	Food security: Complete resolution of food as priority problem	58% (7/13)

Nguyen,²⁷ 2016	Retrospective observational, pre-/post-intervention, pilot	Self-identified Hispanic patients aged ≥60 years with DM at FQHC	18/28 participants followed up at 3 months	Referrals from clinic integrated Health Connector Program	Self-efficacy: Change in mean scores on the Stanford Diabetes Self-efficacy Scale Diabetes self-efficacy	Diet/healthy eating plan: –0.14, (–0.79 to 0.51), 0.11 Physical activity: –0.07, (–0.73 to 0.58), 0.11 Diabetes self-efficacy: 0.30, (–0.35 to 0.96), 0.11 General self-efficacy: 0.13, (–0.52 to 0.79), 0.11

Morales,²⁴ 2016	Retrospective observational cohort with propensity score matching	Pregnant patients with FI at obstetrical clinic	145 adult female patients enrolled; 145 matched not referred	Integrated screening and referral to Food for Families; program for referral to food resources	Health: Blood glucose Health: SBP Health: DBP	0.10, (–0.13, to 0.33), 0.01 0.33, (0.09-0.56), 0.01 0.27 (0.04-0.51), 0.01

Intervention type: referrals & food/food vouchers
Beck,³¹ 2014	Observational	Families with infants aged <1 year with FI that stretched formula or infants with failure-to-thrive at large, urban, academic primary care clinic	1,042 families with infants	Supplemental formula and educational materials for as-needed referrals were provided directly (eg, to social workers, MLP, or food pantries)	Utilization: Completed preventative care Utilization: ED visits	Completed lead test and ASQ: 0.09, (0.04-0.15), <0.01 Received full set of well-infant visits by 14 months: 0.11, (0.05-0.16), <0.01 0.11, (0.05-0.16), <0.01

Bryce,³² 2017	Pre-/post-intervention	Adult, non-pregnant patients with type 2 DM and HbA_1c >6.5 in last 3 months referred by medical provider	65 patients	Voucher for fruits and vegetables, and health education/coaching at health center-based farmers market	Health: Weight change Health: SBP change Health: DBP change Health: Drop in HbA_1c	–0.08, (–0.30 to 0.13), 0.01 –0.04, (–0.26 to 0.17), 0.01 0.15, (–0.06 to 0.37), 0.01 0.39, (0.17-0.60), 0.01

Cavanagh,²⁵ 2017	Retrospective matched cohort; pre-/post-intervention	Adult low-income patients with obesity, hypertension, and/or type 2 DM	54 intervention, 54 matched controls	Voucher (prescription coupon) for weekly mobile produce market	Health: BMI change	–0.11, (–0.18 to –0.05), <0.01

Cohen,¹⁷ 2017	Quasi-experimental, pre-/post-intervention	SNAP-enrolled adult primary care patients	177 patients	Brief clinic-based intervention associated with increase in use of SNAP incentive program	Health behavior: Increased fruits/vegetable consumption^b	0.49, (0.25-0.73), 0.01

Freedman,³³ 2013	Pre-/post-intervention, pilot	Adult patients of FQHCs with farmers markets with DM	41 patients	Community-based participatory research approach for onsite farmers market; financial incentive program to purchase food at market	Health behavior: Increased fruits/vegetable consumption^c	0.41, (–0.02 to 0.85), 0.05 at 2-3 months 0.15, (–0.28 to 0.58), 0.05 at 5 months

Saxe-Custak,³⁶ 2018	Qualitative	Adult caregivers of pediatric patients at an urban pediatric clinic	32 caregivers	Provided vouchers for farmers market or bag of food when market closed; cooking/nutrition classes	Acceptability Health behavior: Increased fruits/vegetable consumption Food security	Appreciated convenience of clinic within farmers market building Preferred prescription vouchers over food bags Reported increased Improved food security and access to healthy foods

Watt,¹⁸ 2015	Quasi-experimental prospective	Adult Hispanic pregnant women at low-income Texas primary care clinic	32 intervention, 29 control	Prenatal care-based nutrition education, food resources education, and farmers market vouchers	Health behavior: Increased fruits/vegetable consumption^d Health: Depression (mean gain PHQ2 score) Health: Excess maternal weight gain Health: Breastfeeding at age 6 months Health: Pass ASQ screening	Fruits: d = 0.47^e,f Vegetables: –0.71, (-1.19 to -0.22), 0.06 d-0.34,(–0.91 to 0.22), 0.08^f –0.19, (–0.80 to 0.41), 0.09 0.64, (–0.06 to 1.34), 0.13 0.71, (–0.05 to 1.48), 0.15

Intervention type: food only
Berkowitz,²³ 2018	Matched cohort	Adult patients with dual Medicaid/Medicare eligibility; members of Common-wealth Care Alliance	Medically tailored meals program: 133 intervention, 1,002 matched controls. Nontailored food program: 624 intervention, 1,318 matched controls	Provided food: impact of medically tailored meal delivery and Meals on Wheels	Utilization: ED visits, inpatient admissions, use of ET Cost: Medical spending	Medically tailored: ED visits: –0.26, (–0.4 to –0.10), 0.01; Inpatient admissions: –0.09, (–0.27 to 0.09), 0.01; Use of ET: –0.15, (–0.34 to 0.03), 0.01 Non-medically tailored: ED visits: –0.15, (–0.25 to –0.06), <0.01; Inpatient admissions: –0.03, (–0.13 to 0.06), <0.01; Use of ET: –0.07, (–0.17 to 0.02), <0.02 Medically tailored: lower medical spending; net savings $220 per participant Nontailored: lower medical spending: Net savings $10 per participant

ASQ = Ages and Stages Questionnaire; BMI = body mass index; DBP = diastolic blood pressure; DM = diabetes mellitus; ED = emergency department; ET = emergency transportation; FI = food insecurity; FQHC = Federally Qualified Health Center; HbA_1c = glycated hemoglobin; MLP = medical-legal partnership; PHQ2 = Patient Health Questionnaire-2; SBP = systolic blood pressure; SMD = standard mean differences; SNAP = supplemental nutrituion assistance program.
↵a Effect sizes are presented as standardized mean differences (d) unless sufficient alternatives were provided in the reviewed manuscripts (eg, Odds Ratios [ORs]). Effect sizes were not calculated when a plausible control/comparison group was not available to compare with the intervention group and/or if insufficient details were provided in the manuscript and we did not receive responses to requests for further information from study authors.
↵b Increase in fruit/vegetable consumption (servings/day) at 5-month follow-up (n = 138).
↵c Servings/day.
↵d Reported as change from less than 3 servings to 3 or more servings per day; raw data unavailable to adjust results to report as servings per day, as would need to adjust standard deviation.
e 95% CI and varience not calculable as mean gain for control group = 0.
↵F Author provided additional data points to enable effect size calculation.