Fresh and Savory: Integrating Teaching Kitchens with Shared Medical Appointments

Objectives: In the fall of 2017, Fresh and Savory, a Culinary and Lifestyle Medicine Teaching Kitchen (TK) program proved systematically feasible as a Shared Medical Appointment (SMA). A portable TK complemented physician consultations, interactive didactic presentations, nutritious cooking, and mind-body exercises. A series of SMAs were launched to develop a system for physicians to address patients' nutritional and lifestyle needs. Interventions: MedStar Health implemented three TK SMA programs to improve patients culinary and lifestyle skills and improve relevant habits. Two cohorts were recruited from Internal Medicine and Cardiology (Internal Medicine/Cardiology I and II) and completed an 8-week program leveraging a culinary and lifestyle medicine curriculum. One cohort (Sports Performance) was held with young, elite athletes completing a 4-week program regarding athlete's nutrition and lifestyle. Feasibility was assessed through patient surveys, staff program operation assessments, and reimbursement. Results: Fifty-three unique patients attended SMA programs, 4-18 patients per weekly session; 223 appointments billed in 2018. E&M code 99213 was billed at 157 and reimbursed, on average, at 116 per patient encounter. During a 4- to 8-week SMA program, changes in patient vitals were statistically insignificant, yet habit changes showed clinical significance. Patients noted increased knowledge of plant-based meals, importance of sleep, and adding mindfulness and exercise to their weekly routine. Conclusions: This exploration investigated the feasibility to implement TK SMA programs at MedStar Health. Developing financial and operational infrastructure for TK SMAs requires financial, staffing, location, and population considerations. TK SMAs proved patient demand for opportunities to develop healthy behaviors. However, sufficient time is required to recruit patients. Vital signs may not acutely improve over an 8-week period, however, small habit changes may improve health outcomes longitudinally and additional exploration is required to assess longitudinal patient outcomes. Financially, SMAs suggest a sustainable and effective approach to integrative medicine in health care.