NowPow Nutrition Post-Intervention Referral 

Survey 

Q1w 

Tell us your role: 

ANSWER CHOICES 

Primary Care Physician 

Physician's Assistant 

Primary Nurse Practitioner 

Nurse 

Social Worker 

Unit Clerk 

Q2w 

If you are not the professional who identified food insecurity, 

tell us who asks or asked you to make referrals for patients 

who are food insecure? 

% 

ANSWER CHOICES 

 

Primary Care Physician 

Physician's Assistant 

Primary Nurse Practitioner 

Nurse 

Social Worker 

Unit Clerk 

12 
Q3w 

Tell us the primary setting in which you see your patients and 

make referrals for patients who are food insecure. 

ANSWER CHOICES 

Inpatient hospital setting 

Outpatient clinic or primary care office 

Emergency Room 

In-home Health Risk Assessment 

Q4w 

How do you decide if a patient might benefit from a referral to 

address their food insecurity? 

ANSWER CHOICES 

A conversation with the patient 

The result of a screening tool 

Both a conversation and use of a screening tool 

Q5w 

Thinking about the past month, what percent of time do you 

refer older adult patients who present with food insecurity to 

community based resources? 

ANSWER CHOICES 

Zero Percent 

One Percent to 30 Percent 

31 Percent to 60 Percent 

61 Percent to 90 Percent 4 
91 Percent or more 

Q6w 

Thinking again about the past month, when you refer a patient 

for community-based resources for food insecurity, what 

percent of the time do you know if your older adult patients 

obtain or follow-up on these referrals? 

ANSWER CHOICES 

Zero Percent 

One Percent to 30 Percent 

31 Percent to 60 Percent 

61 Percent to 90 Percent 

 

91 Percent or more 

TOTAL 

Q7w 

When the older adult patient has connected with a communitybased resource for food insecurity, how do you find out that 

this occurred? (Check all that apply) 

ANSWER CHOICES 

Patient or Significant Other tells me 

Patient or Significant Other tells another professional at my office who tells 

me 

Information is included in my patient’s Electronic Medical Record (EHR)

Information is identified directly from NowPow 

Thinking back in time before referral information was available 

directly from NowPow or found in the Electronic Health 
Record, what percent of the time did you know if your older 

adult patients followed-up with community-based resources? 

ANSWER CHOICES 

Zero Percent 

One Percent to 30 Percent 

31 Percent to 90 Percent 

 

91 Percent or more 

Q9w 

Now that information is available from NowPow or found in the 

Electronic Health Record what percent of the time do you 

know if your older adult patients followed-up with communitybased resources? 

ANSWER CHOICES 

Zero Percent 

One Percent to 30 Percent 

31 Percent to 90 Percent 

91 Percent or more 

Q10w 

Which statements are true regarding your Electronic Health 

Record? (Check all that apply) 

ANSWER CHOICES 

I routinely check on the status of referrals for home and community-based resources 

addressing food insecurity in the Electronic Health Record 

I am more apt to refer my patients for community-based resources addressing food 

insecurity because information is available in the Electronic Health Record 
I do not routinely check on the status of referrals for home and community-based 

resources in the Electronic Health Record 

 

 

I did not know that status of whether or not a patient who was referred for food 

insecurity could be found in the Electronic Health Record 

Total Respondents: 15 

Q11w 

Which statements are true regarding NowPow? (Check all that 

apply) 

ANSWER CHOICES 

I routinely check on the status of referrals for home and community-based resources 

including food insecurity in NowPow 

I am more apt to refer my patients for community-based resources addressing food 

insecurity because information is available in the NowPow 

I do not routinely check on the status of referrals for home and community-based 

resources addressing food insecurity in NowPow 

I did not know that status of whether or not a patient who was referred for food 

insecurity could be found in NowPow 

Q12w 

How helpful is the closed loop system between your 

healthcare organization and AgeOptions in letting you know 

the outcome that your patient followed-up with the referral for 

community-based resources for food insecurity? 

ANSWER CHOICES 

Highly Helpful 

Moderately Helpful 

Neither Helpful or Unhelpful 

Moderately Unhelpful 

Highly Unhelpful
TOTAL 15 

Q13w 

What benefits have you observed in your patients who 

received a referral for community-based resources to mitigate 

their food insecurity? (Check all that apply) 

ANSWER CHOICES 

 

Improved health status 

Improved emotional or mental health status 

More stable health 

No change 

Responses 

Other (please specify) 

Q14w 

Since NowPow has been available to you, how likely are you 

to refer your patients to community-based resources for food 

insecurity? 

ANSWER CHOICES 

Highly Likely 

Moderately Likely 

Neither Likely or Unlikely 

Moderately Unlikely 

Highly Unlikely 

Q15w 

Since NowPow has been available to you, how connected do 

you feel to community-based resources for food insecurity as 

a treatment option for your older adult patient’s non-medical 

needs? 
ANSWER CHOICES 

Highly Connected 

Moderately Connected 

Neither Connected or Not Connected 

Moderately Not Connected 

 

Highly Not Connected 

Q16w 

How satisfied are you with NowPow and/or the information 

that you find in your Electronic Health Record pertaining to 

being informed of the outcome of your referral for your 

patients identified as food insecure. 

ANSWER CHOICES 

Highly Satisfied 

Moderately Satisfied 

Neither Satisfied or Not Satisfied 

Moderately Not Satisfied 

Highly Not Satisfied 

Q17w 

Are there any changes/ improvements, in the system or the 

information that would be helpful in communicating the result 

of a community-based resource referral addressing food 

insecurity? 
 

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