In addition to expediting patient recovery, community gardens that are associated with medical facilities can provide fresh produce to patients and their families, serve as a platform for clinic-based nutrition education, and help patients develop new skills and insights that can lead to positive health behavior change. While community gardening is undergoing resurgence, there is a strong need for evaluation studies that employ valid and reliable measures. The objective of this study was to conduct a process evaluation of a community garden program at an urban medical clinic to estimate the prevalence of patient awareness and participation, food security, barriers to participation, and personal characteristics; garden volunteer satisfaction; and clinic staff perspectives in using the garden for patient education/treatment. Clinic patients (n=411) completed a community garden participation screener and a random sample completed a longer evaluation survey (n=152); garden volunteers and medical staff completed additional surveys. Among patients, 39% had heard of and 18% had received vegetables from the garden; the greatest barrier for participation was lack of awareness. Volunteers reported learning about gardening, feeling more involved in the neighborhood, and environmental concern; and medical staff endorsed the garden for patient education/treatment. Comprehensive process evaluations can be utilized to quantify benefits of community gardens in medical centers as well as to point out areas for further development, such as increasing patient awareness. As garden programming at medical centers is formalized, future research should include systematic evaluations to determine whether this unique component of the healthcare environment helps improve patient outcomes.

County began a managed care pilot project for the county's Medicaid population. These pilots, then known as Carolina Access II, were "developed to enhance recipient access to primary care, to improve the coordination of care, and to reduce recipient reliance on hospital emergency departments." 1 In 2003, the project was expanded to all counties in North Carolina and Community Care of North Carolina (CCNC) was created, comprised of 14 networks across the state. Surry County joined the five other counties listed above to form Central Piedmont Carolina Access II. Originally a limited liability corporation, in 2005 Piedmont Carolina Access II became Northwest Community Care Network, a not-for-profit organization currently serving over 72,000 Medicaid recipients. The governing board is made up of each participating county's public health director, the NCCN medical director, and a representative from North Carolina Baptist Hospital. The change to not-for-profit status, subsequently made by each network in North Carolina, has allowed for a broader range of projects and has removed barriers to grant applications. The NCCN board governs fiscal as well as operational activities and is charged with approving all projects undertaken by the network. This governance structure allows for flexibility in addressing the core tenets of CCNC as well as incorporating local and regional interests and resources. All of the current projects at NCCN embrace this flexibility and utilize local resources, an approach reflected in the uniqueness of the projects and initiatives, case management, and network administration in NCCN. Projects and InitiativesOf the over 20 specific clinical projects currently active in NCCN, eight originated from the central CCNC office. These include the Behavioral Health Initiative, the Kate B. Reynolds Stroke Reduction Grant, the Chronic Care Program for the Aged, Blind, and Disabled, Emergency Department Diversion, Congestive Heart Failure Management, Improving Pediatric Access through Collaborative Care (IMPACC), Yadkin Healthy Carolinians/Stanford Model Self-Management, and Intensive Pharmacy Management/ Network Pharmacist. The goals for CCNC projects are characterized by clear goals for the populations served, but the means to achieve them are not centrally prescribed.Each CCNC network is able to undertake different approaches to fulfill the goals of each program. This flexibility allows for increased experimentation and the rapid spread of subsequent knowledge of effective practices and methodologies. This freedom and individualization have allowed for the success of many of NCCN's programs.