Abstract Body (Do not enter title and authors here): Background
Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024.

Methods
A CM-specific eConsult was designed and launched on August 1^st 2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4^th 2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement.

Results
In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses.

Conclusions
We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.