P0391 - Food Insecurity Screening in Fetal Cardiology Clinic

Background:
Food insecurity (FI) increases a child's risk of adverse developmental consequences, illnesses, and hospitalizations. Growth, development, and nutrition are key concerns for pediatric cardiology patients. Through a previous QI initiative evaluating FI in our outpatient cardiology clinic, 6% of families were affected by FI, and patients with severe congenital heart disease (CHD) may be at particular risk. As severe CHD may be detected in fetal life, families undergoing fetal echocardiography may represent an especially vulnerable population for FI. As such, we launched an expanded FI screening initiative utilizing the Hunger Vital Signs (HVS) in our fetal cardiology clinic to identify at-risk families. Our smart aim was to screen 80% of families, identify FI in 6% of our families over a 1-year period, and connect families to appropriate resources in the absence of an available licensed social worker (SW).

Methods:
We implemented the HVS in our fetal cardiology office during the intake process. Stakeholders were identified prior to targeting critical key drivers in implementing FI screening. The team conducted four plan-do-study-act (PDSA) cycles based on hypothesis-driven interventions to implement HVS. Our primary process measure was screening for FI and our outcome measure was positive FI screen. We partnered with a local food resource team, Just Harvest, and our FI task force to connect FI families to resources. The HVS were implemented via a written screening protocol and tracked by an annotated run chart. Center Lines were recalculated with PDSA cycles.

Results:
Baseline screening was 0. From 12/2018-12/2019, we screened 780 families, reaching our goal of 80% screened (Figure 1). Sixty-four families screened positive for FI. The percentage of positive screens was higher than our outpatient cohort, reaching a median of 9% positive, above our anticipated goal. Maternal age was younger (28yo vs. 30yo, p=0.042) in FI families. The majority of our families were white. Seventy-seven of the families screened had an abnormal fetal echocardiogram, of which 8 were FI (Table 1).

DISCUSSION/

Conclusions:
HVS can be implemented in a fetal cardiology clinic and improve identification of FI. Staff turnover impacted screening rates and a backup verbal screen improved identification. In the absence of SW, partnership with local FI resources can connect families to FI resources. Those prenatally diagnosed with CHD were not significantly more likely to be FI. This may further highlight the socioeconomic stratification in prenatal diagnosis seen in prior studies, suggesting that our study may underestimate the rate of FI in our patient population. In addition, our study highlights the importance of serial screening for FI, as chronic medical illness, including severe CHD, can place families at significant resource instability and FI risk.