O1004: Improving Food Insecurity Screening in a Pediatric Safety-net Clinic Throughout the COVID-19 Pandemic

Purpose/Objectives: One in seven US children live in a household experiencing food insecurity – the limited or uncertain access to enough food. Food insecurity has direct and indirect negative impacts on the physical and mental health of children, with impacts throughout adult life. Black and Hispanic/Latino households with children experience disproportionately high rates. Rates of food insecurity have increased dramatically from the start of the pandemic, from 3.7% in 2018 to 14.1% of families with children reporting that they did not have enough food in 2020. The AAP recommends pediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patients screened for food insecurity at well-child visits to 85% in the last six months.

Design/Methods: This project occurred at a safety-net, pediatric medical home for children of low-income families. Hispanic/Latino families make up the majority of the patient population. A screening tool was developed using the Hunger Vital Sign questionnaire. A relationship with a local food pantry was developed. Initially, to address the need at hand without delay, families who screened positively were given a paper food prescription and a local food resources handout. Ultimately, a standard screening, documentation, and referral process was created within the EMR. The Model for Improvement was utilized testing changes via PDSA cycles. The percentage of families screened (process measure) was initially tracked using ICD-10 codes and then directly within the EMR. The outcome measures included the percentage of families who screened positively and the number of families who received food from the primary community resource using our clinic’s food prescription.

Results: The percentage of families screened for food insecurity at well-child visits increased from a median of 0% to 75% in the first five months. After the first year, there was a drop to 68% that increased to 80% with EMR optimization and a system-wide push for social determinants of health screening (figure 1). A total of 34% of families (3,217) screened were food insecure during the study period, ranging from 82 to 202 families each month for the last six months. During the study period, 391 families with 1,708 household members received 31,298 pounds of food from our primary community resource using our clinic’s food prescription. Of these families, 42% (163) also qualified for the USDA program ensuring ongoing food distribution up to twice a month.

Conclusion/Discussion: By utilizing quality improvement methodology to address a critical community need, we have increased the median of our pediatric patients screened for food insecurity from 0% to 80% and provided resources. Although we have not met our aim yet, we were able to start addressing food needs immediately. Next steps are to spread interventions to other pediatric clinics and departments within our system.