PC1220: Hunger Has No Home Here: A Resident Driven Initiative to Improve Food Insecurity Screening in Pediatric Outpatient Clinic

Purpose/Objectives: Our food insecurity screening quality improvement project is a resident driven initiative started in 2020 as a response to the COVID-19 pandemic and a perceived increase in the prevalence of food insecurity in the Bronx community. Our initial study aim was to screen more than 75% of pediatric patients in our primary care clinic by May 2021 using a standardized screener and offer nutritional support services to more than 75% of those who screen positive. We expanded our objective to include all follow-up visits.

Design/Methods: Plan-Do-Study-Act (PDSA) method was implemented over the past two years. Between June 2020 - May 2021, cycles 1-5 effectively established screening for food insecurity in our pediatric primary care clinic through the following interventions: 1. an educational conference on food insecurity provided to all residents, 2. embedding the Hunger Vital Sign 2Q screener into all healthcare maintenance (HCM) note templates in our electronic medical record (EMR), 3. the creation of nutritional support services handouts, 4. the launch of NowPow, a digital referral program. Cycles 6-9 commenced June 2021 with the arrival of the new intern class. The 2Q screener was included in follow-up and sick visit EMR note templates and a second educational conference was given to educate new interns and provide a refresher for senior residents. A “spot-check” analysis reviewed all visits at 1:00 PM during September 2021 to evaluate sustainability of food insecurity screening, and a post-interventional survey was conducted to assess new or continued barriers to screening.

Results: Since the launch of the food insecurity project in June 2020, screening using the standardized screener has increased from 0% to 77.5% in the first year with a sustained rate of to 86% in year two. Based on the spot-check analysis, 5.6% of screen positive and of these, 57% were provided with referrals to social work or local services. We note higher levels of screenings amongst residents, with interns screening at 100% of visits. In our post-intervention survey, we had 0% of residents and attendings report feeling uncomfortable in screening for food insecurity versus 49% (uncomfortable or neutral) reported on the initial survey.

Conclusion/Discussion: Through early resident education and incorporation of the standardized screener into note templates, we have been able to successfully increase screening to over 85% overall, and 100% screening in our PGY-1 class, indicating that food insecurity screening has become a part of our clinic culture. However, we have not yet reached our goal of providing 75% of positive screens with resources. Several barriers have been identified, including time limitations, inconsistent referrals, and difficulty using NowPow. Our next steps will be to address these barriers by continuing PDSA cycles to further streamline screening and ensure longevity.