(374) Optimizing screening for food insecurity in a pediatric CF Center

Background: Per Feeding America, 38 million people live in households without consistent access to food. It is likely that these households experiencing food insecurity (FI) increased significantly over the last two years due to the ongoing pandemic. Costs of care, inadequate supplement coverage, and increased caloric needs make people with CF more vulnerable to FI. Previous CF studies have found rates of FI as high as 26.3% among all individuals and 32.6% among children, significantly higher than the 10.9% national average and the 11% previously found in our center when using in-person screening. The objective of this abstract is to examine the frequency of screening for FI by comparing in-person screening using a paper form to virtual screening using an electronic form, additionally we will also examine the current FI positivity rate at our center.

Methods: In-person FI screening using paper forms was completed over a 1-year period from 3/2019-3/2020. Due to the pandemic, virtual FI screening was initially implemented during electronic check-in for the physician’s visit between 2/8/21-7/25/21 (5 months). After implementing the Food Insecurity Quality Improvement Quick Guide by the CF Food Security Committee, the screening was moved to being completed during electronic check-in prior to the virtual registered dietitian (RD) visit, 7/26/21-present (8 months). This screening change was done for continuity, as all RD visits were virtual (while most physician visits were in-person). Of note, most RD and social work (SW) visits were done together, virtually, at this time. Using the validated Hunger Vital Sign (HVS) screening, any score above 0 was considered a positive screen for FI.

Results: With in-person FI screening, 98% of households completed screening compared to 85% and 73% when completed with electronic check-in for the physician and RD visit, respectively. When screening for FI in-person, 11% of households screened positive compared to only 4.9% over the 8-month virtual screening period prior to the RD visit. FI rates were not tracked when screening was done prior to the physician’s virtual visit. Further data analysis indicated that 6% of all households did not have access to do virtual visits, 18% of all households only did a phone visit with RD, even with virtual access, 2% of households signed into the SW visit, and 1% declined to complete the screening.

Conclusions: The response rate for FI screening was lower when questionnaires were done virtually. This was anticipated given the number of households that are not active on the virtual platform. The larger response rate prior to physician’s virtual visits is likely due to more consistent use of the virtual platform. Our virtual positivity rate was lower than the national average and our own previously collected data when completing in-person screening. With 27% of households not screened, this was likely a major contributing factor. Additionally, it is inferred that some individuals do not feel comfortable honestly answering the questions due to the stigma associated with FI. Admittedly we are hopeful part of this lower positivity rate is due to our center normalizing FI and providing more resources to improve access to food. While we still plan to screen for FI prior to the RD’s virtual visit, we aim to verbally read the HVS screening questions to households that do not have access to the virtual platform or choose not to use it, and to continue normalizing FI as a part of clinic visits.

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