306 - Evaluation of Universal Food Insecurity Screening in the Primary Care Setting

Publication Number: 306.4771

Zahra Iqbal, Georgetown University School of Medicine, Washington, DC, United States; Rajeev M. Agrawal, MedStar Health Research Institute, Washington, DC, United States; Joanne S. Odom, MedStar Georgetown Community Pediatrics, Washington, DC, United States; Janine Rethy, Georgetown University School of Medicine, Washington, DC, United States

Background: Food insecurity (FI) has been shown to have a significant impact on multiple aspects of a child’s wellbeing, including overall health and developmental outcomes. The American Academy of Pediatrics recommends universal screening; however, studies have found inconsistencies in screening of FI, documentation of FI, and referral to appropriate resources. An urban pediatric primary care mobile medical clinic in Washington, D.C. implemented a universal FI and response workflow.

Objective: Describe the workflow and results of FI screening in primary care with an interprofessional team in an urban pediatric clinic over 2 years.

Design/Methods: This is a retrospective cohort study using descriptive data from well-child visits of children ages 0-18 years old between Jan 1, 2022 to Dec 31, 2023. The Hunger Vital SignTM is completed as part of universal EPSDT screening on an online platform sent to families prior to the visit or completed in the waiting room and integrated into the Electronic Health Record (EHR). The team implemented a response protocol workflow for positive screens (Figure 1). Metrics include: 1. Uptake of the screening tool 2. Prevalence of FI, defined as a positive screen (+FI) if the response to either or both HVS questions is “Often True” or “Sometimes True” 3. Documentation by providers and interprofessional team 4. Existing utilization of food access resources by families with FI 5. Change in FI and resource utilization between 2022 and 2023 for eligible families.

Results: 392 patients received a well-child visit in 2022. 301 (77%) completed the FI screen, with 33% of those +FI. Of +FI patients, 50% had existing enrollment in a federal assistance program. 90% had documentation of FI by the provider, including an ICD-10 code, clinical note or anticipatory guidance, 35% also had a note from the Wellbeing team, in which specific FI needs and additional resources provided were recorded, and 39% of +FI received additional assistance: 45% received assistance with enrollment in or enhancement of a federal food program and 68% were enrolled in or given referrals to community food access programs. (Table 1 and Figure 2). 166 unique patients completed SDOH screening in both 2022 and 2023. 25% +FI in 2022 became -FI in 2023. Of the -FI patients, 19% became +FI with OR 1.38 (Table 2).

Conclusion(s): This study describes an effective universal FI screening workflow and outcomes in a pediatric clinic with high prevalence and highlights the need for ongoing interprofessional support. The study also provides a model for replicating FI screening, response and evaluation.

Figure 1
Food Insecurity Screening Workflow

Table 1
Summary of results of FI screening in WCC setting 2022 (301), tracking +FI patients into 2023

Table 2
Summary of results of FI screening in WCC setting 2022 (301), tracking +FI patients into 2023