692 - Automating WIC Enrollment: Implementing Electronic Screening, Referral and Data-Sharing Processes in a Pediatric Primary Care Practice

Publication Number: 692.3766

Lilianna Suarez, Duke University School of Medicine, Durham, NC, United States; Rushina Cholera, Duke University School of Medicine, Durham, NC, United States; Murriel B. Fozard, Lincoln Community Health Center, Durham NC, NC, United States; Christopher Fiander, Duke University School of Medicine, Raleigh, NC, United States; Carolyn Avery, Duke University School of Medicine, Durham, NC, United States

Background: The Special Supplemental Nutrition Program for Women, Infant and Children (WIC) has been shown to reduce food insecurity and improve health for children. Yet, just over half of WIC-eligible children are enrolled in North Carolina. Electronic health record (EHR) referrals placed at routine well visits by pediatricians that share limited, clinically collected data could improve both enrollment rates and allow for virtual WIC enrollment.

Objective: To increase screening for WIC eligibility during well visits and implement an EHR referral directly connecting eligible children to WIC.

Design/Methods: A smart-text element prompting assessment of WIC enrollment status was added to select well-child note templates for children under 5. Providers were introduced to an EHR WIC referral notifying WIC of referral and allowing for read-only EHR access to name, contact information, weight, length and lab results until a patient’s 5th birthday. Baseline screening rates were obtained via monthly chart review of 25 randomly selected newborn visits, which were the only visits where screening was previously the standard of care, with a screening rate of 0 assumed for all other visits from November 2023-January 2024. WIC screening rate, screening outcome and electronic referral rate were obtained from the EHR through September 2024. WIC collected aggregate referral outcome data from May-September 2024.

Results: The average baseline WIC screening rate was 11.6%. Following implementation of template changes and the electronic referral process, the average WIC screening rate rose to 21.0% and 49.4%, respectively (Figure 1). Among those with a completed WIC screening prompt (N=1367), 51.2% were already enrolled, 26.2% were not eligible, 4.4% declined referral, and 7.2% had a referral placed (Table 1). Since provider education, a total of 251 WIC referrals have been placed via EHR. Of available WIC data for 191 referrals, 42 (22.0%) identified patients who were previously enrolled, but not currently enrolled, and 131 (58.2%) were for new clients of which 100 (44.4%) completed WIC enrollment (Figure 2).

Conclusion(s): With most referrals identifying new or previously enrolled clients and almost half completing enrollment, standardized WIC screening prompts and direct referrals to WIC increase connection and promote identification of eligible, but not yet enrolled, families. Future studies should evaluate the implementation and expansion of this referral process in diverse settings and explore the potential for proactive WIC enrollment through data-sharing between health systems and WIC.

Figure 1: Run Chart for WIC Screening Rates After Screening Prompt and Referral Implementation
Run Chart PAS through Oct..pdf

Table 1: WIC Screening Outcome for Children with Documented Screen
WIC PAS Table 1 Clean.pdf

Figure 2: WIC Continuum from Electronic Health Record Referral to Completed Enrollment
WIC Continum Graphic.pdf