Improving food insecurity screening across a health system throughout the COVID-19 pandemic

Abstract

Background: Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year.

Methods: This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles.

Results: The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic's food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month.

Discussion: Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.

Keywords: Ambulatory care; Continuous quality improvement; Emergency department; Paediatrics.

Figure 1

Screening process for food insecurity. ED, emergency department.

Figure 2

(A) Patients screened for food insecurity at well-child visits. (B) Patients screened for food insecurity at paediatric ED visits. (C) Patients screened for food insecurity at the specialty clinic. ED, emergency department; EMR, electronic medical record; ICD-10, International Classification of Diseases 10th Revision; QI, quality improvement; SDoH, social drivers of health.