419 - Sustainable Multi-site Food Referral Processes through Resident Education and Collaboration

Poster Number: 419
Publication Number: 419.445

Brittany B. Williams, University of South Carolina School of Medicine Greenville, Piedmont, SC, United States; Jane B. Amati, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Shailly Gaur, Levine Children's Hospital, Atrium Health, Charlotte, NC, United States; Elzia R. Broussard, Duke University Health Graduate Medical Education, Durham, NC, United States; Joseph S. DeRaddo, Duke University School of Medicine, Durham, NC, United States; Talia Buitrago-Mogollon, Atrium Health Levine Children's, Charlotte, NC, United States; Kimberly Montez, Wake Forest School of Medicine, Winston-Salem, NC, United States; Carolyn Avery, Duke, Durham, NC, United States

Background: Food insecurity (FI) impacted 14.8% of US households with children in 2020, and leads to adverse health outcomes with long-term effects in children.1 There has been extensive research evaluating best methods for identifying FI with validated screening tools in clinical care, but less attention to the management of FI and resource referrals.   

Objective: The Carolinas Collaborative, formed by the eight pediatric residency sites in North and South Carolina, implemented a quality improvement project in December 2020 with the goal to increase FI screening and connection to local and federal food assistance programs to 80% of pediatric clinic patients by December 2021. 

Design/Methods: Caregivers of children served at each clinic or patients 18 years or older were screened for FI using a validated screening tool during designated visits.  Those identified as having FI were eligible to receive interventions, including referrals or other food resources. Each site completed monthly chart audits of 30 patients eligible for FI screening and collected data on screening response, referrals and patient demographics.  Deidentified data was entered into the AAP QIDA database to generate run charts for clinical site and collaborative review.   

Results: A total of 2380 charts were reviewed across eight institutions over a span of 11 months.  Of the charts reviewed, 282 were identified to have food insecurity with 240 of those identified receiving a referral for connection to resources.  When reviewing the number of referrals across PDSA cycles, there is an overall upward trend in referrals with majority of cycles exceeding the goal of 80% of referrals for food insecure households.   Conclusion(s): Increase in referrals in May is associated with two institutions providing resident lectures on food insecurity in the prior PDSA cycle.   Another institution initiated weekly updates on food insecurity, reminders for screening and referrals, and feedback to providers that missed opportunities for referrals. Six of the eight programs developed a formal process for addressing food with four programs creating an algorithm for management. This increase was sustained across subsequent cycles with percentage of referrals exceeding goal of 80% including the next academic year reinforcing the sustainability of these efforts. 
Brittany Williams, MD, MPH CVCV.pdf
Table 1.Demographics of pediatrics patients identified with Food Insecurity at each Pediatric Resident Teaching clinic (December 2020 – October 2021)