180 - What’s Trending? A Look at Food Insecurity Referral Patterns in the Carolinas

Poster Number: 180
Publication Number: 180.412

Jane B. Amati, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Kerry Sease, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Carolyn Avery, Duke, Durham, NC, United States; Meredith Eicken, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Debra Best, Duke University School of Medicine, Durham, NC, United States; Shivani Mehta, Atrium Health, Charlotte, NC, United States; Kristina Gustafson, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Kimberly Montez, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, WINSTON-SALEM, NC, United States

Background: Healthcare institutions are increasingly screening for food insecurity (FI), however there is little guidance on how to best provide referrals for families with FI. The Carolinas Collaborative, comprising the 8 pediatric academic institutions in North and South Carolina, has been working to establish best practices around FI screening and referral.

Objective: The primary aims of this QI project were to increase FI screening and referrals to local and federal food assistance programs for families served by the 8 pediatric academic institutions in North and South Carolina to 80%. Secondary goals included increasing the number of active referrals (including provision of food) by 5% while decreasing patients receiving no referral by 5%.

Design/Methods: Families served at our clinics were screened for household FI using a validated screener during designated visits. Those identified as having FI were offered referrals/resources to mitigate FI. FI interventions included passive (resource list provision) and active referrals (medical team accessed resource on families’ behalf or provided food on-site). Monthly chart audits of 30 clinic patients per site identified with FI were completed. The AAP Quality Improvement Data platform created de-identified aggregate run charts and bar graphs that were reviewed at each site and discussed during monthly Collaborative meetings. Plan-Do-Study-Act cycles were tailored to each site.

Results: Met and sustained primary goal of screening 80% of eligible patients since June 2020. Our rate of FI aligns with the national average (Figure 1). Demographics of patients with FI are in Table 1; 67% of families with FI identified as Hispanic. Active referrals surpassed the initial goal, increasing from 63% to 80% (median rate 72%). Active referrals expanded from 1 to 6 sites and food provision programs (food pantry, food pharmacy, food box/bag, food vouchers/gift cards) increased from 11 to 19, with another prescription box program to start in January 2022. The rate of no referral offered decreased from 17% to 9% (median 10%) (Figure 2).Conclusion(s): Over the last year, the 8 pediatric academic clinics in North and South Carolina have shifted to more comprehensive FI intervention approaches. This may be in part due to the support, idea-sharing and networking occurring through the concerted effort of all sites on one project. There was an ethnic disparity noted, as the majority of families identified are Hispanic. It will be important for future strategies to be sensitive to this, both on a community advocacy and federal policy level, to mitigate FI in a culturally effective way.
Figure 1Food Insecurity Screening and Referral Rates (December 2020-October 2021)
Table 1