410 - Asking the Right Questions: A Multicenter Resident Quality Improvement Initiative to Improve Screening for Food Insecurity in Pediatric Teaching Clinics

Poster Number: 410
Publication Number: 410.445

A. Brooke Baggett, Vidant Medical Center / ECU Brody School of Medicine, Winterville, NC, United States; Anna Laughman, James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, United States; Amanda Hall, Levine Children's Hospital, Charlotte, NC, United States; Talia Buitrago-Mogollon, Atrium Health Levine Children's, Charlotte, NC, United States; Kristina Gustafson, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Shivani Mehta, Atrium Health, Charlotte, NC, United States

Background: Food insecurity (FI), which is linked to poor health outcomes in children and families, has increased during the COVID-19 pandemic from 1 in 7 to 1 in 4 children nationally. The AAP recommends FI screening with referral to available community resources as part of Bright Futures; however, 40% of pediatricians are not completing this screening with fewer assisting children & families who report FI. In the states of NC & SC, 19.3% & 16.2% of children are FI, respectively.

Objective: Enhance FI screening and support for children/families through QI in the 8 NC & SC pediatric academic centers of the grant-funded Carolinas Collaborative (CC).

Design/Methods: The CC worked to optimize trauma-informed FI screening within their individual outpatient clinics by 1) utilizing multi-stakeholder teams to ensure adequate support & promote success, 2) establishing flow diagrams to design screening and intervention processes, identify potential barriers to screening & determine how positive screens would be addressed, & 3) applying knowledge gained from prior research at 1 institution to utilize a written rather than verbal screening tool at all sites. Each site implemented a written tool that included the Hunger Vital Signs, a validated 2-question FI screening tool. At each site, resident leaders promoted screening and educated staff and colleagues on the process. Individual teams established a system to collect and review data to assess QI progress. All institutions could access and contribute to cross-institution data collection through a common database.

Results: Although each institution started with various screening practices & clinic flows, we saw collective improvement in screening rates because of this initiative. Over 11 months, FI screening at designated well-child visits increased from 64.0% to 93.3% in our 8-institution collaborative (goal: 80%; Figure 1). As a balancing measure when FI was identified, we measured documentation of results being discussed and met our threshold goal of < 20% missed opportunities when positive (Figure 2-3).Conclusion(s): Our work reinforces the benefit of a multicenter, multidisciplinary collaborative to support and promote resident-led QI focused on FI screening. Through collaborative storytelling and information sharing, 8 NC and SC pediatric academic centers improved FI screening to > 80%, while maintaining appropriate discussion of positive screens. Future collaborative work should focus on building effective intervention strategies and strengthening of community-based partnerships to further decrease FI rates, particularly as the COVID-19 pandemic evolves.
Figure 1. % Screened for Food InsecurityGraph depicting the percentage of well-child visits screened for food insecurity across all Carolina Collaborative sites each month. The red line represents the median and the green line represents goal of 80% screening rate for all well-child visits.
Figure 2. % Food Insecurity IdentifiedGraph depicting the percentage of food insecurity identified at well-child visits across all Carolina Collaborative sites by month. The red line reflects the median.