Date of Publication



Reducing Food Insecurity Amongst Vermont Children

Purpose. In Vermont, one in five children suffers from hunger. Food insecure children are at risk for anemia, low bone density, increased hospitalizations, obesity and other chronic illness. Children living with food insecurity experience higher rates of depression, anxiety, behavioral dysregulation, cognitive delays, and even suicidal ideation. Clinical guidelines endorse screening during routine health maintenance visits. Cross-sectional studies demonstrate that only 15% of health care providers comply. The purpose of this project was to increase rates of food insecurity screening at a local private practice clinic, with the overall goal of reducing the number of food insecure children living in Vermont.

Methods. A pilot quality improvement project using the “Plan, Do, Study, Act (PDSA)” format was implemented at a local, private, family practice medical home. Kurt Lewin’s “Planned Change Theory” was used as a theoretical framework. Posters placed in the waiting room and exam rooms, advertised the screening with the intent of normalizing the screening for caregivers. A screening process was established using the electronic health record (EHR). Hager’s 2-point screening instrument was built into the clinic’s EHR as a screening tool. Food insecurity screening was added to the health maintenance alerts within all pediatric records, so that providers would be alerted to children not yet screened. A referral and patient education tool was built into the EHR so that providers could facilitate fast, appropriate referrals to families with a positive screen. An in-service was held to introduce the purpose and methods of the project to all stakeholders at the clinic. As part of this in-service, providers were instructed on which E&M codes and CPT codes to use in order to accurately document screening, diagnosis and referral. The project started the week following the in-service. After 30 days, the EHR was queried in order to determine how many children presented for routine health supervision visits, how many children were screened and how many positive screens were found. ICD 10 codes z65.9 (problem related to unspecified psychosocial circumstance) and z59.4 (lack of adequate food and safe drinking water) were used. The CPT code 96160 (implementation and interpretation of health risk screening instrument) was also queried. Results were documented in a PDSA format and reported to stakeholders in both PDSA and scorecard format. E-mail reminder was sent to all stakeholders, reminding them to continue screening at health supervision visits.

Results. Twenty-six children presented for routine health supervision visits, 8 were screened. Zero were identified as having food insecurity. Screening rates increased from zero to thirty percent.

Conclusion. Pilot data suggests that a quality improvement project using planned change theory and the EHR, can increase rates of food insecurity screening in a medical home setting.

Keywords. Food insecurity, children, quality improvement project, health supervision visits, “PDSA”.

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