Implementation of Food Insecurity Screening in Adult Primary Care Patients
Conference Year
January 2019
Abstract
Background
Social determinants of health (SDH) are increasingly recognized for their importance in driving health outcomes. Food insecurity (FI), a lack of regular access to adequate food, is prevalent in the United States, impacting an estimated 12% of households in 2017. The two-item Hunger Vital Sign (HVS), has demonstrated validity in identifying FI, though there is not agreement on how best to address FI in a healthcare setting. This study aimed to evaluate the implementation of a screening protocol for FI in adult primary care patients, and to investigate any downstream impacts on services delivered in patients who screened positive for FI.
Methods
In December 2017, our institution added functionality for entering and tracking SDH via an Epic-based EMR. The tool, which incorporated the HVS, was developed based on the Health Related Social Needs Screening Tool by CMS. We instituted protocols for administering and entering the HVS component at two academic primary care sites in Vermont: a semi-urban adult internal medicine practice and a rural family medicine practice. Implementation plans were developed at both sites, each involving education for providers and staff, and pairing of the HVS with annual behavioral health screening. We then identified patients who screened positive for FI from January 1 through April 30, 2018 and retrospectively analyzed charts for services in place prior to positive screens, as well as for documentation and actions taken in response to positive screens.
Results
A total of 1,188 patients were screened for FI during the study period, and 79 (7%) screened positive. Of patients with FI, 41 (48%) had some documentation of food or financial insecurity prior to screening. A total of 32 (37%) were documented to have prior access to food insecurity services such as food stamps, food bank etc., and 19 (22%) had been previously seen by a social worker embedded in the practice. At the time of positive screen, 26 (31%) provider notes included documentation of FI. In response to a positive screen, 16 patients (19%) were offered social work referral, of whom 12 (14%) completed a visit.
Conclusions
In this brief pilot study, we found the implementation of a process for FI screening in primary care to be relatively straightforward, made so by pairing it with other annual health screening protocols and the presence of a function for entering SDH in Epic. The HVS screening tool was also successful in newly identifying FI, as evidenced by the absence of prior documentation in nearly half of food insecure patients. However, the paucity of subsequent documentation and the small fraction of patients who received targeted intervention, despite the education for providers and staff at both practices, indicate a need for further investigation around the best approach to addressing FI in a primary care setting, once it is identified.
Primary Faculty Mentor Name
Dr. Michael Latreille
Faculty/Staff Collaborators
Dr. Charles Maclean (Collaborating Mentor)
Status
Medical Students
Student College
Larner College of Medicine
Program/Major
Undeclared Major
Primary Research Category
Health Sciences
Secondary Research Category
Social Sciences
Tertiary Research Category
Food & Environment Studies
Implementation of Food Insecurity Screening in Adult Primary Care Patients
Background
Social determinants of health (SDH) are increasingly recognized for their importance in driving health outcomes. Food insecurity (FI), a lack of regular access to adequate food, is prevalent in the United States, impacting an estimated 12% of households in 2017. The two-item Hunger Vital Sign (HVS), has demonstrated validity in identifying FI, though there is not agreement on how best to address FI in a healthcare setting. This study aimed to evaluate the implementation of a screening protocol for FI in adult primary care patients, and to investigate any downstream impacts on services delivered in patients who screened positive for FI.
Methods
In December 2017, our institution added functionality for entering and tracking SDH via an Epic-based EMR. The tool, which incorporated the HVS, was developed based on the Health Related Social Needs Screening Tool by CMS. We instituted protocols for administering and entering the HVS component at two academic primary care sites in Vermont: a semi-urban adult internal medicine practice and a rural family medicine practice. Implementation plans were developed at both sites, each involving education for providers and staff, and pairing of the HVS with annual behavioral health screening. We then identified patients who screened positive for FI from January 1 through April 30, 2018 and retrospectively analyzed charts for services in place prior to positive screens, as well as for documentation and actions taken in response to positive screens.
Results
A total of 1,188 patients were screened for FI during the study period, and 79 (7%) screened positive. Of patients with FI, 41 (48%) had some documentation of food or financial insecurity prior to screening. A total of 32 (37%) were documented to have prior access to food insecurity services such as food stamps, food bank etc., and 19 (22%) had been previously seen by a social worker embedded in the practice. At the time of positive screen, 26 (31%) provider notes included documentation of FI. In response to a positive screen, 16 patients (19%) were offered social work referral, of whom 12 (14%) completed a visit.
Conclusions
In this brief pilot study, we found the implementation of a process for FI screening in primary care to be relatively straightforward, made so by pairing it with other annual health screening protocols and the presence of a function for entering SDH in Epic. The HVS screening tool was also successful in newly identifying FI, as evidenced by the absence of prior documentation in nearly half of food insecure patients. However, the paucity of subsequent documentation and the small fraction of patients who received targeted intervention, despite the education for providers and staff at both practices, indicate a need for further investigation around the best approach to addressing FI in a primary care setting, once it is identified.