Presenter's Name(s)

Arjun JanardhanFollow

Primary Faculty Mentor Name

Dr. Michael Latreille

Project 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

Presentation Title

Implementation of Food Insecurity Screening in Adult Primary Care Patients

Time

11:00 AM

Location

Silver Maple Ballroom - Food & Environmental Sciences

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.

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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.