Improving the Food Insecurity Screening Rate at One Outpatient Ambulatory Care Center: A Quality Improvement Project

Abstract

Food Insecurity is defined as not having consistent, meaningful access to enough food for both an active and healthy lifestyle. It is a social determinant of health that significantly impacts a multitude of health outcomes, including hypertension, diabetes, and mental health. Estimates indicate food insecurity affects approximately 10.5% of households in America, which has only been exacerbated by the COVID-19 pandemic. The scope of this project was to better understand the prevalence in our population while creating a new workflow process to provide vital resources to patients who had a positive screening. The aim of this project was to increase the number of patients being screened for food insecurity from 0 to 5 total per week from April 1, 2021 to December 31, 2021 through the use of a paper screening. The validated two-question food insecurity screening tool that is present in the institution’s electronic medical record (EMR) was made into a paper survey and distributed at intake. These screenings would be collected by the nursing staff and inputted into the chart. Positive screenings would be addressed by the provider who provided resources and/or a social work consult. We utilized a data collection system that tracked the deidentified total number of responses and each individual answer. A random sampling of 22 paper screenings were selected for in-depth review to determine how the positive screening was addressed. In total, we had 787 survey responses with 220 (27.9%) positive screenings for food insecurity. The total amount of screenings each month varied considerably. Based on our random sampling of 22 patients who had a positive screening, 6 (27.3%) had documentation of a discussion on food insecurity in the EMR and 2 (9.1%) had a referral made to social work. Our project demonstrated that a validated paper screening can increase the identification, documentation, and education of food insecurity significantly. The responses we received indicated that food insecurity rates are much higher than previously understood in other results and warrant further work to improve routine screening and to address the fundamental need in our communities.