Addressing Social Needs in Healthcare Systems: Food Insecurity Screening at Legacy Health

Context: Healthcare systems are increasingly aware of the impact of health-related social needs (HRSNs) on health and are integrating social care into the delivery of healthcare to address these needs. Legacy Health’s 2020 Strategic Plan focused on increasing diversity, equity, and inclusion, which necessitated an organizational focus on HRSNs. In February 2021, Legacy began piloting routine food insecurity (FI) screening in primary care.

Objective: Implement a multi-level approach to identify and address FI: 1) establish FI screening in all primary care clinics, 2) provide food and food resource lists, 3) implement UniteUs, and 4) train internal medicine physicians on HRSNs.

Study Design: Quantitative medical record and qualitative interview data were collected and analyzed to understand FI screening processes and patient and care team perspectives on how to measure and address FI. Findings informed intervention. Weekly medical record data pulled during study period to assess intervention impact.

Setting: Legacy’s 25+ primary care clinics in Portland, OR metro area.

Population Studied: All Legacy primary care patients (n = 108,000) from Sept. 2021 to Sept. 2022. Interviews conducted with 4 primary care clinic staff and 4 patients with FI.

Intervention: Implement routine FI screening in primary care clinics, train MAs on screening, and provide patients with food bags and resource lists.

Outcome Measures: Percent patients screened for FI per week at each clinic; number food bags provided.

Results: In-depth interviews with patients and care team members taught us: 1) patients with FI are highly resilient and knowledgeable of resources; although many food resources are available, they often don’t meet patient needs; clinic staff feel unable to help patients with HRSNs despite seeing them as a root cause of health. FI screening rates increased from 60% to 86%, a 43% improvement. 2,730 food bags distributed. FI screening paired with the immediate food resource garnered support from clinic management and staff who saw its value in improving patient health outcomes.

Conclusions: Poor health tied to unmet social needs is a widespread problem. HRSN screening is the first step in addressing the major causes of poor health. Identifying the most vulnerable populations gives providers and health plans meaningful insights into the health of their patients and HRSN screening contributes to the complete picture of an individual.