Improving Identification of Food-Insecure Patients in an Outpatient Clinic Setting

Food insecurity (FI) is defined as limited or uncertain access to enough nutritious food for all household members to lead an active and healthy life. In 2017, roughly 12% of US households reported FI. FI screening is not standard practice despite FI's association with poor health outcomes. This study compared FI screening strategies in a community-based family medicine residency clinic to determine which strategies identified the largest number of FI patients.

We conducted this study using a validated two-question screening tool with high sensitivity and specificity for identifying FI. Three implementation strategies of the screening tool were tested: two clinician-initiated and one staff-initiated. Data measured included opportunities to screen, patients actually screened, and the number of positive (disclosure) responses.

Clinician-initiated screening rates increased when clinicians followed a standard note template with embedded FI questionnaire vs no template (58.6% vs 7.1%). Despite this improvement, staff-initiated screening returned an even higher screening rate (95.2%). The disclosure of FI determined by staff-initiated screening was also higher (12.2%, similar to previously published data) than clinician-initiated screening (2.3%).

Staff-initiated screening for FI was the best way of identifying FI patients and yielded results consistent with local and national estimates. Clinicians did not screen patients for FI often enough for this approach to be effective, but embedding FI screening into templated notes improved clinician screening rates. Disclosure of FI when staff conducted screening far exceeded disclosure when screening was initiated by clinicians.