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Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network
Noah Kim1, Laura Fischer1,2, Sarah Haley Gross3
1Children's National Hospital, Washington, DC, USA.
Insights
Pediatric clinicians screened all children for food insecurity (FI), but found limited impact and desired better resources. Improving FI management requires streamlined protocols and effective community partnerships.
Area of Science:
- Pediatric primary care
- Public health
- Health services research
Background:
- Food insecurity (FI) significantly impacts child health in the US, affecting 1 in 6 households with children in 2022.
- Pediatric clinicians are encouraged to screen for and intervene in cases of FI within clinical settings.
- A pilot FI management protocol was implemented in 2017 at a Washington, DC pediatric primary care network serving Medicaid-eligible patients.
Purpose of the Study:
- To evaluate the feasibility of implementing an FI management protocol in a pediatric primary care setting.
- To assess the impact of the FI management protocol on clinician practices and patient outcomes.
- To identify barriers and facilitators to the successful implementation of FI screening and intervention.
Main Methods:
- An 18-item electronic survey was administered to 42 pediatric clinicians in 2019.
- The survey collected quantitative (Likert-type responses) and qualitative (open-ended responses) data on knowledge, attitudes, and behaviors regarding FI protocol implementation.
- Statistical analyses included frequencies, chi-square tests, and Cramer's V; qualitative data were analyzed for common themes.
Main Results:
- 35 out of 42 clinicians completed the survey, reporting 100% universal FI screening and 80% frequent electronic documentation.
- 91% of clinicians referred families to FI resources, but only 24% found these resources adequate.
- Clinicians reported increased awareness and satisfaction but noted time constraints and inadequate resource effectiveness.
Conclusions:
- The pilot FI management protocol was feasible in a pediatric primary care setting.
- Clinicians perceived a limited impact on alleviating FI and expressed a need for more effective intervention options.
- Recommendations include streamlining the protocol, delegating tasks, and establishing "Food as Medicine" programs.
Introduction/Objectives:
In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC.
Methods:
In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results.
Results And Conclusions:
Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations.
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