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Published on: August 21, 2015
Addressing food insecurity: a paediatric academic advocacy collaborative quality initiative
J Blakely Andrews Amati1,2, Shivani Mehta3, Talia Buitrago Mogollon4
1Pediatrics, Prisma Health, Greenville, South Carolina, USA.
Insights
This quality improvement initiative successfully increased food insecurity (FI) screening and referrals in pediatric clinics. The program improved identification and support for families facing food assistance challenges.
Area of Science:
- Pediatric Health
- Public Health Initiatives
- Quality Improvement Science
Background:
- Food insecurity (FI) affects numerous families, necessitating improved identification and support systems within healthcare settings.
- Paediatric academic institutions play a crucial role in addressing social determinants of health, including FI.
- Existing systems often lack efficient mechanisms for screening and referring families with FI to necessary resources.
Purpose of the Study:
- To enhance the identification of food insecurity (FI) among families served by paediatric academic institutions.
- To improve the referral process for families identified with FI to appropriate food assistance programmes.
- To implement and evaluate a collaborative quality improvement (QI) initiative across multiple institutions.
Main Methods:
- A collaborative quality improvement (QI) initiative involving eight paediatric academic institutions in North and South Carolina.
- Implementation of standardized screening for FI, with a target of 80% of eligible families.
- Utilized the Quality Improvement Data Aggregator (QIDA) for monthly chart audits and data analysis through Plan-Do-Study-Act cycles.
- Statistical process control charts were employed to monitor changes and identify variations.
Main Results:
- Achieved an increase in FI screening rates from 68.5% to 86%, exceeding the 80% goal.
- Consistently offered food referrals 90% of the time for identified FI cases.
- Improved FI diagnostic coding from 38.3% to 70.5%, though not reaching the 80% target.
- Maintained a low rate of missed referral opportunities (9.5%), well below the 20% threshold.
Conclusions:
- A collaborative QI initiative effectively improved food insecurity (FI) identification and referral processes in paediatric settings.
- The initiative demonstrated the feasibility of rapid implementation, dissemination, and spread of QI strategies.
- Paediatric academic collaborations can lead to significant improvements in addressing critical family needs like food insecurity.
Objective:
This quality improvement (QI) initiative aimed to address food insecurity (FI) by improving FI identification and referral to food assistance programmes for the families served by the eight paediatric academic institutions in North and South Carolina.
Methods:
The primary process measures were screening 80% of eligible families for FI and coding for FI. The outcome measure was referring 80% of families identified with FI to appropriate resources. The balancing measure was maintaining a rate below 20% of missed opportunities for referral. Change ideas were organised into four main key drivers. The eight teaching clinics of the Carolinas Collaborative completed monthly chart audits using the Quality Improvement Data Aggregator (QIDA). Baseline was December 2020 and implementation occurred January 2021-May 2022. Creation of run charts was later transferred to statistical process control charts. Standard probability or Montgomery rules were used to identify special cause variation. Sites used individual QIDA data to conduct Plan-Do-Study-Act cycles; aggregated data were shared during bimonthly meetings.
Results:
A total of 4270 eligible charts were audited, 3430 patients screened and 525 identified as having FI. The rate of FI screening shifted from 68.5% to 86%. The rate of FI identified remained at 15%, and food referrals were consistently offered 90% of the time. While FI diagnostic coding did not reach the 80% goal, there was a shift from 38.3% to 70.5%. The balancing measure remained well below the goal of less than 20% of missed opportunities to discuss positive FI (centreline of 9.5%).
Conclusions:
A paediatric academic collaborative QI initiative focused on FI demonstrated collective improvement and allowed for rapid implementation, dissemination and spread.
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