Enhancing food insecurity screening in pediatric celiac disease using a quality improvement framework

Area of Science:

• Pediatric gastroenterology
• Public health nutrition
• Healthcare quality improvement

Background:

• Food insecurity (FI) impacts millions of US households, disproportionately affecting children.
• Children with celiac disease (CeD) require strict gluten-free diets, making FI screening crucial for their well-being.
• Gaps exist in identifying food-insecure households in pediatric settings, hindering access to vital interventions.

Purpose of the Study:

• To develop and implement a system for identifying and overcoming barriers to FI screening in a pediatric CeD clinic.
• To improve the rate of FI screening among children diagnosed with celiac disease.
• To establish a sustainable process for addressing FI in vulnerable pediatric populations.

Main Methods:

• Utilized the Model for Improvement framework for quality initiatives over 12 months.
• Conducted surveys to identify medical team barriers to FI screening.
• Implemented a validated screening form, clinic flowsheet, educational module, and EHR visual aid.
• Employed plan-do-study-act cycles to refine screening processes.

Main Results:

• Median FI screening rates increased from 0.0% to over 75.0% within 12 months.
• Sustained high screening rates for over 6 months post-implementation.
• Identified key barriers: language, resource availability, provider forgetfulness, and discomfort with screening questions.
• Reported general FI at 19.7% and gluten-free FI at 14.8% among screened children.

Conclusions:

• A systematic framework effectively addressed team-reported barriers, significantly increasing FI screening for children with CeD.
• Interventions targeting FI are essential for improving health outcomes in food-insecure households.
• This quality improvement initiative provides a scalable model for other pediatric clinics.