P2.B034: Implementation of Food Insecurity Screening in Pediatric Cardiology Clinic

Purpose/Objectives: Food insecurity (FI) negatively impacts millions of children in the United States. Children with congenital heart disease are at high risk of adverse clinical outcomes related to FI. The American Academy of Pediatrics recommends screening for FI at well child visits. There is added value for patients/families by screening at subspecialty care visits where nutrition is a component of the therapeutic plan. We sought to implement routine FI screening in a fellow-led pediatric cardiology clinic within a large, academic pediatric healthcare center, and identify risk factors associated with FI in our patient population.

Design/Methods: We utilized the Hunger Vital Sign™, a validated two-question screening tool based on the U.S. Household Food Security Survey Module, to screen for FI in our hospital-adjacent clinic. For families with a positive screen, we provided printed instructions for accessing resources in their area utilizing a tool created in partnership with the social care network findhelp.org. Primary outcome measures included the percentage of families screened and the percentage of families provided with printed resource materials following a positive screen. Sociodemographic data were analyzed and risk factors for food insecurity were compared using logistic regression.

Results: From September 2023 through March 2024 there were 671 patients seen in clinic. Run charts revealed variable screening success early in the intervention (median 50.0%, IQR 34.4-58.8%) (Figure 1). Overall, 282 families were successfully screened for FI with a 22.0% positivity rate. Our screening process successfully distributed resource information to 72.9% of families who screened positive for FI. In our sample there were no significant differences between families experiencing FI and those who were food secure on the basis of patient sex, age, race, ethnicity or insurance provider type. FI families were more likely to have a non-English primary language and median household income was lower among those with FI (p < 0.001). When adjusting for median household income, Spanish-speaking families had a 3.7x risk of having food insecurity compared to English-speaking families (p < 0.001).

Conclusion/Discussion: We successfully started FI screening in a pediatric cardiology clinic. A key driver of early screening challenges was rotation of ancillary staffing for the clinic. An educational intervention stabilized screening rates in the first PDSA cycle, but further optimization is needed. FI is common in our patient cohort and higher than nationally reported FI rate of 17.3% of households with children. We found FI was associated with household income and non-English primary language, likely reflective of complex interactions between social drivers of health. Improved understanding of these drivers, as well as optimization of interventions for families experiencing FI will be essential measures in improving health equity for our patients. Next steps include utilization of EMR to facilitate screening processes.