title: Enhancing accurate identification of food insecurity using quality-improvement techniques.
abstract: OBJECTIVE
  Infants who live in households experiencing food insecurity are at risk for negative health and developmental outcomes. Despite large numbers of households within our population experiencing food insecurity, identification of household food insecurity during standard clinical care is rare. The objective of this study was to use quality-improvement methods to increase identification of household food insecurity by the second-year pediatric residents working in the Pediatric Primary Care Center from 1.9% to 15.0% within 6 months. A secondary aim was to increase the proportion of second-year pediatric residents identifying food insecurity.
  
  
  METHODS
  A team was formed to identify key drivers thought to be critical to the process of identifying food insecurity during well-child care. This project addressed 5 key drivers and tested interventions based on these drivers over a 6-month period at a hospital-based primary care site that serves ∼15 000 children from underserved neighborhoods. Tests included implementing an evidence-based electronic screen for food insecurity, educational interventions to improve understanding of food insecurity, empowerment exercises targeting clinicians and families, and gaining buy-in and support from ancillary personnel.
  
  
  RESULTS
  Implementation of these changes led to an increase in the identification rate of household food insecurity from 1.9% to 11.2% over the 6 months (P < .01). The proportion of residents identifying food insecurity increased from 37.5% to 91.9% (P < .01).
  
  
  CONCLUSIONS
  Application of quality-improvement methods in a primary care clinic increased ability to effectively screen and positively identify households with food insecurity in this population.
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. mary.burkhardt@cchmc.org
authors.forename: Mary Carol
authors.initials: MC
authors.lastname: Burkhardt
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Conway
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Klein
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002662:Child Health Services; D003479:Curriculum; D057286:Electronic Health Records; D005260:Female; D005523:Food Supply / Q000592:standards*; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007396:Internship and Residency; D008297:Male; D008403:Mass Screening; D009820:Ohio; D018802:Patient-Centered Care; D010372:Pediatrics / Q000193:education*; D011209:Power, Psychological; D011320:Primary Health Care; D011502:Protein-Energy Malnutrition / Q000517:prevention & control*; D058996:Quality Improvement / Q000458:organization & administration*