Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department

Cullen, Danielle; Woodford, Ashley L.; Fein, Joel A.

doi:10.1016/j.acap.2018.11.014

Cited by 80 publications

(68 citation statements)

References 30 publications

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“…Authors of a recent study of food insecurity screening in pediatric emergency department patients found that participants felt more comfortable with completing the screen in the emergency department in comparison to their pediatrician' s office, although they reported feeling favorable about screening in both settings. 27 A previous cross-sectional study of caregivers of hospitalized patients also found that caregivers feel their physicians should ask about social needs and that caregivers who have been screened previously have even more favorable views toward SDH screening. 28 Screening in the inpatient setting creates an opportunity to identify these patients, provide appropriate resources, and arrange follow-up, especially when an in-house social worker is available.…”

Section: Discussionmentioning

confidence: 94%

Screening for Social Determinants of Health in Hospitalized Children

Schwartz

Herrmann

Librizzi

et al. 2020

Hospital Pediatrics

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Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children's hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for $1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.

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Section: Discussionmentioning

confidence: 94%

Screening for Social Determinants of Health in Hospitalized Children

Schwartz

Herrmann

Librizzi

et al. 2020

Hospital Pediatrics

View full text Add to dashboard Cite

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“…Because children in foodinsecure households may use the ED more frequently, this clinical setting may present opportunities for identifying needs and making connections to community-based services. 36 Second, we uniquely examined differences in patient experience of care quality on the basis of food insecurity. Authors of previous studies have suggested that lacking a usual source of care and foregoing medical care is more common among children who are food insecure.…”

Section: Discussionmentioning

confidence: 99%

Food Insecurity and Health Care Use

Peltz

Garg

2019

Pediatrics

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BACKGROUND AND OBJECTIVES: Fifteen percent of US children live in households with inadequate food. Children who are food insecure often experience worse physical, emotional, and developmental health outcomes. Authors of previous studies have not examined the quality and cost implications of food insecurity in children. METHODS: This is a retrospective study of 7959 nationally representative US children (aged 1-17 years) in the 2016 Medical Expenditure Panel Survey. Households with food insecurity were identified by $3 positive responses to the 30-day, 10-item US Food Security Survey. Main outcomes were annual health expenditures and quality of care indicators: emergency department (ED) and inpatient use, primary care and specialist visits, routine medical and dental care, patient experience measures, and school absenteeism. Logistic and 2-part regression models were constructed to estimate outcomes conditional on sociodemographic and medical covariates. RESULTS: Children in households with food insecurity were more often publicly insured and had special needs compared with all other children. In multivariable logistic regression, household food insecurity was associated with significantly higher adjusted odds of an ED (adjusted odds ratio [aOR] = 1.37) or primary care treatment visit (aOR = 1.24) during the year. Household food insecurity was associated with significantly higher school absenteeism (aOR = 1.74) and lower access to care for routine (aOR = 0.55) or illness (aOR = 0.57) care. There were no differences in annual health expenditures, hospitalizations, or receipt of routine medical or dental care. CONCLUSIONS: Household food insecurity is associated with higher ED use and school absenteeism and lower access to care; however, it was not associated with higher annual health expenditures in children. WHAT'S KNOWN ON THIS SUBJECT: Fifteen percent of US children experience food insecurity. Children who are food insecure are less likely to attain healthy growth and development. The relationship between food insecurity, health care service use, quality of care, and expenditures is not well established in children. WHAT THIS STUDY ADDS: Using national US survey data, we found that household food insecurity was associated with higher emergency department use and school absenteeism and lower access to care quality among children; however, there were no differences in annual health expenditures.

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“…Although screening for caregiver-reported social risk factors in pediatric patients is becoming more prevalent in primary care clinics and is being refined for diseasespecific conditions, 6,[18][19][20][21][22][23][24][25][26][27][28] screening for social risk in hospitalized children is largely unaddressed. [29][30][31] Potential contributing factors to this scarcity of screening include a keen focus on meeting acute medical needs and a tendency to maintain a high census that may overwhelm patient care resources (eg, case managers, social workers, and behavioral health providers) even when social risk factors are identified.…”

mentioning

confidence: 99%

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Vaz

Wagner

Ramsey

et al. 2020

Hospital Pediatrics

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Although health systems are increasingly moving toward addressing social determinants of health, social risk screening for hospitalized children is largely unexplored. We sought to determine if inpatient screening was feasible and describe the prevalence of social risk among children and caregivers, with special attention given to children with chronic conditions. METHODS: Caregivers of pediatric patients on the hospitalist service at a children's hospital in the Pacific Northwest completed a social risk survey in 2017. This survey was used to capture items related to caregiver demographics; socioeconomic, psychosocial, and household risks; and adverse childhood experiences (ACEs). Charts were reviewed for child demographics and medical complexity. Results were tabulated as frequency distributions, and analyses compared the association of risk factors with a child's medical complexity by using x 2 tests. RESULTS: A total of 265 out of 304 (87%) caregivers consented to participate. One in 3 families endorsed markers of financial stress (eg, difficulty paying for food, rent, or utilities). Forty percent experienced medical bill or insurance troubles. Caregiver mental health concerns were prevalent, affecting over one-third of all respondents. ACEs were also common, with 38% of children having at least 1 ACE. The presence of any ACE was more likely for children with chronic conditions than those without. CONCLUSIONS: We found that social risk screening in the inpatient setting was feasible; social risk was uniformly common and did not disproportionately affect those with chronic diseases. Knowing the prevalence of social risk may assist in appropriate alignment of interventions tiered by social complexity.

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Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department

Cited by 80 publications

References 30 publications

Screening for Social Determinants of Health in Hospitalized Children

Screening for Social Determinants of Health in Hospitalized Children

Food Insecurity and Health Care Use

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

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