Assessing Hunger Vital Signs in a Pediatric Cardiology Clinic

BACKGROUND and SPECIFIC AIMS: The American Academy of Pediatrics (AAP) notes that food insecurity (FI) at any level increases a child's risk of illness, hospitalizations, behavioral problems, and suffering in school. Growth and development is a major concern in pediatric patients and is a specific concern for pediatric cardiology patients. 1.2 million people living in Allegheny County are food insecure. Based on national data, roughly 42,000 of these individuals are children1, 2. The original Hunger Vital Signs (HVS) asks families two validated questions to assess their access to food. Providers are encouraged to ask HVS and intervene, as appropriate. The aims of this project are to educate the cardiology outpatient team on FI, implement the HVS screening tool in our cardiology office at Children';s Hospital of Pittsburgh, assess the clinical success in asking these questions during medical intake, evaluate FI in our clinic patients, act on these results by connecting families to community resources. METHODS: We conducted two plan-do-study-act (PDSA) cycles aimed at implementing HVS in our cardiology outpatient office to assess FI. The clinical team was trained on the HVS. Referral processes and resources were collected for positive screens with multidisciplinary teams including social work. The screening tool was implemented and tracked via electronic medical record. Our social work team provided additional follow up. Screening methods were adjusted following the first round of screening to include a scripted option to address families. Follow up resources were adjusted based on family needs. The QI team used a run chart to assess QI status (Figure 1), to monitor progress toward improvement. RESULTS: Interim results revealed that our clinic increased screening to 56% from baseline of zero. Staff meetings revealed hindrances to screening included time, assumed parental concern for getting in trouble, staff turnover, and difficulty remembering to incorporate the results in the medical record. A total of 3% of patients screened positive for FI during the initial study period. DISCUSSION/CONCLUSIONS: The HVS can be effectively implemented in a busy cardiology office and can improve identification of food insecure families. Successful screening can be improved using standard QI methodology. Understanding FI can aid in individualized care and access to resources. Providing individualized training on HVS for screening intake may improve the success of discoverin