Background: Healthcare disparities have existed for decades, yet it took a global pandemic to put this emergency into the spotlight. The Joint Commission states “health related social needs” (HRSN) are the root cause of many disparities. HRSN encompasses a wide spectrum including inability to pay bills, poor access to transportation, and lack of housing. At our urban tertiary academic medical center, the specific HRSN that took precedence in our population was food insecurity. This HRSN was amplified during the COVID pandemic with rising food prices and access to lower quality foods. Based on population data, food insecurity has become pronounced in our service area and falls far above the national average of 10.9%. We developed a healthcare disparities committee in 2022 and launched a pilot in November 2022 on one of our inpatient units to address this pressing need.
Purpose: We work as an interdisciplinary team to achieve 3 primary goals: 1) Counsel patients on healthy meal plans and provide recipe books to take home 2) Offer community resources for our patients through a referral platform known as “Now Pow.” This platform connects patients to neighborhood food pantries and meal delivery services. 3) Provide a 3-day bag of healthy food items on day of discharge as a bridge to the community resources offered through Now Pow.
Description: Every inpatient at our facility completes a HRSN questionnaire with the bedside nurse. Since the initiation of HRSN screening at our facility, nearly 67,000 patients have been screened. For the current year to date, January 1, 2022 to November 18, 2022, 16, 448 were screened, and of those that screened, 1,303 were positive for one or more HRSN, with 13.4% of patients reporting food insecurity. The questionnaire includes the following: “do you need help getting public benefits such as food stamps?” or “do you worry that you will run out of food before you get money to buy more?” All patients who screen positive are discussed during interdisciplinary rounds (IDRs). The social worker meets and provides community resources to the patient identified in Now Pow. These resources are communicated during IDRs so that the hospitalist can continue this conversation at the next bedside visit. A registered dietician is consulted to provide recommendations on meal plans and dietary adjustments. These recommendations also become a point of conversation between the hospitalist and the patient. Lastly, in partnership with our food services department, we provide a bag of groceries to our food insecure patients on day of discharge. The department is notified 24 hours in advance and a bag of perishable and non-perishable healthy food items is supplied. The items are adjusted to the patient’s dietary needs (i.e. low sodium, pureed) and are enough to last 3 days. We determined 3 days of food was an adequate bridge until the patient arranged outpatient resources. The pilot began in early November and data regarding our intervention if being collected.
Conclusions: Starting in January 2023, the Joint Commission will require all critical access hospitals to establish leaders who will drive initiatives to reduce inequities in our communities. It is imperative for HRSN to be addressed in the hospital setting to set our patients to help achieve pursuits central to the Institute of Medicine’s quintuple aim, improving patient outcomes and providing equitable care. Our interdisciplinary initiative can be implemented in a range of settings to address patient’s HRSN.