Ulintz Alexander J, Patel Seema S, Anderson Katherine, Walters Kevin, Stepsis Tyler J, Lyons Michael S, Pang Peter S
The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio.
Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.
West J Emerg Med. 2024 Nov;25(6):993-999. doi: 10.5811/westjem.18513.
Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit.
This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM-8 PM from July-October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital's co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics.
Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30-58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit.
A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.
粮食不安全是急诊科患者中普遍存在的社会风险。可通过基于急诊科的筛查来识别可能受益于粮食不安全资源的患者；然而，许多患者在出院后难以获取这些资源。在急诊科内或附近设置资源可能会提高患者的利用率，但这种方法在很大程度上仍未得到研究。本研究描述了一种可在医院食品市场兑换的食品券在急诊科就诊期间筛查出粮食不安全呈阳性的患者中的接受和使用情况。
这项前瞻性队列研究在一家由县资助的急诊科进行，纳入了2022年7月至10月工作日上午8点至晚上8点就诊的连续成年患者，且他们同意参与研究。我们排除了到达时需要复苏或无法用英语提供书面知情同意书的患者。研究参与者完成了由研究人员管理的两问题饥饿生命体征筛查工具的纸质版。筛查呈阳性的参与者获得了一张编号唯一的30美元食品券，可在医院内的食品市场兑换。通过定期每30天评估市场收据记录来量化食品券的兑换情况。主要结果是兑换食品券的比例。次要结果包括筛查粮食不安全呈阳性的参与者比例、接受食品券的参与者比例以及相关的描述性统计数据。
在396名符合条件的人中，377人（95.2%）同意并完成了粮食不安全筛查。大多数为中年人（中位数53岁，四分位间距30 - 58岁），191人为女性（50.4%），242人为黑人（63.9%），343人为非西班牙裔（91.0%）。在参与者中，228人（60.2%）筛查粮食不安全呈阳性，224人接受了食品券（98.2%），其中86人进行了兑换（38.4%），中位数为急诊科就诊后九天。
很大比例的参与者筛查粮食不安全呈阳性并接受了食品券；然而，在医院内食品市场兑换的食品券不到一半。这些结果表明，为粮食不安全患者发放急诊科食品券是可行的，但仅设置资源可能不足以解决社会风险，这暗示了对基于急诊科的社会需求筛查后资源利用的促进因素和障碍的理解有限。
