Amati J Blakely Andrews, Mehta Shivani, Buitrago Mogollon Talia, Maldonado Lizmarie, Sease Kerry K, Best Debra, Montez Kimberly, Vander Schaaf Emily, Erickson Elizabeth, Holloway Jeffrey, Gustafson Kristina, Roberts James, Avery Carolyn
Pediatrics, Prisma Health, Greenville, South Carolina, USA.
University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA.
BMJ Open Qual. 2025 May 13;14(2):e003083. doi: 10.1136/bmjoq-2024-003083.
This quality improvement (QI) initiative aimed to address food insecurity (FI) by improving FI identification and referral to food assistance programmes for the families served by the eight paediatric academic institutions in North and South Carolina.
The primary process measures were screening 80% of eligible families for FI and coding for FI. The outcome measure was referring 80% of families identified with FI to appropriate resources. The balancing measure was maintaining a rate below 20% of missed opportunities for referral. Change ideas were organised into four main key drivers. The eight teaching clinics of the Carolinas Collaborative completed monthly chart audits using the Quality Improvement Data Aggregator (QIDA). Baseline was December 2020 and implementation occurred January 2021-May 2022. Creation of run charts was later transferred to statistical process control charts. Standard probability or Montgomery rules were used to identify special cause variation. Sites used individual QIDA data to conduct Plan-Do-Study-Act cycles; aggregated data were shared during bimonthly meetings.
A total of 4270 eligible charts were audited, 3430 patients screened and 525 identified as having FI. The rate of FI screening shifted from 68.5% to 86%. The rate of FI identified remained at 15%, and food referrals were consistently offered 90% of the time. While FI diagnostic coding did not reach the 80% goal, there was a shift from 38.3% to 70.5%. The balancing measure remained well below the goal of less than 20% of missed opportunities to discuss positive FI (centreline of 9.5%).
A paediatric academic collaborative QI initiative focused on FI demonstrated collective improvement and allowed for rapid implementation, dissemination and spread.
这项质量改进（QI）计划旨在通过改善北卡罗来纳州和南卡罗来纳州八家儿科学术机构所服务家庭的粮食不安全（FI）识别情况，并将其转介至粮食援助计划，来解决粮食不安全问题。
主要过程指标是对80%符合条件的家庭进行FI筛查并对FI进行编码。结果指标是将80%被确定为有FI的家庭转介至适当资源。平衡指标是将错过转介机会的比率维持在20%以下。改进想法被组织成四个主要关键驱动因素。卡罗来纳州合作组织的八家教学诊所使用质量改进数据汇总器（QIDA）每月进行图表审核。基线时间为2020年12月，实施时间为2021年1月至2022年5月。运行图的创建后来转移到统计过程控制图。使用标准概率或蒙哥马利规则来识别特殊原因变异。各站点使用单独的QIDA数据进行计划-执行-研究-行动循环；汇总数据在双月会议期间共享。
共审核了4270份符合条件的图表，筛查了3430名患者，其中525名被确定为有FI。FI筛查率从68.5%升至86%。确定为有FI的比率保持在15%，并且在90%的时间里都能持续提供粮食转介服务。虽然FI诊断编码未达到80%的目标，但从38.3%升至70.5%。平衡指标远低于错过讨论阳性FI机会少于20%的目标（中心线为9.5%）。
一项专注于FI的儿科学术合作QI计划显示出集体进步，并实现了快速实施、传播和推广。
