Screening for Food Insecurity in an Outpatient Ophthalmology Clinic: A Health Equity- Quality Improvement Fellowship Project

Background: Various social determinants of health have been implicated in ophthalmic diseases, with food insecurity being particular important, given the link between food and conditions such as diabetic and hypertensive retinopathy. Although quality improvement initiatives that address food insecurity screening exist, data extending to the ophthalmic clinical setting is limited. Purpose: We implemented a health equity quality improvement fellowship project to improve screening for food insecurity in an urban ophthalmology outpatient clinic that sees adults and children. Methods: Several initiatives were implemented in an attempt to reach a goal of 80% of patients screened for food insecurity. Project initiatives included improving the patient visit flow to incorporate screening, training clinic staff and providers on this new process, and introducing an onsite food pantry. Various quality improvement tools were employed, such as a current state process map, a cause-and-effect diagram, a key driver diagram, and infographics for patient education. Results: Weekly screening for food insecurity increased from 60% to 70% to exceeding the 80% goal. Improvements and refinements were made until special cause variation was reached. Conclusion: This novel health equity–quality improvement project served as a model for improving social determinants of health screening in ophthalmologic settings and also as a model for work that can be done through health equity or quality improvement fellowships.