Implementing Food and Nutrition Security Screening in EPIC and Clinical Care at Tufts

Food insecurity and nutrition insecurity refer to the inability to access and afford enough food, and enough food that promotes well-being and prevents disease, respectively, on a regular basis for all members of a household. Food insecurity is associated with poor diet quality, poor health overall and high health care costs; these outcomes are experienced disproportionately by marginalized and vulnerable populations. In 2021, 32% of Massachusetts adults experienced food insecurity.

Providers do not currently have access to this information about their patients in a uniform and regularly collected manner. Our project will advance the ability to utilize the electronic health record to identify food insecure and nutrition insecure patients, and to advance the science and future study of food-based interventions in health care. The key product of this project will be the creation and integration of a successful workflow protocol for food and nutrition insecurity screening tools within Tufts Medicine’s electronic health record platform EPIC as well as via the Tufts Medicine patient portal.

The translational pathway will be based on (1) identifying best practices for streamlining clinical workflow to include screeners; (2) expanding those successful screening practices across departments and practices (e.g. family medicine, maternal and infant health, pediatrics, cardiology, etc.); (3) having reliable data for research that can explore associations between positive screens and health outcomes, health care utilization and cost, and ultimately; (4) improving nutritional status and patient health through resource referral and related research. We will also work to identify the next departments within Tufts Medicine to replicate these efforts.

Aim One

Integrate a patient portal screening tool for food and nutrition security into the clinical workflow at Tufts Medicine.

Aim Two

Assess the feasibility of the tool through screening completion rates and qualitative feedback from clinic staff and patients.

Aim Three

Report the prevalence of food/nutrition insecurity among a sample of patients, including concordance between the two constructs.