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2023 HSR&D/QUERI National Conference Abstract

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1122 — Contextualizing Findings from an Updated VHA Food Insecurity Clinical Reminder

Lead/Presenter: Alicia Cohen,  COIN - Providence
All Authors: Cohen AJ (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University Medical School and School of Public Health), Thomas, KS (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University School of Public Health) Rudolph, JL (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University Medical School and School of Public Health) Halladay, CW (Center of Innovation in Long Term Services and Supports, VA Providence) Haigh, S Center of Innovation in Long Term Services and Supports, VA Providence) Heisler, M (Center for Clinical Management Research, VA Ann Arbor; University of Michigan Medical School and School of Public Health) Dosa, DM (Center of Innovation in Long Term Services and Supports, VA Providence; Brown University Medical School and School of Public Health)

Objectives:
The Veterans Health Administration (VHA) has been conducting universal screening for food insecurity since 2017. In April 2021, VHA updated the food insecurity clinical reminder from a single, non-validated question to a validated two-question screener. It is unknown if this change in screening instruments affected identified prevalence or correlates of food insecurity among Veterans screened, and if so how.

Methods:
Using the VA Corporate Data Warehouse, we examined: 1) the prevalence of reported food insecurity between March 2020-March 2021 (old clinical reminder) and April 2021-April 2022 (new clinical reminder) across VA facilities nationally, and 2) sociodemographic, medical, and psychosocial characteristics associated with a positive food insecurity screen during each of these time periods. Multivariable logistic regression models were separately estimated for the old and new screeners to identify correlates of food insecurity with each instrument.

Results:
During the final 14 months of the old clinical reminder, 2,409,493 Veterans were screened for food insecurity. Of these, 25,099 screened positive (1.0%). During the first 14 months of the new clinical reminder, 2,827,319 Veterans were screened for food insecurity, of whom 56,967 screened positive (2.0%). Sociodemographic, medical, and psychosocial characteristics of those screened were comparable across study periods for the old versus new screeners (SMDs all < 0.05). For both screeners, food insecurity was significantly associated with identifying as American Indian/Alaskan Native, Non-Hispanic Black, Hispanic, and Native Hawaiian/Pacific Islander, as well as being non-married/partnered, low-income and non-service connected, experiencing housing instability, and mental health and/or trauma-related comorbidities including depression, PTSD, history of military sexual trauma, and intimate partner violence. The new screener was more likely to identify as food insecure women (2.9% with the new screener vs 1.3% with the old screener) and those with a history of intimate partner violence in the prior 12 months (6.3% vs 3.0%).

Implications:
The rate of reported food insecurity with the new clinical reminder, while still low, doubled compared with the old reminder. Approximately 28,000 more Veterans screened positive for food insecurity in the first 14 months of the new screener who may have otherwise not been identified. Early findings suggest that the new clinical reminder may also be more likely to identify food insecurity among certain high-risk Veteran populations including women and those with a history of intimate partner violence. Future work is needed to better understand variation in how screening is administered, if certain Veterans experiencing food insecurity may remain unidentified, and if so who and why.

Impacts:
Accurately identifying food insecurity is a critical to connecting Veterans with needed services, developing tailored interventions for those at highest risk, and informing future resource allocation within VHA in order to reduce health disparities and improve health equity.