PROJECT MANAGEMENT PLAN – Utilization of Community Resources to Address Food Insecurity in a Federally Qualified Health Center
Vision StatementOur vision is to have a diverse community outreach program that will reduce food insecurity while being a model that others can emulate.
Team ObjectivesOur team objectives were as follows:

  • Identify the prevalence of food insecurity at our practice site

  • Initiate a triage/referral system to link patients with food resources

  • Coordinate the distribution of food boxes


Our project assumptions were as follows:

  • Our patient population lives in Desert Mission Food Bank serviceable ZIP codes

  • Patients can read and understand the 2-question food insecurity screening tool

  • Patients can be contacted and have the means to obtain food boxes


Our measures of success were as follows:

  • Implementation of a food insecurity screening program with a screening rate >40%

  • Identification and referral of patients identified as food insecure

Success FactorsThe most successful part of our work was implementing a simple tool that has uncovered a significant healthcare disparity in our patient population (food insecurity). We were inspired by the alarming number of individuals who are food insecure in our community.
BarriersThe largest barrier encountered was engaging patients and physicians to consistently complete the 2-question food insecurity screening tool at every office visit. We worked to overcome this challenge by integrating this screening tool into our EHR to identify patients who have already been screened. We decreased the frequency of screening to every 6 months and will continue to reevaluate the process and make adjustments to the workflow.
Lessons LearnedThe most important advice to provide another team embarking on a similar initiative is (1) to have an established form of documentation of screening questions prior to starting the initiative, preferably embedded into each patient’s EHR; (2) to try to collaborate with a food distributor prior to kicking off your food insecurity screening tool so that resources will be available for those in need at the time of diagnosis; (3) to find creative methods to consistently engage providers and patients to complete the questionnaire while also identifying EHR tools to mainstream and standardize the questionnaire.