Ask Two Questions, Walk Them Down the Hall: Disseminating a Food Insecurity Screening and Referral Project to Primary Care Leaders
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP880: DNP Project
Instructor Name
Month Day, Year
Slide 2: Why Food, in a Diabetes Clinic
About one in five adults with diabetes in a Massachusetts clinic study reported food insecurity
Food insecurity is linked with poorer glycemic control
Our clinics documented food access at 6 of 100 diabetes visits
Speaker notes: I want to start with a patient pattern many of you will know: the insulin dose adjusted again and again for someone whose real problem is that food runs out at the end of the month. In a Massachusetts study that randomly sampled 411 diabetes patients across four clinics, 19.1 percent reported food insecurity, and it was associated with poor diabetes control (Berkowitz et al., 2015). At our composite health center, a chart review found food access documented at 6 of 100 diabetes visits. We were not asking, so we could not help.
Slide 3: What We Changed
Two validated questions at rooming, after the depression screen
Positive screen: the community health worker comes to the room before the patient leaves
Electronic referral to the regional food bank
Follow-up call at two weeks
Speaker notes: The change was deliberately small. Medical assistants asked two questions about the past year, whether the household worried food would run out and whether food ran out with no money to buy more. In its validation study, an affirmative answer to either had 97 percent sensitivity for household food insecurity (Hager et al., 2010). Patients who answered yes met a community health worker before leaving, who made a direct electronic referral to the food bank and called two weeks later.
Slide 4: How We Tested It
Four PDSA cycles over 16 weeks, two clinics
Each cycle: one question, one numeric prediction
Weekly run charts reviewed at a 20-minute team meeting
Speaker notes: We did not roll this out; we tested it. Each of four cycles asked one question: can the questions fit into rooming, does the handoff work, do patients reach food, and does it spread to a second clinic. Each cycle had a prediction in numbers, so that we could be wrong in a way we could see. The team met for 20 minutes every Tuesday with the week's run charts.
Slide 5: What Changed Along the Way
Questions moved after the depression screen
Phone handoff within 48 hours when the worker was busy
Produce boxes delivered to the clinic for patients without transportation
Speaker notes: Three parts of our final workflow were not in the original plan. In the first cycle, placing the food questions after the depression screen made them feel less abrupt. In the second, roughly a third of patients who screened positive left before the in-person meeting, so we added a phone handoff. In the third, transportation was the most common reason people did not get food, and the food bank began delivering produce boxes to the clinic monthly. Every one of these changes came from our data, which is the main lesson I would pass on.
Slide 6: Screening Results
Baseline weekly median: 5 percent
Final four weeks: 89 percent (clinic 1), 86 percent (clinic 2)
Few declines: about 3 in 100 screened visits
Speaker notes: At the first clinic, every weekly point after screening began sat above the baseline median, which meets the run chart definition of a shift (Perla et al., 2011). The second clinic reached 86 percent, but it started in week 12, and five weekly points are one short of what the shift rule needs. I report that honestly because it is a timing limitation, and because I promised to judge the data by rules set in advance. Very few patients declined.
Slide 7: The Referral Cascade
164 patients screened positive
142 referred (131 same day, 11 by phone)
86 received food within two weeks: 60.6 percent of referred
Speaker notes: This slide is the one to remember. Of 164 patients who screened positive, 142 were referred, and 86 received food within two weeks. That met our target of 60 percent, but it also shows where people were lost. The biggest drop was after the visit: 24 referred patients could not be reached by phone, and 21 reported trouble with transportation.
Slide 8: Did It Slow the Clinic?
Early weeks: visits about 90 seconds longer
Later weeks: under one extra minute
Below our two-minute balancing threshold
Speaker notes: The first question medical assistants asked us was whether this would make their mornings longer. The added time was about 90 seconds at first and then settled below a minute above baseline, within the limit we set before starting. Tracking this balancing measure every week helped keep staff trust.
Slide 9: A1c: An Honest Answer
97 of 164 positive-screen patients had two A1c values
Mean 9.1 to 8.9 percent; not statistically significant
Observation only: no comparison group, short follow-up
Speaker notes: People always ask about A1c. Among patients who screened positive and had two values, the mean fell by two tenths of a point, to 8.9 percent, and that difference could easily be chance. With 16 weeks, no comparison group, and many patients missing a second value, we cannot say the project changed glycemic control. What it changed was whether we knew about the problem and did something about it.
Slide 10: What Patients Said
Most comments were positive
Several said no one had asked before
Barriers: phone numbers changed, bus routes, distribution hours
Speaker notes: Our community health worker recorded comments that patients volunteered at the follow-up call. Most were positive, and several patients said this was the first time anyone at a clinic had asked them about food. The complaints were practical: phones disconnected, bus routes that did not reach the food bank, and hours that conflicted with work. Those comments pointed us to the next change we will test, a text reminder before the follow-up call.
Slide 11: What It Takes to Copy This
A community partner that accepts direct referrals
A named person who meets patients the same day
Two fields in the rooming template and a weekly report
About 14 hours of staff training time
Speaker notes: If you want to try this at your site, the list is short. You need a food partner willing to accept referrals and ideally deliver, a person who can meet patients during the visit, a place in your rooming template for two answers, and a report your team can read weekly. Training took about 14 hours of staff time in total. Do not screen until the referral pathway is working; asking about hunger without offering help does harm.
Slide 12: Sustainment and Next Steps
Screening rate now on the monthly quality dashboard
Spread to three more clinics next quarter
Next test: text reminder before the follow-up call
Speaker notes: The project has ended, but the workflow has not. The nurse manager owns it, screening is on the quality dashboard, and the quality committee has approved spread to the remaining three clinics. The full report follows the SQUIRE 2.0 guidelines so that others can judge what might transfer to their setting (Ogrinc et al., 2016). Thank you, and I am glad to share the workflow and the referral form.
References
Berkowitz, S. A., Meigs, J. B., DeWalt, D., Seligman, H. K., Barnard, L. S., Bright, O.-J. M., Schow, M., Atlas, S. J., & Wexler, D. J. (2015). Material need insecurities, control of diabetes mellitus, and use of health care resources: Results of the Measuring Economic Insecurity in Diabetes study. JAMA Internal Medicine, 175(2), 257-265. https://doi.org/10.1001/jamainternmed.2014.6888
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., de Cuba, S. A. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26-e32. https://doi.org/10.1542/peds.2009-3146
Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411
Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895
How this DNP 880 Module 8 example is structured
DNP880 ends with the final project paper and a dissemination piece. Aspen does not publish module deliverables, so check your classroom for the format your faculty expect, such as a poster, slides or a manuscript. This example builds slides for an audience that might adopt the change, with results against targets, the limits stated plainly and a replication checklist.
DNP880 Module 8 questions, answered
What does DNP880 Module 8 usually ask for?
The final part of the DNP project course typically asks for a dissemination piece, such as a presentation, poster or manuscript, that shares the project with an audience outside the course. Aspen does not publish module deliverables, so your classroom's instructions govern.
What should a DNP dissemination presentation include?
The problem, the change, how it was tested, results against targets, what did not work, limitations and what another site would need to copy it, pitched to the audience that might adopt it.
Should I include results that were not significant?
Yes. Report them plainly with the design's limits. Audiences trust a project more when it states what it could not show.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.