U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force (USPSTF) has published their final study plan for review of the research on food insecurity screening in health care. The plan proposes to answer the following questions:
Does identifying food insecurity in healthcare improve health outcomes?
What is the performance of risk assessment or screening tools to identify food insecurity?
What are the harms or unintended consequences of assessment for food insecurity?
What is the effect of healthcare-related interventions to address food insecurity on food security, intermediate outcomes, or health outcomes?
What are the effects of improvements in food security outcomes on intermediate and health outcomes?
What are the effects of improvements in intermediate outcomes on health outcomes?
What are the harms or unintended consequences of healthcare-related interventions to address food insecurity?
Bi-State Primary Care Association submitted comments on the draft plan expressing concern that the implementation of food insecurity screening in health care is so disparate, with system maturity poorly defined in published studies, that it is not possible to draw useful conclusions around the proposed key questions. A recently published review of social risk screening studies reached a similar perspective on the state of literature available to review.
Bi-State comments also observed that food insecurity is linked to both prevention activities and treatment for a range of conditions, and that different health care systems may be placing food in the context of clinical activities while others center it in community health work. Without distinguishing the original intent of the program it is difficult to compare health outcome results.
The USPSTF made the following modifications in response to public comment:
A draft Research Plan was posted on the USPSTF website for public comment from February 22 to March 21, 2022. In response to public comment, the USPSTF added a few additional outcomes to KQs 1 and 4, including food access, clinical decision making, and patient adherence. The USPSTF also added moderators of benefits and harms of assessment/screening (in addition to interventions) to CQ3 and added “facilitators” in addition to barriers for CQ6 and CQ7. A few commenters asked for inclusion of interventions to address food insecurity beyond the scope of the USPSTF. The USPSTF added a section, “Approach to Assessing Health Equity and Variation in Evidence Across Populations,” that addresses how the review would address health equity, heterogeneity by population, as well as heterogeneity of screening or interventions for food insecurity. Last, the USPSTF made minor clarifying changes to the questions and inclusion criteria.
The next step in the research process will be posting a draft recommendation and draft evidence review for public comment.