Peer-reviewed article
An Electronic Health Record-Based Intervention to Facilitate Primary Care Referrals to the Special Supplemental Nutrition Program for Women, Infants, and Children: Retrospective Cohort Study.
Montez K, Kay MC, Taxter AJ, Lewis KH ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated an electronic health record tool designed to screen children under 5 for eligibility and refer them to the WIC nutrition program during well-child visits in 8 clinics. Among 5,385 children screened, about one-third were not initially enrolled in WIC. When referred, 59% of eligible families accepted the referral, and 61% of those who accepted were successfully enrolled. Enrollment rates varied by family characteristics, with Medicaid-insured, non-Hispanic Black and Hispanic families, and newborns showing higher acceptance and enrollment.
Key points
- 34% of screened children (1,235 of 3,606) were not enrolled in WIC at their first screening
- 59% of referred families (488 of 819) accepted the WIC referral
- 61% of referral acceptors with follow-up data (265 of 438) were successfully enrolled in WIC
- Higher referral acceptance and enrollment rates were observed among non-Hispanic Black and Hispanic families, newborn-aged children, and those with Medicaid coverage
- An EHR-embedded automated screening and referral tool can facilitate nutrition program access and identify disparities in enrollment
Limitations
This is a retrospective cohort study without a comparison group, so it cannot determine whether the EHR tool itself caused the referral and enrollment outcomes compared to standard practice. Follow-up data were not available for all families, reducing the sample size for enrollment analysis.
Abstract
Background Despite the benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), many eligible children remain unenrolled. Objective This study evaluated responses to an electronic health record (EHR)-embedded federal nutrition program (FNP) participation screening and WIC referral tool implemented within 8 clinics during well-child visits for children younger than 5 years of age. Methods Structured EHR data from July 2020 to October 2023 were extracted to summarize screening, referral acceptance, WIC enrollment outcomes, and patient demographics. Multivariable logistic regression was used to examine patient-level predictors of WIC nonenrollment at the first screening, referral acceptance, and enrollment among those accepting a referral, with analyses stratified by clinic type. Results Among 5385 children, 51.8% (n=2785) were newborn-aged, 36.6% (n=1969) were Hispanic, and 87.8% (n=4726) were Medicaid-insured. The mean age at the initial screening was 10.7 (SD 14.2) months. Among screened patients (n=3606), 34% (n=1235) were not enrolled in WIC at the first screening. Medicaid coverage, an academic clinic setting, non-Hispanic Black or Hispanic race, and ethnicity were associated with lower odds of WIC nonenrollment. Among those not enrolled with a documented response to referral (n=819), 59% (n=488) accepted the referral. Acceptance was higher among non-Hispanic Black and Hispanic patients, newborn-aged patients, those with Medicaid coverage, and those seen in academic clinics. Among referral acceptors with follow-up (n=438), 61% (n=265) were enrolled at the last screening, with higher odds among newborn-aged patients and those in academic clinics. Conclusions An EHR-based automated intervention can facilitate screening and referral to WIC. WIC participation at the first screening, referral acceptance, and enrollment after referral varied by sociodemographic characteristics, suggesting opportunities to improve equitable access through health care system-based approaches.