Assessing and Improving WIC Enrollment in the Primary Care Setting: A Quality Initiative.

BACKGROUND AND OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food and other resources to mitigate the harmful effects of food insecurity on child and maternal health. From a 2009 peak, nationwide WIC participation declined through 2020. Our objectives were to understand factors influencing WIC engagement and improve WIC enrollment through novel, primary care-based quality improvement interventions. METHODS: Plan-do-study-act cycles were implemented at a majority Medicaid-insured pediatric primary care clinic. Universal WIC screening at <5-year-old well-child visits was initiated, with counseling and referrals offered to nonparticipants. Clinic providers received WIC education. WIC screening, counseling reminders, and referrals were streamlined via the electronic health record. Families were surveyed on WIC participation barriers. Patient demographic data were analyzed for predictors of WIC participation. RESULTS: Mean new WIC enrollments increased significantly (42%) compared with baseline, with sustained special cause variation after study interventions. Provider WIC knowledge improved significantly at study end (P <.001). Rates of WIC screening, counseling, and referrals remained stable for >1 year after study interventions. The most common family-reported barriers to WIC participation were "Access problems" and "WIC knowledge gap." Factors associated with decreased WIC participation in multivariable analysis were increasing age (P <.001), and non-Medicaid insurance status (P = .03). CONCLUSIONS: We demonstrate feasible primary care-based screening, education, and referral interventions that appear to improve WIC enrollment. We identify knowledge gap and access problems as major potentially modifiable barriers to WIC participation. The expansion of similar low-cost interventions into other settings has the potential to benefit under-resourced children and families.

Clinical Characteristics and Health Outcomes of Neonates Reporting to the Emergency Department With Hypothermia.

OBJECTIVES: Although hypothermia has long been considered a sign of serious bacterial infection (SBI) in neonates, there is a lack of medical literature on this topic, and little is known about the prevalence of serious infection in these patients. Our primary objective was to assess the prevalence and type of serious infection in neonates with hypothermia. Our secondary objective was to describe the prevalence and type of significant pathology overall in this cohort. METHODS: We examined neonates (≤28 days old) evaluated in the emergency department and/or admitted to the hospital with hypothermia over a 3-year period. Demographics and relevant clinical data were extracted from the medical record. Fisher's exact test was used to determine differences in the prevalence of clinical and demographic characteristics in patients with and without a diagnosis of serious infection. RESULTS: Sixty-eight neonates met inclusion criteria, and 63 (93%) were admitted. Of those admitted to the hospital, 5 (7.9%) had a diagnosis of serious infection, including SBI (n = 4) and disseminated herpes simplex virus (n = 1). The types of SBI included urinary tract infection, septicemia, and meningitis. Eighty percent and 60% of neonates with hypothermia and diagnosed with serious infection had a temperature ≤34.4°C and ill appearance, respectively. Significant pathology was found in 9 (14.3%) patients and included both infectious and noninfectious diagnoses. CONCLUSIONS: Neonates presenting with hypothermia have a substantial risk for SBI or other significant pathology. This population merits further investigation; a multicenter prospective study should be conducted to better understand associations between risk factors and outcomes.