Application of quality-improvement methods in a primary care clinic increased ability to effectively screen and positively identify households with food insecurity in this population.

FI and formula stretching were common, even among families receiving public benefits. Many families were cautious about using generic formula.

With discouragingly low vaccination rates for human papillomavirus (HPV), we sought to improve the HPV vaccine completion rate for adolescents by increasing the consistency and quality of provider recommendations. Baseline data was extracted for vaccine completion rates among patients aged 13 to 17 years. Quality improvement measures led to interventions targeting factors associated with vaccine noncompletion, in particular, weaknesses in provider recommendations and patient characteristics most strongly correlated with missed vaccination opportunities. Vaccine completion rates increased overall from 50.9% to 61.7% ( P < .05), an increase seen in both males (42.6% to 57.3%, P < .001) and females (60.0% to 66.5%, P = .04). One-dose rates improved to 88.4% for males ( P = .02) and 91.5% for females ( P = .43). Vaccination also occurred more consistently, increasing from 77.5% of visits (95% CI 71.2-83.0) before study onset to 90.9% of visits (95% CI 85.4%-94.8%) afterward ( P < .01). HPV vaccination rates can increase through focused provider-level prompts and by offering the vaccine consistently.

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Residents who practiced in continuity clinics with increased social and legal resources were more confident in their knowledge and screened for social determinants of health more frequently.