Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Nov 11, 2025
Date Accepted: May 8, 2026
Date Submitted to PubMed: May 8, 2026
An Electronic Health Record-based Intervention to Facilitate Primary Care Referrals to WIC: A Retrospective Cohort Study
ABSTRACT
Background:
Despite benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), many eligible children remain unenrolled. Primary care clinics are uniquely positioned to counsel patients about WIC, facilitate WIC referrals, and encourage enrollment during standard discussions about nutrition at well visits.
Objective:
This study sought to: (1) evaluate an electronic health record-based (EHR) federal nutrition program (FNP) participation screening and WIC referral tool, and (2) examine patient-level correlates of screening, referral, and enrollment responses.
Methods:
An automated, EHR-embedded FNP participation screening and WIC referral tool was implemented within eight clinics during <5-year-well visits. Structured data were extracted and summarized for screening, referral and enrollment responses and demographics between 7/2020-10/2023. To understand predictors of these responses, we conducted multivariable logistic regression to model these outcomes.
Results:
5,385 children had FNP screening for 1 visit and complete demographics. Mean age at initial screening was 0.9 years (SD +/- 1.2), 52% were male, 37% Hispanic, 76% English-speaking and 88% Medicaid-insured. Patients with non-Medicaid insurance, non-academic clinic attendance, and non-Hispanic White race were less likely to be enrolled in WIC at baseline (all p<.001). Among those who were offered a WIC referral and a response was documemented (n=819), 60% accepted WIC referral (n=488) and were more likely to be non-Hispanic Black or Hispanic (p<.001 and p=.011, respectively), Spanish speaking (p=.038), Medicaid-insured (p<.001), newborn (p<.001) and academic clinic patients (p<.001). Among those accepting referral, 54% were enrolled in WIC at follow-up (n=265). Newborns and academic clinic patients were more likely to become WIC enrolled (p<.001).
Conclusions:
An EHR-based automated intervention tool can facilitate screening and referral to WIC; WIC enrollment at first screening, referral acceptance, and enrollment after referral varied by sociodemographic factors. Clinical Trial: NA
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