Transcript Childhood Lead Screening Intervention

Improving Lead Screening Rates
Through The Use of Statewide
Immunization Registry Data
Jacob L. Bidwell, MD
Medical Director, Aurora Clarke Square Family Health
Center
Jared E. Collins, MS, MPH
Center for Urban Population Health
Project Partners:
o
o
o
o
Dennis J. Baumgardner, MD
Jeff Havlena
Elizabeth Albino, RN
The Center for Urban Population
Health
o Aurora Clarke Square Family
Health Center / Aurora UW
Medical Group Staff
Introduction
 Lead is an environmental toxin linked to neurological,
developmental, and behavioral problems in children.
 Screening for elevated lead levels and early intervention
are effective in limiting these effects.
 Sources of lead exposure
o
o
o
o
o
Lead-based paint and lead-contaminated dust found in deteriorated buildings
Hobbies- stained glass work
Occupational
Drinking water
Home health remedies
Background
 Approx. 310,000 U.S. children aged 1-5 years have
blood lead levels (BLLs) greater than 10 mcg/dL, the
level at which the CDC recommends public health
actions be initiated
 In 2009
o 2.9% of children tested in WI for lead have EBLL
o 7.0% of children tested in Milwaukee for lead have EBLL
o 8.8% of children tested in the 53204 zip code (Milwaukee) have
EBLL
o 9.6% of children tested at Aurora Clarke Square Family Health
Center (53204 zip code) have EBLL
Background (cont.)
 At risk populations
 Children under the age of 6 years
 Children from all social and economic levels
 Children of some racial and ethnic groups
 Lead exposure is very costly to treat.
 $43.4 billion annually
 Lead poisoning and its sequelae are preventable.
• Dearth of information exists regarding how to increase lead
screening compliance
Case Example
• 12 month old male
• BLL 10 mcg/dL
• Family moved into old
home (built in 1905) in
Milwaukee suburb at 6
months old
Case Example (Cont.)
• Mother reports
significant time spent
playing on painted
porch floor
• Tested paint found to
be 80% lead by weight
• Home abated
Case Example (Cont.)
• Recheck at 15 months
BLL decreased to 3
mcg/dL
• Levels have remained
low since
• Pt currently doing well
in K4 with no obvious
sequelae
Overview
 Objective: Determine whether the use of a clinic
database using information from a statewide
immunization registry improves lead screening
rates in a residency affiliated community clinic in
Milwaukee, WI.
 Design: Longitudinal cohort study of children age
birth to 84 months .
Instrument
• A clinic lead screening database was developed
including all children between 0 and 6 years of age
who are seen at the Aurora Clarke Square Family
Health Center.
• The database combined information from the
Wisconsin Immunization Registry and the state lead
screening database.
• This was used to identify and track patients needing
lead screening.
Intervention
• Patients were contacted by letter and a follow-up
telephone call every 3 months to arrange screening
based on Milwaukee Public Health Department lead
screening guidelines
• This included children who either needed to be
screened or who had documented EBLL.
Intervention
 Clinic staff checked the responses
received from the letters that were mailed
the month before
o Who has come in for screening?
o Who has a future appointment scheduled?
• Parents who did not respond to the letter
within 1 month received a follow-up phone
call.
Results
Lead Screening Rates
70.00%
Percent
60.00%
8.90%
50.00%
40.00%
10.10%
30.00%
20.00%
9.90%
36.60%
% >9mcg/dL
% normal
47.40% 48.80%
10.00%
0.00%
April
June
Sept
Time (2009)
Results (cont.)
• 12% absolute increase in patients screened
• Yet just over half met lead screening
guidelines in Milwaukee County
• Stable percent with EBLL
• Chi square test with Yates correction = 4.17
• p = 0.041
Discussion
 Strengths of our intervention
 Cost effective
 Utilizes information from a database that is already being used to
track youth immunizations (ease of implementation)
 Intervention poses very low risks to patients
 Limitations
 Lead screening differs from immunization in public perception of
importance
 Clinic manager time to maintain clinic database and generate
letters
Discussion (cont.)
• Our hypothesis that tracking lead screening using statewide
immunization registry data will result in increased lead screening
compliance was confirmed.
 Our short term goal to increase lead screening compliance in
our clinic was successful.
 However, we did not reach our goal of 90% compliance during
the study period reported.
 Similar results had been obtained for immunization rates in
the same setting using a similar tracking system.
 Our long-term goal is to improve adherence to public health
department recommendations county and statewide, using this
public health model.
Conclusion
 Including lead screening data in the statewide
immunization registry may be an effective
intervention to improve lead screening rates in
children.
Thanks
Staff at Aurora Clarke Square Family Health Center