Transcript Childhood Lead Screening Intervention
Improving Lead Screening Rate by the Use of a Statewide Immunization Registry
Jared E. Collins, MS MPH Candidate Master of Public Health Program Dept. of Population Health Sciences University of Wisconsin School of Medicine and Public Health Spring Public Health Symposium Fluno Center May 8, 2009
Acknowledgments
Capstone Committee Members: Preceptors o Jacob L. Bidwell, MD o Dennis J. Baumgardner, MD Chair o Patrick L. Remington, MD, MPH Faculty o Susan Zahner, DrPH, RN o o o o o o Non-committee Members: o o Jeff Havlena The Center for Urban Population Health o Aurora Clarke Square Family Health Center / Aurora UW Medical Group Staff Barbara Duerst, RN, MS Heather Cote, BA D. Paul Moberg, PhD Nancy Eberle, MPH Bridget C. Booske, PhD 2006-08 MPH Entering Classes
Outline
Introduction/Background Overview Methods Results Discussion Conclusion Question & Answer
Introduction/Background
Approx. 310,000 U.S. children aged 1-5 years have blood lead levels (BLLs) greater than 10 micrograms per deciliter of blood (10 μg/dL), the level at which the CDC recommends public health actions be initiated In 2006, 1.21% of children tested in U.S. for lead had confirmed elevated blood lead levels (EBLLs) In 2009… o 2.9% of children tested in WI for lead have EBLLs o 7.0% of children tested in Milwaukee for lead have EBLLs o 8.8% of children tested in the 53204 zip code (Milwaukee) have EBLLs o 9.6% of children tested at Aurora Clarke Square Family Health Center (53204 zip code) have EBBLs
Introduction/Background
(cont.)
Sources of lead exposure o Lead-based paint and lead-contaminated dust found in deteriorated buildings o Hobbies o Work o Drinking water o Home health remedies At risk populations o
Children
under the age of 6 years o
Children
from all social and economic levels o
Children
of some racial and ethnic groups Lead exposure is very costly to treat o $43.4 billion annually Lead poisoning is entirely preventable
Overview
Clinical quality improvement project Purpose: To determine the effect of including lead screening in a statewide immunization registry on rates of recommended lead screening in an urban community clinic in Milwaukee (53204 zip code) Cohort study of children age birth to 6 years
Overview
(cont.)
Problem: Health care providers are missing opportunities to screen children who are at high risk for EBLLs Hypothesis: Tracking lead screening in a statewide immunization registry will result in increased lead screening compliance among providers in patients age birth to six years Short-term goal: To increase lead screening compliance in providers treating a pediatric population o Goal: 90% compliance Long-term goal: To utilize the Wisconsin Immunization Registry (WIR) to track child lead screening rates and thus improve adherence to professional recommendations
Methods
What did we do?
Conducted a literature search of the adverse health effects of childhood lead exposure/poisoning Developed a lead screening database of children between 0 and 6 years of age who are seen at the Aurora Clarke Square Family Health Center Mailed a bilingual (English/Spanish) letter to the parents of children who either need to be screened or who have EBLLs What will we do?
Clinic staff will check 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 already set up?
Parents who didn’t respond to the letter will receive a follow-up phone call
Methods
(cont.)
If the intervention is successful (i.e., if we reach our goal of 90% compliance), we hope to… o Collect baseline lead screening data using chart reviews, and o Enter the lead screening information from chart reviews into the WIR As children come to the clinic to be immunized, providers can use data from the WIR to determine their need for lead screening
Results
Recently began collecting lead data, so the results are still TBD… However, this lead project is based on a similar study focused on improving childhood immunization rates in Milwaukee Results from this lead screening project are expected to be similar o o Pre-intervention (baseline): 76.9% Post-intervention: TBD AUWMG = Aurora UW Medical Group ACSFMC = Aurora Clarke Square Family Health Center
Results
(cont.)
Additional results from childhood immunization study o Process culturally concordant with majority of patient population o Obtained feedback from staff on how process accurately reflects needs of patient o Patients demonstrated more interest in making sure their children were up-to-date with their immunizations Again, expecting similar results
Discussion
Relation of findings to existing literature o Dearth of information exists regarding how to increase lead screening compliance among providers o This project will address gaps in current research by examining an intervention aimed at increasing lead screening compliance in providers treating a pediatric population Strengths o Cost effective o Utilizes a database that is already being used to track youth immunizations (ease of implementation) o Intervention poses very low risks to patients and is efficient for clinic use Limitations o Still collecting data, so results are TBD o Lead screening differs from immunization
Discussion
(cont.)
Implications for public health
o Systems approach versus individual approach o Increased compliance to lead screening recommendations and early detection of EBLLs in children could… Improve future health outcomes for children Help parents identify and eliminate causes of potential lead exposures in child’s environment Alert providers to potential health problems a child may face and ensure adequate treatment for their exposure Increase likelihood that patients, as a whole, will be screened o This research will add data to the limited number of studies that have suggested innovative office practices that can contribute to increased adherence to lead screening guidelines
Conclusion
Expect similar results Recognize differences between immunizations and lead screening o Legal regulations o Expense o Follow-up o Abatement
Questions?
Staff at Aurora Clarke Square Family Health Center