P2.278: Improvement in Lead Screening Rates

Purpose/Objectives: Lead exposure can impact the developing brain of a child, with higher levels linked to reduced cognitive advancement and lower IQ. The AAP recommends that lead risk assessments be performed at each well visit from 6 months to 6 years. The CDC and our regional Medicaid Managed Care Organizations are congruent with APP recommendations and endorse obtaining capillary or venous lead screening at 12 and 24 months of age. Lead screening rates at our practice were previously less than 50%. Our objective was to increase the initial lead screening rate to at least 60% for all patients between the ages of 9 and 24 months during our 8-month study (Apr-Dec 2023).

Design/Methods: This study was completed at a resident-run primary care clinic at a regional safety-net hospital serving low-income families. Data was compiled from well visits between the ages 9 months to 24 months to assess completion of a single lead screening from 2020-2023. Several modifications were implemented via PDSA cycles to help increase lead screening rates. These interventions included increasing visibility by adding MedTox (point of care capillary lead test) screening to appointment face sheets and maximizing our EHR capability by adding MedTox as a default order for specific well child visits at 15, 18 and 24 months. In subsequent PDSA cycles, the changes were reinforced by providing didactic resident education and email communication reminders to all providers. These interventions occurred at different months throughout the total eight months of study duration. Percentage of completed lead screenings were compared to assess for improvement.

Results: Our baseline lead screening rate for the practice was 44%. After the interventions, lead screening rates improved to 60%. There was a 15% increase in lead screening after the first PDSA cycle during which MedTox screening was added to the face sheets as well as added to specific well child visit default order sets. During the second PDSA cycle, which included new residents and attending education, there was an additional 1% increase in lead screening.

Conclusion/Discussion: There was a greater increase in lead screening rates after workflow adjustments compared to the increase following re-education of providers and improvements appeared to be sustained. The primary factor that affected our success was the addition of the MedTox to the default order for specific month well visits. This prompted providers to double check completion of lead screening and order an in-office test if needed. There are areas for further study including the level of appropriate follow up for abnormal lab values and assessing the rates of a second lead screening around 24 months of age. Additional future goals include exploring the differences in lead screening rates based on patient demographics.