Improving Lead Screening Rate by the Use of a Statewide Immunization Registry
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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
Improving Lead Screening Rate by the Use of a Statewide Immunization
Registry
Acknowledgments
Capstone Committee Members:
Preceptorso Jacob L. Bidwell, MDo Dennis J. Baumgardner, MD
Chairo Patrick L. Remington, MD, MPH
Facultyo Susan Zahner, DrPH, RN
Non-committee Members:
o Jeff Havlena
o The Center for Urban Population Health
o Aurora Clarke Square Family Health Center / Aurora UW Medical Group Staff
o Barbara Duerst, RN, MS
o Heather Cote, BA
o D. Paul Moberg, PhD
o Nancy Eberle, MPH
o Bridget C. Booske, PhD
o 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 EBLLso 7.0% of children tested in Milwaukee for lead have EBLLso 8.8% of children tested in the 53204 zip code (Milwaukee)
have EBLLso 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 buildingso Hobbieso Worko Drinking watero Home health remedies
At risk populationso Children under the age of 6 yearso Children from all social and economic levelso Children of some racial and ethnic groups
Lead exposure is very costly to treato $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 populationo 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
MethodsWhat 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 beforeo 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…oCollect baseline lead screening data using chart
reviews, andoEnter 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 Pre-intervention (baseline): 76.9%o Post-intervention: TBD
AUWMG = Aurora UW Medical Group ACSFMC = Aurora Clarke Square Family Health Center
Results (cont.)
Additional results from childhood immunization studyoProcess culturally concordant with majority of patient
populationoObtained feedback from staff on how process
accurately reflects needs of patientoPatients 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 literatureo Dearth of information exists regarding how to increase lead
screening compliance among providerso This project will address gaps in current research by
examining an intervention aimed at increasing lead screening compliance in providers treating a pediatric population
Strengthso Cost effectiveo 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
Limitationso Still collecting data, so results are TBDo Lead screening differs from immunization
Discussion (cont.) Implications for public healthoSystems approach versus individual approacho 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
oThis 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 screeningoLegal regulationsoExpenseoFollow-upoAbatement
Questions?
Staff at Aurora Clarke Square Family Health Center
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