Improving Lead Screening Rates Through The Use of Statewide Immunization Registry Data

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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

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Project Partners

• Dennis J. Baumgardner, MD
• Jeff Havlena
• Elizabeth Albino, RN
• The Center for Urban Population Health
• Aurora Clarke Square Family Health Center /
  Aurora UW Medical Group Staff

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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
• Lead-based paint and lead-contaminated dust found
  in deteriorated buildings
• Hobbies- stained glass work
• Occupational
• Drinking water
• Home health remedies

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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
• 2.9 of children tested in WI for lead have EBLL
• 7.0 of children tested in Milwaukee for lead
  have EBLL
• 8.8 of children tested in the 53204 zip code
  (Milwaukee) have EBLL
• 9.6 of children tested at Aurora Clarke Square
  Family Health Center (53204 zip code) have EBLL

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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

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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

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Case Example (Cont.)

• Mother reports significant time spent playing on
  painted porch floor
• Tested paint found to be 80 lead by weight
• Home abated

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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

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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 .

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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.

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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.

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Intervention

• Clinic staff checked the responses received from
  the letters that were mailed the month before
• Who has come in for screening?
• Who has a future appointment scheduled?
• Parents who did not respond to the letter within
  1 month received a follow-up phone call.

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Results
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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

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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

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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.

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Conclusion

• Including lead screening data in the statewide
  immunization registry may be an effective
  intervention to improve lead screening rates in
  children.

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Thanks
Staff at Aurora Clarke Square Family Health Center