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 Dennis J. Baumgardner, MDo Jeff Havlenao Elizabeth Albino, RNo The Center for Urban Population

Healtho 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 exposureo Lead-based paint and lead-contaminated dust found in deteriorated buildingso Hobbies- stained glass worko Occupationalo Drinking watero 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 2009o 2.9% of children tested in WI for lead have EBLLo 7.0% of children tested in Milwaukee for lead have EBLLo 8.8% of children tested in the 53204 zip code (Milwaukee) have

EBLLo 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 beforeo 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

36.60%47.40% 48.80%

10.10%

8.90% 9.90%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

April June Sept

Time (2009)

Pe

rce

nt

% >9mcg/dL% normal

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