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