006 - Improving Childhood Lead Screening Rates at a Community Federally Qualified Health Center

Publication Number: 6.5421

Christopher H. Kim, University of California, Davis, School of Medicine, Sacramento, CA, United States; Sofia Devers, UC Davis, Sacramento, CA, United States; Erik Fernandez y Garcia, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Lead poisoning remains a costly and preventable environmental health risk to children, especially those in poverty. In California, screening rates for lead exposure remain well below pre-pandemic levels. We present results from a resident-driven quality improvement project aiming to increase rates of blood lead testing among pediatric patients at a resident continuity clinic within Sacramento Native American Health Center (SNAHC), a Federally Qualified Health Center serving a diverse, primarily minoritized, 100% publicly insured patient population located in one of the region’s most underserved areas.

Objective: We aimed to increase primary lead screening rate, defined as the percent of patients 1-2 years old with ≥1 completed blood lead level test (BLL), from 22.1% to 35% over a 16-month period.

Design/Methods: The proportion of SNAHC patients aged 1-2 with ≥1 BLL (point-of-care (POC) or lab order) at time of project start determined the baseline primary screening rate. Missed opportunities to schedule well-child visits, failure to order any BLL, POC test unavailability, compliance with lab appointments, and competing visit priorities were identified as barriers to screening.
We established a recall/outreach list of patients in whom a lab BLL was ordered due to POC testing being unavailable, or an elevated POC level required follow-up. Weekly review of the list ensured lab orders had resulted and if not, families were contacted to encourage completion. Outreach efforts for timely well-child scheduling were also initiated. A resident champion was designated each week to preview schedules, anticipate screening needs, remind care teams to order BLLs, and perform recall list outreach.

Results: Over 11 months, our primary screening rate increased from 22.1% to 35.5%. The population of patients aged 1-2 ranged from 112-125 during this time.
Increased clinic attention to lead screening led to more BLLs ordered for children beyond the primary screening age. We therefore defined a secondary measure of catch-up BLL screening rate in patients 2-6 years old, which increased from 9% to 12.7% over 7 months.

Conclusion(s): We improved our primary lead screening rate to 35.5%, on par with California’s 34.5% for children on Medicaid. Having the ability to complete BLL testing immediately during an encounter was crucial to improving our screening rates, adding to the body of evidence that requiring additional follow-up for primary care and preventive services (e.g. immunizations, contraception, connection to mental health services) leads to missed opportunities to provide those services.

Figure 1: Primary and Catch-up Lead Screening Rates
Primary lead rate defined as percentage of patients ages 1-2 years old enrolled at SNAHC with ≥1 blood lead level (POC test or lab order). Catch-up lead screening rate (shaded inset, data tracking started 4/1/24) defined as percentage of patients ages 2-6 years old enrolled at SNAHC with ≥1 blood lead level (POC test or lab order).