004 - Evaluating the Impact of a Centralized Lead Team on Blood Lead Levels and Social Determinants of Health

Caitlin K. Hoffman, Medical College of Wisconsin, Milwaukee, WI, United States; John R. Meurer, Medical College of Wisconsin, Elm Grove, WI, United States; Anastasia Brennan, Children's WI, Milwaukee, WI, United States; Diana Barany, Children's Hospital of Wisconsin, Waukesha, WI, United States; Heather Paradis, Children's Wisconsin, Milwaukee, WI, United States; Kathy Szopinski, Children's Hospital of Wisconsin, Wauwatosa, WI, United States; Amy Kastens, Children's Hospital of Wisconsin, Germantown, WI, United States

Background: Lead toxicity poses severe and irreversible health risks with significant concerns for children in Milwaukee where aging housing stock increases the likelihood of environmental lead exposure. Children’s Wisconsin has established a Centralized Lead Team (CLT) to identify children with elevated blood lead levels (BLLs) in primary care settings and coordinate necessary follow-up.

Objective: This project represents the first phase of a two-part quality improvement study. Through quantitative and qualitative analysis, it seeks to identify the strengths of the program and highlight areas for potential improvement. Key objectives include analyzing the demographics of the population served, assessing rates of social determinants of health (SDOH) screenings and the percentage of positive screens, and examining metrics such as screening rates and reductions in BLLs.

Design/Methods: Quantitative analysis examined the demographics of families interacting with the CLT, SDOH screening rates and outcomes, and the average length of time from initial point-of-care testing to confirmatory venous testing. Additional metrics included the percentage of children without confirmatory tests due to missed or canceled appointments and the overall reduction in BLLs among the CLT patient panel. The study further compares children served by the CLT to a similar control group of children with elevated initial BLLs who share the same primary care office but were not enrolled in the CLT program.

Results: The results revealed a diverse patient population with notable differences in SDOH needs and lead levels. Screening rates and positive SDOH screens were higher among CLT children than in the control group. Whereas only 30% of children in the control group reported at least one SDOH need, nearly half of the children in the CLT reported one or more needs, with almost one-third reporting two or more needs. Additionally, the average initial BLL was higher in CLT patients (8.3 μg/dL) compared to the control group (5.2 μg/dL). Approximately 30% of CLT children with elevated initial results did not receive confirmatory testing. Among those tested, over half of the CLT children continued to exhibit elevated lead levels, compared to 18% in the control group. For CLT patients completing at least two tests, there was an absolute reduction in BLL of 1.54 μg/dL, reflecting a 19% overall reduction.

Conclusion(s): This analysis highlights CLT’s successes over its first 18 months, showcasing reductions in BLLs and the identification of significant SDOH needs among patients, underscoring the CLT’s valuable role in public health and pediatric care.

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Figure 1: Social Determinant of Health Screening Rates, Positive Screens, and Number of Uncovered Needs
PAS Figure 2.pdfFigure 1A shows the proportion of families screened while Figure 1B reveals the proportion of positive screens in each SDOH domain and Figure 1C depicts the number of needs uncovered for those families screened for the Centralized Lead Team (CLT) panel as well as the control group.

Table 2: Key Lead Testing Metrics
PAS Table 2 CLT.pdfTable 2 reveals key lead testing metrics for children on the Centralized Lead Team (CLT) from its initiation in 2022 through testing as of April 2024 as compared to children in the control group.