046 - Lead the Way: How Point-of-Care Testing is Keeping Our Kids from Going Off the Rails!
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 46.5974
Swetang J. Shah, Bay Area Community Health, Fremont, CA, United States; Pallavi R. Bollapragada, Bay Area Community Health, San Jose, CA, United States; Anupriya Anadure, Bay Area Community Health, Fremont, CA, United States; Aparna Arun, Bay Area Community Health, Fremont, CA, United States; Harsha Ramchandani, Bay Area Community Health, Fremont, CA, United States
Clinical Adjunct Professor AT Still University, Duke School of Nursing San Jose, California, United States
Background: Lead exposure remains a significant public health concern, particularly in children living in underserved communities. Early detection through blood lead screening is crucial for timely intervention and prevention of long-term irreversible neurodevelopmental and physical health effects in children, such as low intelligence quotient, learning difficulties, poor attention span, hearing loss, and anemia. Point-of-care (POC) testing for lead screening offers potential advantages in accessibility and rapid results for timely intervention. Objective: This quality improvement study aimed to evaluate the impact of implementing POCT lead screening in an urban underserved population, comparing pre- and post-implementation outcomes and providing descriptive data for lead screening Design/Methods: This longitudinal study aimed to enhance lead screening rates in pediatric primary care settings serving a predominantly low-income, minority immigrant population in Santa Clara County. The primary objectives were to improve lead screenings at 12- and 24-month well visits and extend screening for refugees and immigrants up to 6 years of age. The initiative utilized Point-of-Care (POC) testing and the Plan-Do-Study-Act (PDSA) cycle to achieve these goals. The study design incorporated a 15-month baseline data collection period prior to POC testing implementation, followed by a 15-month post-implementation data collection phase. The intervention was initially piloted in one clinic before gradual expansion to other clinics. Results: Post-implementation, 40% of lead screenings were POC tests, with a 10% increase in elevated blood lead levels detected. Screening rates rose by 60% for ages 0-2 and 50% for ages 2-6. Results time decreased from 3 days to under 10 minutes, significantly improving patient satisfaction. Of abnormal POC tests confirmed by VBL, 2.5% were truly abnormal. However, 26.6% of patients didn’t complete the confirmation VBL follow-up
Conclusion(s): Point-of-care (POC) lead screening in pediatric primary care settings serving an underserved population has significantly improved screening rates and efficiency for underserved urban populations. This approach, combining POC testing with provider education and quality improvement methods PDSA), effectively addresses health disparities in vulnerable populations. Future efforts should improve follow-up compliance with venous blood lead levels, reduce false positives, and expand the model to other underserved communities to enhance early detection and prevention of lead poisoning in at-risk children.
