Improving Lead Screening Rates in a Large Pediatric Primary Care Network

Abstract

Exposure to environmental lead continues to be a significant public health concern. Elevated blood lead levels can lead to neurocognitive delays and other adverse health outcomes. Unfortunately, screening rates in most communities remain low. This quality improvement project aimed to improve universal screening at 12 months of age and increase screening rates from 71% to 95%. The project team also aimed to improve risk-based screening at 24 months of age to increase screening rates from 41% to 70%.

Methods: This project utilized the Model for Improvement. After identifying key drivers, the team designed, tested, and adopted a series of interventions to improve lead screening. Dynamic order sets were developed that pre-checked the lead order, if appropriate, based on the patient's age, previous results, and risk factors. Sites received regular feedback on their screening rates.

Results: The percentage of patients receiving universal lead screening at their 12-month well visit increased from 71% to 96%. 70% of 2-year-olds were at risk for lead exposure based on ZIP code and insurance provider. Development of dynamic orders for patients at risk increased screening rates from 41% to 74% at the 24-month well visit.

Conclusions: Utilization of clinical decision support tools within an electronic health record can significantly increase the percentage of children screened for lead toxicity. Similar tools could identify patients due for other screens or interventions, resulting in improved care and patient outcomes.

Fig. 1.

Key Driver Diagram demonstrating global aim, SMART aim, the target population, key drivers, and necessary interventions to achieve the SMART aim.

Fig. 2.

Run chart depicting the percentage of patients with a lead test ordered at the 12-month well-child visit. The upward arrow demonstrates the direction of the desired improvement. Annotations identify the timing of key interventions. The dashed green line denotes the goal. The solid red line is the median screening rate and shifts according to the standard run chart rules.

Fig. 3.

Run chart depicting the percentage of patients with lead order at the 24-month well-child visit. The upward arrow demonstrates the direction of the desired improvement. Annotations identify the timing of key interventions. The dashed green line denotes the goal. The solid red line is the median screening rate and shifts according to the standard run chart rules.