family medicine, residency, lead, screening, children, blood level
Background: Lead screenings, as part of a child’s preventive examinations, are offered by many Women, Infants, and Children (WIC) clinics in the Milwaukee area. Previously, the Family Care Center (FCC) at Aurora Sinai Medical Center (Milwaukee, WI) did not have access to lead screenings performed by WIC clinics and later recorded in the Wisconsin Blood Lead Registry (WBLR). Therefore, unnecessary duplicate screenings may have occurred on children seen at FCC for their preventive exams.
Purpose: To determine if children were undergoing unnecessary duplicate lead screenings at FCC.
Methods: We conducted a retrospective review of lead screenings performed at well-child exams in children 1–5 years of age at FCC from March 2017 to August 2017. We reviewed FCC patients in the WBLR, gathering additional lead screening information, noting that lead levels were often reported to nearest whole number. Screenings performed less than 6 months apart in children age 12–24 months and less than 12 months apart in children age 2–5 years were considered duplicate lead screens. Basic descriptive statistics were calculated. Categorical data were analyzed using chi-squared tests and continuous variables with 2-sample t-tests or nonparametric alternative tests. Stepwise regression and binary logistic regression was used for multivariable analysis as appropriate.
Results: After excluding 10 children with elevated blood lead levels and required repeat testing, 161 were included in our analysis. Children of mean age 1.8 years were more likely to be female (54.0%) and African American (70.2%). Of children with at least 1 ordered lead test, 39% were not completed; mean first lead level result was 2.4. Only 20 (12.4%) had duplicate lead screenings ordered, of which 12 (60.0%) were ordered inappropriately (ie, ordered as a duplicate), with 9 (75.0%) being ordered by FCC. Interestingly, on univariable analysis, higher lead levels were significantly associated with male gender (3.2 vs 1.8; P = 0.022) and Asian race (4.6 vs 2.1 for all other races; P = 0.046). On multivariable analysis, when including age, only Asian race remained significantly associated with higher lead levels (P = 0.002).
Conclusion: Inappropriate lead tests were more commonly ordered at FCC. With access to the WBLR, we can determine if patients have had lead levels drawn at outside facilities and eliminate unnecessary duplicate tests. To further aid in decreasing the number of inappropriately ordered tests, we developed a workflow for clinic medical assistants to check blood lead screening and will conduct a 6-month postintervention analysis.
Dement KE, Kram JJ, Baumgardner DJ, Bobot B, Jalan A. Monitoring lead screening within a Milwaukee family medicine residency clinic. J Patient Cent Res Rev. 2018;5:324.
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