1. Jared E. Collins, MS MPH Candidate Master of Public Health Program Dept. of Population Health Sciences University of Wisconsin School of Medicine and Public Health Spring Public Health Symposium Fluno Center May 8, 2009 Improving Lead Screening Rate by the Use of a Statewide Immunization Registry

2. Acknowledgments Capstone Committee Members:  Preceptors o Jacob L. Bidwell, MD o Dennis J. Baumgardner, MD  Chair o Patrick L. Remington, MD, MPH  Faculty o Susan Zahner, DrPH, RN Non-committee Members: o Jeff Havlena o The Center for Urban Population Health o Aurora Clarke Square Family Health Center / Aurora UW Medical Group Staff o Barbara Duerst, RN, MS o Heather Cote, BA o D. Paul Moberg, PhD o Nancy Eberle, MPH o Bridget C. Booske, PhD o 2006-08 MPH Entering Classes

3. Outline  Introduction/Background  Overview  Methods  Results  Discussion  Conclusion  Question & Answer

4. Introduction/Background  Approx. 310,000 U.S. children aged 1-5 years have blood lead levels (BLLs) greater than 10 micrograms per deciliter of blood (10 μg/dL), the level at which the CDC recommends public health actions be initiated  In 2006, 1.21% of children tested in U.S. for lead had confirmed elevated blood lead levels (EBLLs)  In 2009… o 2.9% of children tested in WI for lead have EBLLs o 7.0% of children tested in Milwaukee for lead have EBLLs o 8.8% of children tested in the 53204 zip code (Milwaukee) have EBLLs o 9.6% of children tested at Aurora Clarke Square Family Health Center (53204 zip code) have EBBLs

5. Introduction/Background (cont.)  Sources of lead exposure o Lead-based paint and lead-contaminated dust found in deteriorated buildings o Hobbies o Work o Drinking water o Home health remedies  At risk populations o Children under the age of 6 years o Children from all social and economic levels o Children of some racial and ethnic groups  Lead exposure is very costly to treat o $43.4 billion annually  Lead poisoning is entirely preventable

6. Overview  Clinical quality improvement project  Purpose: To determine the effect of including lead screening in a statewide immunization registry on rates of recommended lead screening in an urban community clinic in Milwaukee (53204 zip code)  Cohort study of children age birth to 6 years

7. Overview (cont.)  Problem: Health care providers are missing opportunities to screen children who are at high risk for EBLLs  Hypothesis: Tracking lead screening in a statewide immunization registry will result in increased lead screening compliance among providers in patients age birth to six years  Short-term goal: To increase lead screening compliance in providers treating a pediatric population o Goal: 90% compliance  Long-term goal: To utilize the Wisconsin Immunization Registry (WIR) to track child lead screening rates and thus improve adherence to professional recommendations

8. Methods What did we do?  Conducted a literature search of the adverse health effects of childhood lead exposure/poisoning  Developed a lead screening database of children between 0 and 6 years of age who are seen at the Aurora Clarke Square Family Health Center  Mailed a bilingual (English/Spanish) letter to the parents of children who either need to be screened or who have EBLLs What will we do?  Clinic staff will check the responses received from the letters that were mailed the month before o Who has come in for screening? o Who has a future appointment already set up?  Parents who didn’t respond to the letter will receive a follow-up phone call

9. Methods (cont.)  If the intervention is successful (i.e., if we reach our goal of 90% compliance), we hope to… o Collect baseline lead screening data using chart reviews, and o Enter the lead screening information from chart reviews into the WIR  As children come to the clinic to be immunized, providers can use data from the WIR to determine their need for lead screening

10. Results  Recently began collecting lead data, so the results are still TBD…  However, this lead project is based on a similar study focused on improving childhood immunization rates in Milwaukee  Results from this lead screening project are expected to be similar o Pre-intervention (baseline): 76.9% o Post-intervention: TBD AUWMG = Aurora UW Medical Group ACSFMC = Aurora Clarke Square Family Health Center

11. Results (cont.)  Additional results from childhood immunization study o Process culturally concordant with majority of patient population o Obtained feedback from staff on how process accurately reflects needs of patient o Patients demonstrated more interest in making sure their children were up-to-date with their immunizations  Again, expecting similar results

12. Discussion  Relation of findings to existing literature o Dearth of information exists regarding how to increase lead screening compliance among providers o This project will address gaps in current research by examining an intervention aimed at increasing lead screening compliance in providers treating a pediatric population  Strengths o Cost effective o Utilizes a database that is already being used to track youth immunizations (ease of implementation) o Intervention poses very low risks to patients and is efficient for clinic use  Limitations o Still collecting data, so results are TBD o Lead screening differs from immunization

13. Discussion (cont.)  Implications for public health o Systems approach versus individual approach o Increased compliance to lead screening recommendations and early detection of EBLLs in children could…  Improve future health outcomes for children  Help parents identify and eliminate causes of potential lead exposures in child’s environment  Alert providers to potential health problems a child may face and ensure adequate treatment for their exposure  Increase likelihood that patients, as a whole, will be screened o This research will add data to the limited number of studies that have suggested innovative office practices that can contribute to increased adherence to lead screening guidelines

14. Conclusion  Expect similar results  Recognize differences between immunizations and lead screening o Legal regulations o Expense o Follow-up o Abatement

15. Questions? Staff at Aurora Clarke Square Family Health Center