PC1227: Lead-free Ohio: Prevention, Screening, Care

Purpose/Objectives: In July 2019, the Ohio Chapter, American Academy of Pediatrics launched the Lead-Free Ohio Quality Improvement Program, to help primary care providers improve lead testing and anticipatory guidance during well child checks (WCC).
• 90% of patients attending 6-month WCC will receive primary prevention anticipatory guidance.
• 90% of patients attending 12 and 24 month WCC with high risk will have a lead test ordered.
• Improve blood testing completion rates by 25% for 12 and 24 month olds.
Ohio has the 3rd highest elevated childhood blood lead levels in the country. Ohio Department of Health requires testing for one and two year olds who live in high risk zip codes and/or are insured by Medicaid, but only about 50% of these high risk children are tested.

Design/Methods: The QI project was designed using the Institute for Healthcare Improvement Model for Improvement. 11 practices were recruited based on high-risk zip codes identified by ODH. To aid in implementation, practices were provided with a toolkit of monthly mentoring sessions with QI and environmental health experts, an Ohio AAP website with resources, and patient rack cards. Practices participated in 5 action period calls, 4 cycles of data collection (chart review), 2 EMR data pulls (pre and post), and 2 coaching calls.

Results: 11 practices completed the 6-month project. There were a total of 1755 high risk 12 month olds and 1089 24 month olds across all practices during the project. Of note, 670/1755 (38.2%) of high risk 12 month olds attended a well child visit and 310/1089 (28.5%) of high risk 24 month olds attended well child visits. Practices reported that partnering with their IT department was essential to achieving results. Processes that influenced success were incorporating a checkbox reminder, a dot phrase, or a statement on anticipatory guidance into the 6-month WCC visit template and implementing a Health Maintenance Decision Support Tool. (See table)

Conclusion/Discussion: The QI project resulted in sustained changes in office workflow to increase adherence. Following this QI collaborative, many practices recognized that while blood lead tests were appropriately ordered at the 12 and 24 month well visits, there are multiple barriers to lead test completion. To overcome these challenges, practices hope to continue to make improvements by
• Walking patients to the lab for test completion.
• Requesting that the lab be drawn prior to the visit.
• Offering capillary testing in the office.
Of note, in the Greater Cleveland region, partnerships were formed between practices committed to sharing data and best practices to further increase testing rates and to improve care coordination. The impact of this ongoing collaboration will extend beyond the participating practices as they are working with their regional population health network to scale their efforts regionally.