Laura Leonard, Michele M McGowan, Tina M Evans

Assessing Lead Screening Rates at a Rural Tertiary Teaching Hospital

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Background: Significant adverse health outcomes in children are related to elevated blood lead levels (BLL). Exposure to lead remains a significant public health issue in the United States, yet screening rates remain low. This study assessed lead screening rates in a rural tertiary teaching hospital serving a bi-state area to determine if opportunities exist to improve care. Methods: The study performed a retrospective review of 5,016 electronic medical records for children who turned 30 months old between January 1, 2017, and December 31, 2021, and received care from ages 9 through 30 months. Chi-square tests assessed differences between groups. Logistic regression examined state-by-provider interaction. Results: No significant difference ( P = 0.734) was found between states in the first BLL completion rate. There was a statistically higher ( P < 0.001) difference between states for a second BLL test completion. In the state with a universal screening requirement, the health system was below standard but performed equivalently or better than research studies. In the state requiring only children benefiting from Medicaid to undergo screening, compliance could not be definitively established. However, proxy statistics concluded that screening rate improvements could be made. Pediatric offices were more likely to realize first and second BLL test results. State-by-provider interaction provided mixed results. Conclusion: This health care system aims to provide the highest evidence-based care to each patient, regardless of provider type or service location. The study shows opportunities exist to improve BLL screening and proposes education, electronic reminders, and in-office blood collection solutions.

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