Study Aims: 
Examine the effect of on-site lead screening collection on resulted lead screening rates.https://jdc.jefferson.edu/patientsafetyposters/1018/thumbnail.jp

Altshuler, MD, Marc

Amadi, MD, Grace

Askie, MD, MPH, Phoebe

Castellan, MD, Tina

Chung, MD, Daniel

Foster, MD, MPH, Krys

Kuperman, MD, MPH, Mariana R.

Lopez, MD, PGY-III, Kelly

Parente, MD, Laura

Parra, MD PGY2, Yury

Reaves, MD, Bruce

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety6-13-2016On-Site Test Collection Intervention ImprovesLead Screening Rates at an Urban Family MedicinePracticeKrys Foster, MD, MPHThomas Jefferson University, Krys.foster@jefferson.eduTina Castellan, MDThomas Jefferson University Hospital, christine.castellan@jefferson.eduKelly Lopez, MD, PGY-IIIThomas Jefferson University, kelly.lopez@jefferson.eduPhoebe Askie, MD, MPHThomas Jefferson University Hospital, Phoebe.askie@jefferson.eduDaniel Chung, MDThomas Jefferson University, daniel.chung@jefferson.eduSee next page for additional authorsFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationFoster, MD, MPH, Krys; Castellan, MD, Tina; Lopez, MD, PGY-III, Kelly; Askie, MD, MPH, Phoebe; Chung, MD, Daniel; Parente,MD, Laura; Parra, MD PGY2, Yury; Amadi, MD, Grace; Kuperman, MD, MPH, Mariana R.; Reaves, MD, Bruce; and Altshuler, MD,Marc, "On-Site Test Collection Intervention Improves Lead Screening Rates at an Urban Family Medicine Practice" (2016). HouseStaff Quality Improvement and Patient Safety Posters. Poster 19.http://jdc.jefferson.edu/patientsafetyposters/19AuthorsKrys Foster, MD, MPH; Tina Castellan, MD; Kelly Lopez, MD, PGY-III; Phoebe Askie, MD, MPH; DanielChung, MD; Laura Parente, MD; Yury Parra, MD PGY2; Grace Amadi, MD; Mariana R. Kuperman, MD,MPH; Bruce Reaves, MD; and Marc Altshuler, MDThis poster is available at Jefferson Digital Commons: http://jdc.jefferson.edu/patientsafetyposters/19Background and Introduction •  Inclusion Criteria: •  Patients ages 9-72 months who visited Jefferson Family Medicine Associates Practice (JFMA) between 4/1/2015-6/15/2015, 9/8/2015-11/16/2015, or 1/4/2016-3/13/2016 without prior lead screening  •  Interventions:  •  Initiation of on-site lead filter paper testing on 8/12/2015 •  Email to Providers on 8/12/2015 •  Medical Assistant Education 8/2015 •  QI PowerPoint presentation 9/3/2015  •  Measures:  •  Number of lead tests ordered and resulted during pre-  and post-intervention period •  Number of on-site lead testing completed post-intervention Results Subgroup Analysis Conclusions Acknowledgements 1. Childhood Lead Poisoning Data, Statistics, and Surveillance.  Centers for Disease Control and Prevention Web site.  2. http://www.cdc.gov/nceh/lead/data/StateConfirmedByYear_1997_2012.pdf  Published June 15, 2013. Updated October 15, 2013. Accessed August 28, 2014. 3. Childhood Lead Screening Prevention. City of Philadelphia Web site.  http://www.phila.gov/health/FAQ/FAQ_LeadPoisPrev.html  Accessed August 28, 2014. 4. Philadelphia Department of Public Health, Guide for Clinicians: Preventing Lead Poisoning of Children. City of Philadelphia Web site. http://www.phila.gov/health/pdfs/GuideforClinicians7_8_13.pdf  (Ref 1).       Published May 2013. Accessed August 28, 2014. 5. Lead Poisoning in Children: NEW Guidelines for Prevention, Screening and Medical Management. City of Philadelphia Web site. http://www.phila.gov/health/pdfs/SchwarzLetter7_8_13.pdf (Ref 2). Published July 8,        2013. Accessed August 28, 2014. 6. Lead Poisoning Prevention and Control. Pennsylvania Department of Public Health Web site. http://www.portal.state.pa.us/portal/server.pt/community/lead_poisoning_prevention___control/14175 Published 2014.        Accessed August 28, 2014. 7. Gutierres, SL and Welty, TE. Point of Care Testing: An Introduction. The Annals of Pharmacotherapy. Jan 2004, 38: 119-125.  8. Wengrovitz, Anne, MPH and Mary Jean Brown, ScD.  Recommendations for Blood Lead Screening of Medicaid-eligible Children Aged 1-5 years: an Updated Approach to Targeting a Group at High Risk. MMWR Recommendations and Reports.  8/7/2009.  58(RR09);1-11. 9. St. Louis, P. Status of Point-of-Care Testing: Promise, Realities, and Possibilities. Clinical Biochemistry. 2000, 33(6): 427-440.  On-Site Test Collection Intervention Improves Lead Screening Rates at an  Urban Family Medicine Practice  Krys Foster, MD, MPH; Christine Castellan, MD; Kelly Lopez, MD; Phoebe Askie, MD, MPH; Daniel Chung, MD; Laura Parente, MD; Yury Parra, MD; Grace Amadi, MD; Mariana Kuperman, MD, MPH; Bruce Reaves, MD; Marc Altshuler, MD Thomas Jefferson University Hospital, Department of Family And Community Medicine, Philadelphia 19107 References Materials and Methods  •  Elevated blood lead levels (BLL) can cause multiple deleterious effects in pediatric patients, leading to neurological disease and delays in development 1, 5 •  The CDC and state governments have made recommendations for screening in pediatric patients to allow for prompt intervention 1, 4, 5   •  Two blood lead tests for children at “higher risk”: one at age 9-12 months and one at age 2 years; screening should be done at 36-72 months if no prior test completed •  The Philadelphia Department of Health has recommended that 100% of children be screened due to housing conditions 2, 3, 4   •  In Philadelphia, only 26.80% of children under  the age of             7  have been appropriately screened; in Pennsylvania, the                                           number is only 14.05% 3  2014-2015 Quality Improvement Lead Study: •  Provider reminders within the EMR pediatric note template significantly increased provider ordering behavior (p<0.0001) •  However, this did not lead to a significant increase in resulted lead screening tests (p = 0.8485)  Ordered  Complete 109 84 90 % of eligible 75 78 55 •  Availability of on-site lead testing increased the rate of appropriate lead screening •  Over time, the percentage of pediatric patients eligible to be screened decreased •  Short term increase of physician/MA ordering practices following education but was not sustained   Future Directions  ●  Qualitative analysis of barriers to Lead Test ordering  ●  Determine need and feasibility for on-site hemoglobin assessment in addition to on-site lead testing  ●  Introduce a pediatric checklist   •  Medical Assistants •  Dr.  Victor  Diaz  •  Thomas  Jefferson University  Hospital, Department of Family and Community Medicine  Study Aims: Examine the effect of on-site lead screening collection on resulted lead screening rates.  Proportion of Tests Ordered that were Completed  Percentage of Eligible Patients Pre-intervention Post- intervention #1 Post- intervention #2 Provider Ordering Behavior Eligible Patients Lead Test Ordered 32 32 8 No Lead Test Ordered 58 46 47 p-value 0.5251 0.0071* Appropriate Lead Screening Lead Test Ordered Test Resulted 14 29 8 Test Not Resulted 18 3 0 p-value 0.0001 * 0.0047 * Post Intervention Group # 1 Post Intervention Group # 2 Fischer’s Test Analysis  

On-Site Test Collection Intervention Improves Lead Screening Rates at an Urban Family Medicine Practice

Study Aims: 
Examine the effect of on-site lead screening collection on resulted lead screening rates.http://jdc.jefferson.edu/patientsafetyposters/1018/thumbnail.jp

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On-Site Test Collection Intervention Improves Lead Screening Rates at an Urban Family Medicine Practice

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