Davidson Joel R, Karas David R, Bigham Michael T
Akron Children's Hospital, Department of Pediatrics, Akron, Ohio.
Northeast Ohio Medical University, Rootstown, Ohio.
Pediatr Qual Saf. 2021 Sep 24;6(5):e478. doi: 10.1097/pq9.0000000000000478. eCollection 2021 Sep-Oct.
Exposure to environmental lead continues to be a significant public health concern. Elevated blood lead levels can lead to neurocognitive delays and other adverse health outcomes. Unfortunately, screening rates in most communities remain low. This quality improvement project aimed to improve universal screening at 12 months of age and increase screening rates from 71% to 95%. The project team also aimed to improve risk-based screening at 24 months of age to increase screening rates from 41% to 70%.
This project utilized the Model for Improvement. After identifying key drivers, the team designed, tested, and adopted a series of interventions to improve lead screening. Dynamic order sets were developed that pre-checked the lead order, if appropriate, based on the patient's age, previous results, and risk factors. Sites received regular feedback on their screening rates.
The percentage of patients receiving universal lead screening at their 12-month well visit increased from 71% to 96%. 70% of 2-year-olds were at risk for lead exposure based on ZIP code and insurance provider. Development of dynamic orders for patients at risk increased screening rates from 41% to 74% at the 24-month well visit.
Utilization of clinical decision support tools within an electronic health record can significantly increase the percentage of children screened for lead toxicity. Similar tools could identify patients due for other screens or interventions, resulting in improved care and patient outcomes.
接触环境铅仍然是一个重大的公共卫生问题。血铅水平升高会导致神经认知发育迟缓及其他不良健康后果。不幸的是，大多数社区的筛查率仍然很低。这个质量改进项目旨在改善12个月龄时的普遍筛查，并将筛查率从71%提高到95%。项目团队还旨在改善24个月龄时基于风险的筛查，将筛查率从41%提高到70%。
本项目采用了改进模型。在确定关键驱动因素后，团队设计、测试并采用了一系列干预措施来改善铅筛查。开发了动态医嘱集，根据患者年龄、既往结果和风险因素，在适当情况下预先勾选铅检测医嘱。各医疗机构会收到关于其筛查率的定期反馈。
在12个月健康检查时接受普遍铅筛查的患者百分比从71%增至96%。根据邮政编码和保险提供商，70%的2岁儿童有铅暴露风险。为有风险的患者制定动态医嘱，使24个月健康检查时的筛查率从41%提高到74%。
在电子健康记录中使用临床决策支持工具可显著提高筛查儿童铅中毒的百分比。类似工具可识别应进行其他筛查或干预的患者，从而改善医疗护理及患者预后。
