P2.O298: Recent Pediatric Immigrants: Implementing Comprehensive Laboratory Screening in Outpatient Settings - A Quality Improvement Project

Purpose/Objectives: Immigrant foreign-born children often lack regular medical care and may not have received essential screenings or immunizations in their home countries. Tiered laboratory screening/parasite treatment options for most immigrant children originating from resource-limited settings or from low socioeconomic circumstances is strongly recommended by the American Academy of Pediatrics (AAP): 2013 AAP Policy, Providing Care for Immigrant, Migrant, and Border Children. Implementing standard screening using QI methodology can identify serious health conditions in new coming children in newly immigrated children, often unnoticed and uncommon in the US. Our SMART Aim was to increase early health screening rates for immigrant patients from 42.4% to 75% within 6 months. We are conducting Plan-Do-Study-Act cycles to ensure at least 3 standard tests, including tuberculosis screening, are ordered during patients' first visits. This article shares interim data as we continue our project.

Design/Methods: Recently arrived patients under 18 years old attending our outpatient clinic for their initial health care maintenance visit underwent screening using a modified set of standard labs based on the AAP Policy: Complete blood count, Basic metabolic panel, Hemoglobin electrophoresis, Lead screening, HIV and Syphilis screening, Hepatitis B surface antigen, Hepatitis C antibody, QuantiFERON / Purified Protein Derivative (PPD) Skin Test, and ova and parasites. We analyzed the count of ordered tests and the percentage of completion. Multiple PDSA cycles were conducted, involving education for residents, nurse practitioners, attendings on the significance of screening, integrating screening tools and proposed interventions into the EMR, and providing educational resources.

Results: Comprehensive discussions and emphasis on project goals and strategies began in September 2023. To assess intermediate results and identify areas for improvement, we compared data from July-August (66 immigrant children registered) with short-term September-October 2023 (96 patients) and long-term January 2024 (68 children). During the initial two months of implementation, the screening rates with 3 or more tests ordered during the first visit significantly increased from 42.4% to 61.4% (Chi-square 5.6, P=0.02). By January 2024, we reached the interim target point of 75% of tested children, achieving 79.4% (Chi-square 19.1, P< 0.01). Moreover, the rate of age-appropriate tuberculosis screening notably increased from 42.4% to 64.5% (Chi-square 7.7, P=0.01) and further to 77.9% (Chi-square 17.5, P< 0.01) respectively. More than one order failing to complete was noted in 14.3%, 25.4%, and 22.2% of cases, with no significant differences observed.

Conclusion/Discussion: With the increasing immigrant population, we must improve our screening protocols and reinforce guidelines. Our QI project successfully reached its goal by January 2024. Since implementation, we have identified nine patients with Indeterminate QuantiFERON test results and four children who tested positive, receiving appropriate follow up and treatment. Continuing education for medical personnel remains crucial to minimize health risks and ensure compliance.