P3.T383: Lead by Example: Improving Lead Screening at the Walter Reed Pediatric Patient Centered Medical Home

Purpose/Objectives: Lead screening in children is a critical priority, as high lead levels early in childhood can lead to irreversible neurological damage and permanent developmental delays. The Maryland government requires lead screening at 12 and 24 months of life, while the Defense Health Agency (DHA) mandates that Military Treatment Facilities (MTFs) follow local jurisdiction screening guidelines. The DHA also set a 90% threshold for lead screening all children by 15 months of age, and since October 2021, the Walter Reed Pediatric Patient Centered Medical Home (WR Peds PCMH) had not achieved this benchmark. Screening requirements can be fulfilled through questionnaire (Figure 1) or blood test documentation. Our project sought to investigate the reasons for missed lead screening and implement changes to increase compliance.

Design/Methods: In June 2023, we embarked on a quality improvement project focusing on documentation, education, and notification to improve compliance with local lead screening guidelines. In our root cause analysis, we learned that initially MHS Genesis did not include a location to document formal lead screening. Thus, we prioritized entering and backdating patients’ historical laboratory data. Once a space for documentation was created, we made educational documents and conducted formal teaching sessions to assist screeners and providers to obtain and properly document lead screening. Our chart review also indicated that many patients without screening were seen at the USUHS clinic; therefore, we extended our educational sessions to include providers at USUHS. To better support our military families and remind them of the need for an upcoming appointment, our team developed MHS Genesis dynamic worklists to notify the families of all 11-month-olds with no scheduled 12-month appointment. Finally, the clinic purchased new point-of-care screening equipment to reduce machine non-availability.

Results: We used available lead screening data from 2021 through 2023 for all 15-month-old patients seen at the WR Peds PCMH. In previous years, only 34.5% to 79.3% of patients had undergone lead screening (Figure 2). Upon entering and backdating prior screenings, we saw an improvement of up to 97% compliance, above the 90% goal. Our chart review showed that among the patients listed as noncompliant, about half (46%) were not seen for a 12-month well-child visit, while the remaining children were seen at 12 months but not screened. Data is pulled intermittently for this metric, and we eagerly await additional data after implementing further countermeasures.

Conclusion/Discussion: Our initial results support the need for increased parental awareness and staff education, emphasizing the importance of timely screening. The educational materials and targeted screening initiatives developed by the WR Peds PCMH can benefit our military’s youngest beneficiaries and prevent the long-term consequences of missed lead screening not only at our clinic but throughout the entire Defense Health Agency.