P2.O282: Improving Routine Anemia Screening in Pediatric Population in a Primary Care Setting

Purpose/Objectives: The AAP suggests conducting hemoglobin assessments initially between 9 and 12 months of age. For patients at risk, additional screenings are advised. Anemia is defined as a hemoglobin level 2 standard deviations below the mean for the respective age group. Sufficient iron reserves are crucial for normal neurocognitive development. This quality improvement study aims to enhance anemia screening for children aged 9 to 24 months at our community clinic, the Monmouth Family Health Center (MFHC). Pediatricians should possess knowledge about anemia screening, its management, and available resources. The project's objectives are to increase the following parameters by 10% over baseline:
The percentage of children aged 9 to 24 months who received anemia screening appropriately during well-visits.
The percentage of children with anemia who have documented dietary counseling on iron-rich solids and limiting daily cow’s milk intake.
The percentage of patients with anemia who received appropriate treatment for anemia and, if indicated, hematology referral.

Design/Methods: We conducted a retrospective chart review to gather baseline data on the number of children aged 9 to 24 months who underwent anemia screening from June 2022 to June 2023. We tracked anticipatory guidance, dietary adjustments, and appropriate referral and follow-up for children identified with anemia. Commencing in July 2023, we initiated quality improvement methods aimed at addressing gaps in provider knowledge and systemic barriers. These efforts focused on enhancing anemia screening and interventions through monthly Plan-Do-Study-Act (PDSA) cycles.

Results: Following the lead screening educational conference for residents and the introduction of in-house lead testing at MFHC (cycle 1), an improvement was noted in the rate of appropriate screening per AAP recommendations at the 9 month - 24 month visits, approaching an increase by 25%. The anemia screening rate remained similarly increased following a resident education lecture on anemia offered by the pediatric hematologist in cycle 2. In cycle 3, a “Lunch and Learn” educational session offered, led by residents under the guidance of our attending physicians who supervise the visits at our community pediatric clinic as well, and contributed to a sustained improvement in the anemia screening rate with an increase by 12% on average. Results from the aforementioned data are shown below.

Conclusion/Discussion: This quality improvement initiative aims to establish uniform protocols for assessing and managing anemia screening in primary care, along with providing educational resources and follow-up support. Our preliminary data thus far shows that our interventions have resulted in an increased screening rate above 10% with ongoing analysis of the other objectives. Subsequent PDSA cycles will prioritize acquiring an in-house hematocrit machine, collaborating with WIC to obtain their POC hemoglobin results, raising awareness among parents about anemia assessment, enhancing access to follow-up care for families, and standardizing a clinical pathway for managing anemia.