55 - Increasing Home Lead Inspections in Vermont

Poster Number: 55
Publication Number: 55.2764

Background: Every year, approximately 400 Vermont children under the age of 6 have a detectable lead in their blood. Ensuring a source of lead exposure is identified and removed from the child's environment is critical to treatment. While the Vermont Department of Health offers home lead inspections for select children with elevated lead levels, most primary care offices do not offer any resources for lead inspections.

Objective: To increase the percentage of children 6 years old and younger, who are patients at University of Vermont Pediatric Primary Care, to receive a home lead inspection and risk assessment.

Design/Methods: A multidisciplinary team implemented a quality improvement initiative at University of Vermont Pediatric Primary Care. The aim was to develop a referral process for home lead inspections which integrated into regular office lead screening and communicated referrals to a community agency in an efficient and effective manner. Our primary measures were percent of children receiving referrals for home lead inspections and the percent of children with completed home lead inspections. We included all patients 6 years old and younger who received lead screening by point of care capillary screening and were residing in cities where outreach occurred. Patients who were initially screened by venous sample and those residing outside of where the community outreach were excluded. Baseline data was collected from January 2022 until March 2022. Interventions included developing an in-visit referral process, educating providers on the lead referrals, monthly review of data to identify eligible patients who did not receive referrals. Interventions were performed from April 2022 until April 2023. Data collection is still ongoing as of October 2023.

Results: 60 patients met criteria for referral for home lead inspection from between April 2022 through August 2023. Of those patients, 45 patients were offered referrals (75%) in total and 85% of patients were offered referrals from January to September 2023. 33 of the 45 patients/families accepted referrals of which 21 has lead inspections completed (64%). 6 of the 25 completed lead inspections had detectable lead in the home that was addressed during the assessment (24% of completed assessments).

Conclusion(s): Home lead inspections are beneficial for children with detectable lead levels by capillary sample. Lower thresholds and using capillary samples to guide which children should have home lead inspections can likely prevent unnecessary continued exposure from lead in children.