240 likes | 295 Views
CHEAR Unit, Division of General Pediatrics, University of Michigan. Use of Medicaid Data to Inform Lead Screening Policy. Alex R. Kemper, MD, MPH, MS June 25, 2005. Collaborators / Support. CHEAR Unit Kathryn Fant, MPH Lisa Cohn, MS Kevin Dombkowski, DrPH Sarah Clark, MPH
E N D
CHEAR Unit, Division of General Pediatrics, University of Michigan Use of Medicaid Data to Inform Lead Screening Policy Alex R. Kemper, MD, MPH, MS June 25, 2005
Collaborators / Support • CHEAR Unit • Kathryn Fant, MPH • Lisa Cohn, MS • Kevin Dombkowski, DrPH • Sarah Clark, MPH • Michigan Department of Community Health • Sharon Hudson, RN, MSN, CNM • Research supported by the Michigan Department of Community Health
High Risk Areas for Lead Poisoning High Risk = Red
State Action – 2003 • Series of policy responses to combat lead poisoning, including: • Funding for lead abatement • Penalizing rental agencies who fail to remediate • Mandating that 80% of Medicaid-enrolled children ≤ 5 years receive testing
Study Questions • Questions: • What is the current rate of lead testing among Medicaid-enrolled children? • How many have an elevated blood lead level (≥ 10 μg/dL)? • What predicts who gets tested or who has an elevated blood lead level? • What happens to children after they are found to have an elevated blood lead level? • What predicts follow-up care?
Data Sources • Data Sources • Medicaid enrollment files • Medicaid claims data • Reports of blood lead levels
Testing Rates • Methods • Retrospective analysis of children ≤ 5 years continuously enrolled in Medicaid in 2002
Testing Rates • N = 216,578 • Rate of testing • ≤ 5 years: 19.6% (95% CI: 19.4%-19.8%) • 1-5 years: 22.8% (95% CI: 22.6%-23.0%) • Blood lead level for children 1-5 years • ≥ 10 μg/dL: 8.7% (95% CI: 8.4%-9.0%)
Testing Rates • Associations with testing or elevated blood lead level • Age • Gender • Race/ethnicity • Residence • Urban/rural status • Medicaid enrollment type • Blood sampling method
Testing Rates Cont’d
Testing Rates Cont’d
Conclusions: Testing • The rate of testing is low. • Testing appears geared to perceived risk. • Managed care programs doing better than fee-for-service
Follow-up Testing • Follow-up testing is the cornerstone of management • Confirmatory testing • Repeat testing
Follow-up Testing • Methods • Retrospective cohort study • Children ≤ 6 years who had an elevated blood lead level between 1/1/02 and 6/30/03 • Continuously enrolled in Medicaid during the following 180 days • Excluded children who had elevated lead level in 2001
Follow-up Testing • Methods • For each child, we identified any other lead testing in the 180 days following the first elevated blood lead level • For those without repeat testing, we used claims data to assess for missed opportunities (outpatient office visits)
Follow-up Testing • N=3,682 • Follow-up testing received by 53.9% within 180 days • More than half (56.2%) of those who did not have follow-up testing had a missed opportunity. • What are the factors associated with follow-up testing? For this, we also considered the effect of local health department catchment area.
Follow-up Testing Cont’d
Follow-up Testing Cont’d Cont’d
Follow-up Testing Cont’d
Conclusions: Follow-up • Many children do not have follow-up testing. • Those with the greatest initial risk of having lead poisoning have the lowest likelihood of follow-up testing.
Implications • Defining the role of primary care providers vs. public health • Who should be responsible for testing and follow-up? • How should information be shared – lead registry? • Lessons from managed care
Future Research • Understand barriers • Perspective • Health Care Providers • Families • Define available resources and relationship at the local level between public health departments and private health care providers • Designing interventions that can be prospectively evaluated
Ongoing Efforts • Quality Improvement • Learning from Managed Care plans • Ongoing Challenges