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Changes in Childhood Lead Screening

Changes in Childhood Lead Screening. Stan Sciortino , PhD, MPH Chief, Program Evaluation and Research Section, Childhood Lead Poisoning Program. One Ring to rule them all. J R R Tolkien. RASSCLE I & 2. Two Rings None to Rule Them All. The Rings of RASSCLE.

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Changes in Childhood Lead Screening

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  1. Changes in Childhood Lead Screening Stan Sciortino, PhD, MPH Chief, Program Evaluation and Research Section, Childhood Lead Poisoning Program

  2. One Ring to rule them all. J R R Tolkien

  3. RASSCLE I & 2 • Two Rings • None to Rule Them All

  4. The Rings of RASSCLE • R2 aka Web RASSCLE aka RASSCLE II • R1 aka Legacy System aka RASSCLE I • Two Rings (at least) • Require separate, double data entry • Do not speak to each other, at all • Have diverged • No updates at the State level entered in R1 for LA or Alameda Counties since mid-2006 • LA and Alameda do their own updates

  5. Two Rings or Many?

  6. Lab Data surge into WebCollect’s many portals • Over 700,000 blood tests flood RASSCLE II alone for matching and correction. • Children’s blood results are ghosted to Legacy System’s data bases • Data correction has been done in R2 and in R1 separately.

  7. The State CLPPB will Cease Data Entry into Legacy RASSCLE (R1) • Around 3,000 elevated blood tests are received each year and children need to be correctly identified and followed up. • Now we can focus on one system to identify cases • We can use one system for case management and reports.

  8. How Does This Affect You? • We will continue to support R1 at the county level • However we will have you correct and enter data into R2, eventually • Especially Clinical Nursing Notes. • Monthly Data Disks will continue, but will derive entirely from R2.

  9. Reports • We have been doing most of our recent reports and data requests out of R2. • We will introduce a reporting facility that you can use to create basic reports out of R2. • Based on what YOU need to do case management • Introduction is pending budgetary and contract issues

  10. Recent improvements • Patient name searches have been optimized and are a lot faster now. • R2 is assigning more children to a correct jurisdiction even when the child’s address and the provider address is missing. • Soon—a new alert for any elevated blood lead tests between 14.5 and 19.5 ug/dl

  11. Changes to the Monthly Data Disks • After June 30 the monthly files will come entirely from R2. • We’ll change the look and content • Depending on your feedback

  12. Changes to the Monthly Data Disks We’ll include: • A set of spreadsheets for PHNs. • Printable • Organized better • Column names in plain English • Plus a wide data file for analysts • Column names consistent with PHN files

  13. New Reports • We have several reports that pull data entirely from R2 • Using R2 directly is necessary to obtain prevalence statistics on non-elevated BLLs • So we can report BLLs < 9.5 • And we can do population based research, and geographic analysis

  14. Reports Old and New • Jurisdiction totals in R2 reports will differ slightly from past legacy reports. • The R2 reports have current data. • Late follow-up forms are added and many false positive tests have been resolved. • R2 does not produce archives, but PERS will date stamp the report source and archive all report data. • We will report prevalence data from 2007 onwards. • We will report cases and EBLLs further back in time.

  15. This preliminary report is subject to change as data are updated.Source: RASSCLEII-Unique Children's highest Blood Lead Level (BLL) Data Extract obtained from: r2.CHILD_03APR10Children are Unique per year, only their highest BLL is reportedLab Results with detection thresholds <= 5.0 ug/dl are counted as <4.5 ug/dl

  16. Current Issues: Targeted screening. • Cases have been declining • This is a good thing! • You’ve made a difference. • We still need to continue to identify children and prevent loss to follow-up

  17. Current Issues: Targeted screening. • You will soon be able to set a new alert for any blood test over 14.5. • You will also be able to set this alert to a lower threshold if you’d like. • You can target a lower threshold to ensure follow-up of all lead-exposed children. • This will prevent the loss to follow-up of children with elevated BLLs below 19.5 who only have capillary tests.

  18. Web Portal Web Portal • We will soon share data tables through the Web Portal at CDPH and on our own site. • We’ll also have Statewide maps. • Eventually county-level maps for to target screening geographically. • Individual addresses will not be visible to protect patient confidentiality. • HTTP address to be announced.

  19. We can! • Target areas, zip codes and housing • Continue to reduce the number of cases • Follow-up kids who have been exposed to lead.

  20. We Value Your Feedback! What do you want to see on the data disks? What reports would you like to see? What county maps would you like to see? We’ll follow-up with a brief survey.

  21. Questions? R2DataRequests@cdph.ca.gov Stan.Sciortino@cdph.ca.gov Stan Sciortino, PhD, MPH Chief, Program Evaluation and Research Section, Childhood Lead Poisoning Program

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