Difficulties in evaluating abnormal lead screening results in children.
BACKGROUND
This report chronicles efforts to provide follow-up care for children with abnormal whole blood lead concentrations using the 1991 Centers for Disease Control and Prevention (CDC) guidelines in the Family Health Center at Shadyside Hospital in Pittsburgh.


METHODS
An automated surveillance module found all children with abnormal lead concentrations obtained between January 1994 and July 1995 and singled out children who were overdue for follow-up. Automated physician reminders and nursing case management were used to improve care and documentation. Longitudinal case summaries were used to evaluate care.


RESULTS
All 99 children with a lead concentration of 10 micrograms/dL or greater had a documented follow-up plan. Twenty-nine children (47 percent) who had a lead concentration of 10 to 14 micrograms/dL, 23 (100 percent) who had a lead concentration of 15 to 19 micrograms/dL, and 8 (100 percent) who had a lead concentration of 20 micrograms/dL or greater had at least one follow-up lead concentration measurement by the end of the data collection in July 1995. Follow-up was incomplete in more than 70 percent of children. Nineteen children (19 percent) with initially abnormal lead concentrations had follow-up testing with persistently normal results. The yearly cost of follow-up was $15,888, with only 7 children requiring county health environmental intervention.


CONCLUSIONS
The nurse-centered, computer-aided system improved follow-up care of children with abnormal lead concentrations, but most patients still did not receive mandated follow-up testing because of logistic obstacles. The effort and cost associated with CDC-mandated follow-up of children with lead concentrations between 10 and 19 micrograms/dL provides no apparent benefit and might detract from the care of children at higher risk.
Block
B
B
Primary Care Institute, Shadyside Hospital, Pittsburgh, PA, USA.
Szekely
K
K
Escobar
M
M
D019090:Case Management / Q000458:organization & administration*; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003152:Community Health Nursing; D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D004282:Documentation; D005194:Family Practice; D017048:Health Care Costs; D006266:Health Education; D006801:Humans; D007223:Infant; D007855:Lead Poisoning / Q000097:blood / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D008137:Longitudinal Studies; D008331:Management Information Systems; D010349:Patient Compliance; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D016896:Treatment Outcome; D014481:United States