A statewide assessment of lead screening histories of preschool children enrolled in a Medicaid managed care program.
OBJECTIVE
Despite the prominence of lead poisoning as a public health problem, recent Government Accounting Office reports indicate that only one fifth of children who are covered by Medicaid have been screened for lead poisoning. The purpose of this study was to examine the lead screening histories of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being screened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened.


METHODS
A random sample of 2000 preschool-age children was chosen from those who were enrolled continuously in the statewide, expanded, Medicaid managed care program for a 1-year period and between the ages of 19 and 35 months at the end of that year. Sociodemographic characteristics and lists of primary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the lead screening histories of the children, including test dates and results.


RESULTS
Data on 1988 children were used for study analyses, and 80% of these children had at least 1 documented blood lead level. Children whose primary care provider was an office-based physician were less likely to be screened as compared with patients of health centers, hospital-based clinics, and staff model health maintenance organizations (68%, 86%, 89%, and 91% respectively). Variation in screening rates persisted in a multivariate analysis controlling for family sociodemographic characteristics and practice level variation. Of the 1587 children who had a documented blood lead test, 467 children (29%) had a blood lead level of >/=10 mg/dL on at least 1 test.


CONCLUSIONS
Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children who are enrolled in Medicaid. Potential explanations for this finding are 1) a high sensitization to the problem of lead poisoning in Rhode Island, 2) the primary care focus of the Medicaid program in Rhode Island facilitates the delivery of preventive services, and 3) the medical record audit approach used in this study was more comprehensive in identifying blood lead screens than techniques used in national studies. The high prevalence of elevated blood lead levels found in this study emphasizes the importance of screening among children who are enrolled in Medicaid.
Vivier
P M
PM
Department of Pediatrics, Brown University, Providence, Rhode Island, USA. patrick_vivier@brown.edu
Hogan
J W
JW
Simon
P
P
Leddy
T
T
Dansereau
L M
LM
Alario
A J
AJ
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood; D007855:Lead Poisoning / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors
D007854:Lead