Levin R; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 130-1.
Center for Health Care Policy and Evaluation, United Healthcare, Minneapolis, MN 55440-1459, USA.
RESEARCH OBJECTIVE: Blood lead poisoning affects every system in the body, and at low levels can impair the functioning or development of the central nervous system and kidneys. Severe lead poisoning can cause coma and eventually death. Lead is ranked second in the EPA's list of hazardous substances. This study evaluates the rates of blood lead screening in Medicaid and employer-insured children enrolled in managed health care plans over a 4-year period. Compliance to 1991 and 1997 CDC guidelines is also examined. STUDY DESIGN: All children under 4 years of age, enrolled from 1994 to 1997 in Medicaid and employer-insured (commercial) products in 8 health plans located in different geographic regions were included in this study. Administrative claims data were used, with a screening defined as a claim with a CPT code of 83655. The total number of children included in the analysis was 102,124 for 1994; 171,415 for 1995; 196,458 for 1996; and 196,590 for 1997. Two methods for calculating blood lead screening rates were performed. The first method calculates rates per 1000 with member months as the denominator. This allowed us to include children who were enrolled for short periods of time in the analysis. Rates were calculated by plan, year, and age. The second method was used to examine compliance to CDC guidelines. Rates were calculated for screenings at 6 months, 1 year, and 2 years of age. Children who were continuously enrolled for the year and received a blood lead screening from between the ages of 5 and 7 months, 10 and 14 months, and 22 and 26 months made up the numerator. The denominator consisted of all continuously enrolled children in these age ranges. This emulates the HEDIS methodology for other measures. PRINCIPAL FINDINGS: The overall rates for blood lead testing are very low. For children insured by Medicaid, the rates ranged between 5.39 (1997) and 6.43 (1996). Children insured through a commercial product had rates between 2.36 (1997) and 4.26 (1994). None of the age groups show an increase in blood lead testing over time. Using the first method to calculate rates, the annual average rate for all plans combined for children enrolled in Medicaid who were 1 year of age was between 150.19 and 178.34 per 1000. The annual average rate for all plans combined for children enrolled in a Commercial product who were 1 year of age was between 77.82 and 129.52 per 1000. The average rates per 1000 for Medicaid-enrolled 1 and 2 year olds peaked in 1995 and has declined since then. Rates in Commercially enrolled 1 and 2 year olds were highest the first year of this study. In general, the rates for the Medicaid population were higher than the Commercial population. Using the second method for examining compliance to CDC guidelines, the average blood lead screening rate for Medicaid-enrolled children 5-7 months of age was highest in 1994, at 0.024%. Medicaid-enrolled children 10-14 months of age had their highest rate in 1995, at 0.093%. Children 22-26 months of age enrolled in Medicaid had their highest screening rate in 1994, at 0.147%. In every age strata, for every year, commercially enrolled children received blood lead tests at a lower rate. (The only exception to this was for 10-14 month olds in 1994, where commercially enrolled children were screened at a rate of 0.106). CONCLUSIONS: Despite CDC guidelines, which since 1991 have recommended screening all children insured by Medicaid at ages 1 and 2, and HCFA screening requirements for Medicaid enrolled children, blood lead screening is performed at a very low rate. The results of this study are consistent with other published studies. There is no evidence of blood lead testing rates increasing over time. This suggests that current guidelines and HCFA requirements are not by themselves impacting the rate at which blood lead testing is conducted. IMPLICATIONS: Blood lead screening is currently not a HEDIS measure, and has not received the same degree of support as childhood immunizations as a public health goal. It is possible that many of the interventions that have been used to increase childhood immunizations may have success in increasing blood lead screenings. A weakness of this study is its reliance upon administrative data. Examinations of HEDIS immunization data have shown that immunization rates calculated solely from claims frequently underestimate the true rate as calculated from medical chart abstraction. This may be true for calculating blood lead testing rates as well. However, even taking into account likely under-reporting, that these rates do not show an increasing trend in blood lead testing is cause for concern. According to the CDC, childhood lead poisoning is one of the most common pediatric health problems in the United States, and is preventable. (ABSTRACT TRUNCATED)
Publication Types:
Keywords:
- Child
- Health Services
- Health Services Accessibility
- Humans
- Immunization
- Lead
- Lead Poisoning
- Managed Care Programs
- Mass Screening
- Medicaid
- Research Design
- United States
- economics
- methods
- hsrmtgs
Other ID:
UI: 102194411
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