Improving adherence to universal lipid screening in pediatric patients at a tertiary healthcare system in new jersey through a quality improvement initiative

Abstract

Background/Synopsis

Cardiovascular Disease (CVD) risk factors are identifiable in childhood and predict risk of adult CVD. Hyperlipidemia is a modifiable risk factor of atherosclerotic CVD, the leading cause of mortality worldwide. Current pediatric hyperlipidemia guidelines recommend universal pediatric lipid screening for early identification and treatment of pediatric dyslipidemia.

Objective/Purpose

The objective of this study was to evaluate the prevalence of universal pediatric lipid screening as recommend by the AAP, AHA and NHLBI for all children at two different time intervals: 9-11 and in 17-21 before and after our quality improvement initiative.

Methods

A retrospective chart review was conducted utilizing a Power Business Intelligence (BI) generated report to obtain data from patients seen at pediatric primary care clinics. Lipid screening rates were evaluated for patients ages 9-11 and 17-21 years old in the pre-intervention phase, January 2019-December 2020 and post intervention phase, January 2021-December 2022. QI interventions included provider education at business meetings, grand rounds, and newsletter distribution explaining the rationale for universal screening recommendations.

Results

The percentage of total patients with lipid screen increased from a mean of 6.34% during the pre-intervention phase to a mean of 38.35% post intervention. The percentage of patients ages 9-11 with lipid screen increased from a mean of 5.22% pre-intervention to a mean of 20.30% post intervention. The percentage of patients ages 17-21 with lipid screen increased from a mean of 10.44% pre-intervention to 45.32% in post intervention phase.

Conclusions

Universal pediatric lipid screening identifies children with dyslipidemia and helps in early detection of genetic conditions like familial hypercholesterolemia (FH), which affects 1 in 250. Relying solely on family history or risk factors misses 30-60% of children with severe dyslipidemia. Reverse cascade testing, where the child is the index case, can also identify older family members with FH. Before the release of the NHLBI 2011 guidelines, studies from three large U.S. health systems found that lipid screening was conducted in only 8.9% of children aged 9 to 11 years and 24.3% of individuals aged 17 to 19 years. In our quality improvement project, pre-intervention data also reflected low screening rates, with 5.22% for the 9-11 age group and 10.44% for the 17-21 age group. Our intervention was introduced with the view that enhancing healthcare professionals' understanding and clarifying the rationale for screening in youth could boost screening rates. This approach led to a post-intervention increase in screening rates to 20.30% (15% increase) for the 9-11 age group and 45.32% for the 17-21 age group (34% increase).