An assessment of selected preventive screenings among children aged 12 to 35 months in a hospital-based, Medicaid managed care practice

Abstract

Objectives The goal of this study was to assess (i) whether preschool children enrolled in a hospital-based, Medicaid managed care practice had received recommended preventive screenings, including blood lead, hematocrit and tuberculosis testing, and (ii) the prevalence of positive results in these screens.

Design and methods All children between 12 and 35 months of age who had been continuously enrolled in the practice for the last 6 months of 1996 were included in the study, regardless of their visit frequency. Medical records were reviewed for the study children. The dates and results of all blood lead, hematocrit and tuberculosis tests were abstracted.

Results Eight hundred and twelve children met the study inclusion criteria. All but two of these children had a hospital medical record available for review. Six hundred and ninety of the 812 children (85.0%) had a documented blood lead test. Of those screened, more than one-quarter (190 of 690; 27.5%) had at least one result ≥ 10 μg/dL. A hematocrit result was documented for 742 of the study children (91.4%), and 377 of these children (50.8%) were anemic on at least one test (defined as a hematocrit two standard deviations below published norms). Two-thirds of study children (536) had documentation of a tuberculosis screen being performed, with two-thirds of these having a documented reading. None of the 342 children with a documented tuberclin skin test reading had a positive test.

Conclusions Screening rates were relatively high in this study group, especially when one considers that the denominator for screening rates was based on enrollment in the practice, regardless of whether or not the child had been seen. The results of these screening tests provide evidence for the high burden of lead poisoning and anemia in this low-income population.

Implications for practice This study demonstrates that it is feasible to carry out assessments based

on defined primary care responsibilities, allowing for a more population-based approach to health care in hospital-based clinics.