Paper
Friday, July 23, 2004
Assessing the United States' Health Policy of Mandated Lead Screening for Children on Medicaid in Omaha
Marlene Wilken, RN, PhD, Nursing, Creighton School of Nursing, Omaha, NE, USA, Sarah Currier, PRNC, PhD, NNP, School of Nursing, Creighton University, Omaha, NE, USA, and Carla Abel-Zieg, MS, CS, School of Nursing, Creighton University Medical Center, Omaha, NE, USA.
| Learning Objective #1: Describe the importance of blood lead level screening for children |
| Learning Objective #2: Discuss the need to monitor institutional compliance with blood lead level screening for children |
Objective: To describe the current health policy of the United States for mandated lead screening for children on Medicaid. To identify the frequency of lead screening at four clinics and compare institutional compliance rates. Design: A retrospective chart review. Population, Sample, Setting, Years: Children on Medicaid who were seen at one of four clinics between the ages of 12-18 months in 1999-2002. Variables: clinic site, documentation of blood lead level Methods: A retrospective chart review was conducted of 200 randomly selected records for evidence of lead screening of children on Medicaid who were seen in four Midwestern clinics between the ages of 12-18 months. Findings: The overall incidence of documented blood lead levels was 78.9%. Significant differences (p < 0.001, X2=18.46, df 3) occurred among the four clinics with one clinic demonstrating 100% documentation while only 72% of the charts at the other clinics had documented evidence of blood lead levels. Conclusions: Although universal lead screening is mandated, there were missed opportunities to obtain lead levels in 21.1% of the records reviewed. Thus, the children on Medicaid seen at these clinics are not receiving the quality of health care to which they are entitled. Implications: Health Policy is designed to be inclusive of all individuals who are to receive a mandated service. However, mandating a program appears to be insufficient. Measures need to be put in place to assure institutional compliance. Monitoring systems should be used to provide ongoing evaluation of the degree to which policy objectives are being met. Health Policy is only as good as the system that implements it. When program mandates are not being practiced attention should be focused on where the system is breaking down. This will be the objective of the follow-up study for this project.
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