Lead Testing in a Pediatric Population: Underscreening and Problematic Repeated Tests.

Context: Underscreening and problematic repeat lead testing in children.
Objective: Identify proportion of underscreening for elevated blood-lead levels in children. For children who receive a lead test, measure the level of problematic repeat lead tests, defined as those with a high probability of not meeting recommended guidelines for lead testing in children measured using a combination of patients' age, test type and sequencing, days between tests, and encounter diagnosis coding.
Design: A population-based retrospective cross-sectional design.
Setting: All health care services organizations in the state of Minnesota that delivered health services to the defined study population.
Participants: The study population was a Medicaid cohort of 12 436 children aged 0 to 18 years observed over a 1-year period.
Main Outcome Measures: Proportion of eligible children not receiving at least 1 lead test; proportion of problematic repeat lead tests.
Results: Thirty-five percent of children who should have received at least 1 lead test (n = 1714) during the study period did not. A total of 1856 children had at least 1 lead test and 190 had 2 or more. Fifty percent (50%) of the repeat tests were identified as problematic, representing 5.1% of the lead tests performed. Repeat tests performed in different health systems than the systems where the initial tests were performed had 5.3 times greater odds (adjusted odds ratio: 5.3 [95% confidence interval, 2.8-9.9]) of being problematic.
Conclusions: The current approach to delivering mandatory lead testing across the state Medicaid population does not ensure that children are appropriately tested and has potential inefficiencies in that testing when it does take place. Use of multiple health care systems is associated with increased potential inefficiencies. Future Medicaid accountable care agreements between the state Medicaid program and participating health systems should emphasize clear population accountability for test screenings to improve patients' safety. A central queryable health resource or health information exchange may enable this.