480 - Implementation of Capillary Blood Testing and Provider Education to Improve Lead Screening Rates in a Pediatric Primary Care Practice.

Publication Number: 4471.480

Lourdes M. Valdez, Mayo Clinic Children's Center, Rochester, MN, United States; Joel Hickman, Mayo Clinic, Fergus Falls, MN, United States; Roland Hentz, Mayo Clinic Children's Center, Rochester, MN, United States; Meghan K. Deyo, Mayo Clinic Children's Center, Rosemount, MN, United States; Anna Kellund, Mayo Clinic Children's Center, Rochester, MN, United States; Lynch Brian, Mayo Clinic Children's Center, Rochester, MN, United States; Chetna Mangat, Mayo Clinic Children's Center, Rochester, MN, United States

Background: In December 2022, the Minnesota Department of Health recommended universal lead screening for children at 1 and 2 years of age. Prior to 2023, our practice performed screenings based on a risk questionnaire, resulting in low screening rates-only 16% of children under 6 years had at least one documented lead screen in 2023. Recognizing this gap, we implemented capillary blood testing and Provider education to improve adherence to screening recommendations.

Objective: To increase lead screening rates in our pediatric primary care practice through the introduction of capillary lead testing and provider education.

Design/Methods: This was a pre-post prospective study including children aged 9-28 months receiving care at our practice. The project was IRB-exempt. Interventions included capillary lead testing in place of venous collection and delivering an educational session to pediatric providers. Data was extracted from electronic medical records. Lead screening rates were calculated as the number of blood lead tests per well-child visit at 12 and 24 months. Interrupted time-series logistic regression was used to assess changes in trend and intercept over time. The periods of observation included pre-intervention, post-capillary, and post-education.

Results: At 12-month well-child visits, screening rates improved from 37% at baseline to 50% after capillary testing and 60% one-month post-education, then declined to 56% three months later. For 24-month visits, rates increased from 19% at baseline to 34% post-capillary testing and 37% post-education, then decreased to 29% at three months later (Table 1).
Scatterplots (Figures 1-2) showed variability over time without a statistically significant overall trend change. For 12-month visits, no significant change was observed in slope or intercept after either intervention (p_intercept=0.4, p_slope=0.4 for capillary testing; p_intercept=0.6, p_slope=0.6 for education). For 24-month visits, the slope became negative and the intercept increased after capillary testing (p_intercept=0.004, p_slope=0.004), then partially improved after the educational session (p_intercept=0.049, p_slope=0.048).

Conclusion(s): Implementing capillary blood testing improved lead screening rates in our pediatric practice, while provider education further enhanced uptake, though the effect diminished over time. Sustaining and expanding these gains may require additional interventions such as point-of-care testing, parent education, and inclusion of lead screening as a reportable quality metric. Continued monitoring and system-level strategies are essential to achieving universal screening goals.

Table 1: Percentage of Children screened for lead at around 1 year of age (ages 9 months to <16 months) and around 2 years of age (18 months to <28 months) at baseline and after interventions
(1) Pre-intervention period: 22 month period 1/31/23-11/30/24
(2)Post-Capillary lead test period 12/1/24- 2/28/25
(3)Post-education period after 1 month 3/1/25-3/31/25
(4)Post-education period after 3 months 3/1/25-5/31/25


Figure 1: Plot of monthly lead screening rates for 12-month well-child visits


Figure 2: Plot of monthly lead screening rates for 24-month well-child visits