110 - Point-of-Care testing can be a means to achieve health equity in the primary care setting

Poster Number: 110
Publication Number: 110.212

Leora Allen, Stony Brook Children's Hospital, Stony Brook, NY, United States; Jie Yang, Stony Brook University, STONY BROOK, NY, United States; Chencan Zhu, Stony Brook University, Mount Sinai, NY, United States; Junying Wang, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Hua Wang, Stony Brook Children's Hospital, East Setauket, NY, United States; Susmita Pati, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States

Background: Primary care physicians play a crucial role in delivering preventive care, including lead screening. Disparities in the risk of lead exposure, particularly related to race and socioeconomic class, are known to exist; yet interventions to achieve equity in screening rates are not well documented. 

Objective: We hypothesized that implementing point-of-care (POC) lead testing in the primary care office as a standard operating procedure (SOP) would improve screening rates and achieve equity in screening among different racial/ethnic groups.

Design/Methods: We performed retrospective analyses of lead screening completed among 2-year-old children attending three ambulatory primary pediatric offices owned and operated by a single academic medical center. POC was instated as a SOP in January 2019, with pre-intervention data collected from 9/2017-11/2018, and post-intervention data collected from 3/2019-2/2020. Total number of patients seen was 7273 divided over three practice sites. Data were stratified by race/ethnicity, as well as by insurance type (public vs. private) and were analyzed both within each site and across all three sites. Interrupted time series analysis was performed to compare the change in quarterly rates among patients, as well as to compare pre- and post- intervention trends between different racial/ethnic groups. Data were also compared within each racial/ethnic/insurance group among all 3 sites together, and individually within each site. 

Results: Overall, quarterly lead screening rates in post-intervention periods were significantly higher than in pre-intervention periods at all three primary care locations. Screening rates increased by 7.7% in Site 1, 10.1% in Site 2, and 13.4% in Site 3 (all p < 0.05 in simple linear regression models). Furthermore, quarterly screening rates post-intervention were significantly higher than in pre-intervention in all race/ethnicity groups (Figure). There were no racial/ethnic disparities in lead screening rates observed post-intervention in any of the three sites. Conclusion(s): Implementing POC lead screening as a SOP in the ambulatory setting can achieve equity across different racial/ethnic/socioeconomic groups. 
Estimated pre-/post-intervention trends for compliance rates among overall patients by site