133 - The More You Know – Insights from Integrated Pre-Visit Surveys in a Pediatric Environmental Health Center

Poster Number: 133
Publication Number: 133.108

Shalini H. Shah, Boston Children's Hospital, Boston, MA, United States; Alan D. Woolf, Boston Children's Hospital, Boston, MA, United States; Kimberly Manning, Boston Children's Hospital, Harvard, MA, United States; Faye Holder-Niles, Boston Children's Hospital, Boston, MA, United States; Bridget Tully, Boston Children's Hospital, Melrose, MA, United States; Shelby Flanagan, Brown University, Newport, RI, United States; Matthew C. Spence, Boston Children's Hospital, Boston, MA, United States; Marissa Hauptman, Boston Children's Hospital, Boston, MA, United States

Background: The Pediatric Environmental Health Center (PEHC) at Boston Children’s Hospital is a specialty referral clinic that provides consultation for approximately 200 patients annually for a variety of environmental health concerns. These include exposures to lead, mold, pesticides, perfluoroalkyl substances (PFAS), impaired indoor air quality, pests/rodents, and more. As environmental health hazards are often compounded by one another, identifying overlapping areas of concern is key for clinical management.

Objective: We aimed to better understand environmental health concerns of our patients and identify visit priorities for families. Secondary aims were to increase awareness of environmental hazards through inquiry of potential sources of concern.

Design/Methods: A 47 question pre-visit survey was created exploring a wide range of potential environmental health hazards and concerns. This was administered prior to scheduled visits via an interactive electronic platform in the PEHC from June-Dec 2021 (results ongoing), with a total of 55 completed surveys thus far. 

Results: Of 111 total PEHC visits, 55 surveys were submitted from 6/18-12/28/21, yielding a response rate of 49.5%. Responses were collected from families living in 27 towns in Massachusetts and two from Rhode Island. The majority of visits to the PEHC were related to lead exposure (97/111 or 87.4%). Of lead-related encounters with survey completion, 37/55 or 67.3% of patients had home lead inspections performed prior to their visit. Other environmental concerns highlighted via completed surveys were mold (25.5%), rodents/insects (16.4%), teflon/PFAS (5.5%), pesticides (1.8%), air pollution (1.8%), home temperature management (heating/cooling) (5.5%), formaldehyde (3.6%), and asbestos exposure (1.8%). A significant knowledge gap regarding contact information of the poison control center was identified, with 49.1% (27/55) respondents responding “no” to the screening question if the poison control center phone number was stored in their phone. Conclusion(s): Pre-visit integrated electronic survey implementation helps engage families prior to visits and better direct anticipatory guidance to self-identified concerns. This tool serves as a unique point-of-care platform for immediate education tailored to specific knowledge gaps. Findings from this survey aid in a broader understanding of our clinical population needs, and will guide development of environmental health screening in other clinics.
Shah CV 2022Shah CV.pdf