341 - Improvement science increases routine lipid screening in outpatient pediatric cardiology

Poster Number: 341
Publication Number: 341.345

Jonathan N. Flyer, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Elizabeth Congdon, University of Utah Department of Pediatrics, Salt Lake City, UT, United States; Scott Yeager, The University of Vermont Children's Hospital, Burlington, VT, United States; Niels Giddins, The University of Vermont Children's Hospital, Burlington, VT, United States; Nancy Drucker, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Kristina L. Parsons, The University of Vermont Children's Hospital, Burlington, VT, United States; Caitlin Haxel, The University of Vermont Children's Hospital, Burlington, VT, United States; Keith Robinson, UVM Children's Hospital, Burlington, VT, United States

Background: The American Academy of Pediatrics (AAP) recommends routine screening in primary care to detect lipid abnormalities in well children (9-11 years) and young adults (17-21 years). Despite the importance of lipid screening for preventive cardiovascular health, general pediatric data demonstrate suboptimal AAP compliance rates in both age groups. Routine lipid screening directed by pediatric cardiologists may improve testing rates but has not been studied. We hypothesized that AAP guideline adherence would increase in response to standardized counseling and education from a pediatric cardiologist and implementation of lipid point of care testing (POCT).

Objective: Utilize quality improvement science during 2017-2021 to evaluate the impact of patient counseling, education, and lipid POCT on improving adherence to AAP lipid screening guidelines for 9-11 and 17-21 year age groups in an academic pediatric cardiology practice.

Design/Methods: Regional primary care providers were surveyed to determine support for pediatric cardiologists conducting routine lipid screening. Key drivers of lipid screening were categorized (physician, patient, and system) with corresponding interventions (Figure 1). Pediatric cardiologists offered a preventive cardiovascular education handout for families, and incorporated it into the electronic medical record (EMR). The physician team then created lipid screening educational posters to display in clinic rooms, and standardized their counseling approach and EMR use. Lipid POCT was then implemented in clinic. Run charts and statistical process control charts were used to monitor lipid screening and key process measures.

Results: There was a 32% (95/294) primary care response rate; 97% supported pediatric cardiologists conducting routine lipid screening. The overall mean baseline lipid screening rate was 0%, increased to 21.4% by adding patient education materials and counseling, and decreased to 8.9% without further intervention (Figure 2). The mean rate increased to 47.5% after adding standardized nursing intake, educational posters, physician counseling, and in clinic POCT. Screening rates were similar in both age groups. Once available, lipid screening via POCT became more prevalent (89.8%) compared to lab phlebotomy (10.2%) (Figure 3).Conclusion(s): Patient education, counseling, and readily accessible lipid testing provided by pediatric cardiologists in an outpatient clinic can improve adherence to AAP lipid screening guidelines.
Figure 1: Key Driver Diagram of Lipid Screening in Pediatric Cardiology Outpatient Clinic
P Chart of Lipid Screening in Pediatric Cardiology Clinic: January 2017 - December 2021