A statewide assessment of lead screening histories of preschool children enrolled in a Medicaid managed care program

Objectives. Despite the prominence of lead poisoning as a public health pro blem, recent Government Accounting Office reports indicate that only one fi fth of children who are covered by Medicaid have been screened for lead poi soning. The purpose of this study was to examine the lead screening histori es of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being scr eened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened. Methods. A random sample of 2000 preschool-age children was chosen from tho se who were enrolled continuously in the statewide, expanded, Medicaid mana ged care program for a 1-year period and between the ages of 19 and 35 mont hs at the end of that year. Sociodemographic characteristics and lists of p rimary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the l ead screening histories of the children, including test dates and results. Results. Data on 1988 children were used for study analyses, and 80% of the se children had at least 1 documented blood lead level. Children whose prim ary care provider was an office-based physician were less likely to be scre ened as compared with patients of health centers, hospital-based clinics, a nd staff model health maintenance organizations (68%, 86%, 89%, and 91% res pectively). Variation in screening rates persisted in a multivariate analys is controlling for family sociodemographic characteristics and practice lev el variation. Of the 1587 children who had a documented blood lead test, 46 7 children (29%) had a blood lead level of greater than or equal to 10 mg/d L on at least 1 test. Conclusions. Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children w ho are enrolled in Medicaid. Potential explanations for this finding are 1) a high sensitization to the problem of lead poisoning in Rhode Island, 2) the primary care focus of the Medicaid program in Rhode Island facilitates the delivery of preventive services, and 3) the medical record audit approa ch used in this study was more comprehensive in identifying blood lead scre ens than techniques used in national studies. The high prevalence of elevat ed blood lead levels found in this study emphasizes the importance of scree ning among children who are enrolled in Medicaid.