![]() The primary outcome was the percentage of elevated BLLs for which protocol-adherent care was provided. Data were shared at monthly meetings with all PPCC providers and staff. 19 We reviewed weekly data on protocol adherence to inform next steps in testing. ![]() We therefore worked to create redundancy, employ checklists, and leverage technology because these are well-established methods for achieving high reliability. Given the context of multiple providers reviewing laboratory results, we sought to design and test highly reliable, systemic interventions that were minimally dependent on individuals’ knowledge and effort. The changes (ie, interventions) we tested are described in the sections below. Changes are adapted or new changes are tested until the desired outcome is achieved. Plan-do-study-act cycles involve planning and executing small tests of change for short time periods, reviewing data, and using that data to guide whether to adopt, adapt, or abandon that change. ![]() At our primary care center in 2015, only 36% of patients with elevated BLLs received standardized education about reducing lead exposure, and providers ordered retesting for only 4% of patients with BLLs between 1.0 and 4.9 µg/dL.īeginning in December 2016, the team used the model for improvement and plan-do-study-act cycles 18 to test the impact of various interventions in increasing protocol adherence. 14, 15 Locally, providers’ decision-making was highly variable and often at odds with recommendations. 13 However, provider adherence to clinical practice guidelines is generally poor. In 2013, the Pediatric Environmental Health Specialty Unit (PEHSU) network distilled the CDC recommendations into a fact sheet for health professionals. As a result, the recommendations are difficult to memorize and operationalize in clinical settings. They also urge health care providers to consider availability of local resources for home visits to identify and reduce lead hazards. 12 The recommendations are complex, suggesting different actions on the basis of BLL, age, and risk factors for nutritional deficiencies or developmental delay. For children with elevated BLLs, the CDC has issued recommendations for educating families, investigating lead sources, addressing developmental and nutritional status, and completing follow-up testing.
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