Background: The health services advisory committee (HSAC) of a local Early Head Start, made up of Early Head Start staff, community clinic leadership, public health department personnel, and community organizations interested in early childhood health, was concerned about lack of documentation of lead levels for children enrolled in the program. Simultaneously, there was growing awareness in the community about the risk of lead exposure coupled with a lack of resources. A recent report indicated nearly 50% of the housing stock in the area have a moderate to high risk of lead paint hazards. These homes are located in an area where many children reside. Armed with this information, the HSAC began leveraging an existing partnership between a university pediatric practice co-located with the Early Head Start and community agencies. Even with the existing partnership and co-located organizations, rates of compliance with lead levels were dismal; only 33% of those children recommended to have lead levels had them documented. Specific Aims: Improve compliance with lead level documentation in an early head start. Improve consistency of lead education among home visitors and health care providers. Methods: This project used a Plan-Do-Study-Act method of quality improvement. The first task was to determine if children had lead levels appropriately drawn that were not provided to the Early Head Start or if children in this high risk population were truly missing a blood lead level draw. Medical directors from the clinics serving the majority of these children met with Early Head Start staff to determine how best to provide data from the clinic to the Early Head Start and vice versa and to provide standard lead education information. Results: This collaboration has resulted in a decrease in the number of children without appropriate lead levels on file from 67% to 29%, enabling providers and Early Head Start staff to focus on those children who have not had their lead levels appropriately drawn. A new process was put in place to ensure communication of lead levels between health care providers, parents, and Early Head Start providers, and consistent education about lead avoidance was implemented. Conclusions: Improvement of documentation of lead levels and appropriate lead education were achieved through community partnerships with Early Head Start. The work of the HSAC of the Early Head Start program provided a springboard for lead action in our community, and this group has become an important team member in the community wide effort to improve lead risk, remediation, and education in our community. The next steps of this ongoing quality improvement project will address obtaining lead levels for the 29% of children remaining and partnering with community organizations to reduce lead exposure for children enrolled in the program.
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