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Improving adherence to CDC public health guidance for screening newly arrived refugee children through clinical
Riley Phyu1, Katherine Yun2, Mary B Fabio2
1Rowan University Virtua Health College of Medicine and Life Sciences, Glassboro, New Jersey, USA phyuri84@rowan.edu.
Insights
A clinical decision support (CDS) toolkit improved refugee child health screening adherence. While initial screening rates remained high, the toolkit showed promise in enhancing follow-up care for elevated blood lead levels (EBLL).
Area of Science:
- Public Health
- Pediatrics
- Health Informatics
Background:
- Refugee children often present with health risks like elevated blood lead (EBLL) and latent tuberculosis.
- Comprehensive screening is vital, but clinical implementation faces challenges despite CDC guidelines.
- A clinical decision support (CDS) toolkit was developed to aid screening in a refugee health program.
Purpose of the Study:
- To evaluate the effectiveness of a CDS toolkit in improving clinician adherence to refugee child health screening guidelines.
- To assess the impact of the CDS toolkit across two Plan-Do-Study-Act (PDSA) quality improvement cycles.
Main Methods:
- Retrospective evaluation of health screening data for 830 refugee children (6 months-21 years) from 2011-2023.
- Assessed completion rates for EBLL, tuberculosis, hepatitis B, anemia, HIV, and eosinophilia screenings.
- Compared screening rates across baseline, first PDSA, and second PDSA (updated toolkit) periods.
Main Results:
- Initial screening completion remained high (>90%) throughout the study.
- Follow-up lead testing improved from 21.46% to 36.92% after the second PDSA cycle, though timely follow-up remained a challenge (43.08% missed).
- EBLL prevalence increased from 7.43% to 15.69%, influenced by screening thresholds and demographics.
Conclusions:
- The updated CDS toolkit successfully maintained high initial screening rates.
- The toolkit correlated with improved follow-up testing for EBLL after two PDSA cycles.
- Further interventions are needed to enhance follow-up care, but CDS toolkits show potential for improving refugee child health screening.
Introduction:
Many refugee children arrive in the USA from regions with higher risks of health conditions such as elevated blood lead or latent tuberculosis, making comprehensive health screening on arrival crucial for child health. Despite Centers for Disease Control and Prevention (CDC) screening guidance, clinical implementation challenges persist. To address this, we developed a clinical decision support (CDS) toolkit to support screening within the Children's Hospital of Philadelphia's refugee health programme. This quality improvement project evaluated the CDS toolkit's effectiveness in improving clinician adherence to screening guidance for newly arrived refugee children across two Plan-Do-Study-Act (PDSA) cycles.
Methods:
We retrospectively evaluated health screening for refugee children aged 6 months to 21 years seen in a primary care-based refugee child health programme from 1 January 2011 to 30 September 2023. We assessed completion of recommended screenings for elevated blood lead level (EBLL), tuberculosis, hepatitis B, anaemia, HIV and eosinophilia. The CDS toolkit was updated during the second PDSA cycle to streamline order sets and align with updated CDC guidance. Screening rates were compared across three periods: baseline, first PDSA cycle and second PDSA cycle.
Results:
Among 830 refugee children, initial screening completion remained high at 90.12%. Follow-up lead testing improved from 21.46% at baseline to 36.92% in the second PDSA cycle, though 43.08% of eligible children still missed timely follow-up. EBLL prevalence at arrival increased from 7.43% to 15.69%, reflecting changes in screening thresholds and demographics. These findings demonstrate the CDS toolkit's effectiveness in maintaining high initial screening rates while highlighting persistent challenges in follow-up care.
Conclusions:
The updated CDS toolkit maintained high completion rates for initial screening, and after two PDSA cycles, it correlated with improvements in follow-up testing for EBLL. This project underscores the need for further interventions to improve follow-up care and supports the potential of CDS toolkits to enhance refugee health screening.
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