Hawaii

In Hawaii, most community health centers located in high-risk neighborhoods conduct blood lead testing using point-of-care machines that report the results directly in-house. In a survey conducted by a Hawaii Childhood Lead Poisoning Prevention Program (HI CLPPP) partner, doctors reported only sending results for patients with venous follow-up blood lead tests greater than or equal to 10 µg/dL to the Hawaii Department of Health. Doctors are required by state law to send all blood tests to the Hawaii Department of Health. Additionally, doctors at these health centers often did not follow protocols for determining which children should receive a blood lead test.

The Kalihi Palama Health Center (KPHC) is a community health center located in Hawaii’s highest risk area for lead poisoning, an urban community of approximately 65,000 residents, many of whom are low-income, live in older housing, and face significant barriers to access medical services. KPHC was selected for this intervention because they were reporting the highest number of children tested with point-of-care machines and the highest prevalence of elevated blood lead levels (BLLs) compared to the state average.

HI CLPPP partnered with KPHC’s Director of Clinical Operations, their Quality and Compliance Coordinator, and several of their healthcare providers to:

• establish a lead screening protocol following the state recommended guidelines,
• establish a reporting system to report in-house blood lead test results from all locations to the Hawaii Department of Health, and
• implement quality control measures to ensure continued compliance.

Through these efforts, in-house blood lead testing results at KPHC can now be added from KPHC records into a validated spreadsheet and reported directly to HI CLPPP.

From January 2018 through February 2019, KPHC reported that 895 children were tested, which is a 44% increase in children tested over that period. Over 96% of the children tested were members of minority populations: 50% Native Hawaiian or Pacific Islander, 36% Asian, and 10% Other. Many children were either enrolled in Medicaid (40%) or uninsured (18%). Of all children tested at KPHC, 2.8% had elevated BLLs, three times the state average.

Because KPHC started reporting all blood test results to HI CLPPP, all children with elevated BLLs became eligible to receive HI CLPPP’s case management services, including educational information, telephone follow-ups by a public health nurse, home visits with the public health nurse, and environmental investigations.  Improvement in screening rates and referral to follow‐up services at KPHC following HI CLPPP’s intervention will be a model for future partnerships to prevent high‐risk children who potentially have elevated BLLs from going undetected.