Blood lead screening.

To evaluate local procedures for and barriers to testing Medicaid patients for lead toxicity, a retrospective review of 675 charts of Medicaid patients' age 12 to 36 months form the 7 practices who serve the vast majority of Medicaid children in Kalamazoo, Michigan was undertaken. We identified and tested a model for barriers to patients and physicians obtaining blood lead levels. Only 27.6% had blood lead levels substantially lower than the universal testing mandated by the Centers for Medicare and Medicaid Services. Physicians overestimated the number of children having blood lead tests, even with adjusting for patient non-compliance. Practices varied sharply in their approach to screening. Of 489 patients without findable lead test results, 139 (28.4%) were attributable to previous screening, 98 (20.0%) to patient failure, 181 (37.0%) to physician failure, 52 (10.6%) to patient + physician failure and 19 (3.9%) were indeterminate. There is need for improvement, standardization and unification of lead screening guidelines. Understanding barriers to blood lead testing is also necessary to develop credible data to promote shifts in public policy regarding lead abatement. Further studies should be done, such as interviews and questionnaires to determine why physicians fail to order blood lead tests, and patients fail to appear for a test that has been ordered.