Increasing Universal Lipid Screening Among 9- to 11-Year-Old Children Through a Quality Improvement Initiative

Abstract

In 2011, the National Heart Lung and Blood Institute recommended universal lipid screening (ULS) in 9- to 11-year-old children. This study aimed to determine whether a quality improvement (QI) initiative increased ULS. Data were abstracted from the electronic medical record to compare screening behaviors 1 year preimplementation and postimplementation. A focus group was conducted to examine physicians' attitudes. In preimplementation and postimplementation years, the number of 9- to 11-year-olds seen for well-child checks were 356 and 357, respectively. The first and second phases of the intervention were associated with a 64.3% ( P < .001) and 2.3% ( P = .75) increase in ordering, respectively. The rate of abnormal results was similar (21.4% vs 20.1%, P = .91). Physicians reported "some benefits" to screening but expressed concerns about cost-effectiveness and impact. The QI initiative resulted in high rates of ULS. Nonetheless, physicians continue to question the impact of screening on long-term health. More research on the benefits, costs, and outcomes of ULS is needed.

Longitudinal changes of lipid profile in the Lebanese pediatric population

“…Traditionally, screening for dyslipidemia in children targeted only individuals at-risk with a family history of familial hypercholesterolemia. Since 2011, new recommendations have introduced universal screening for dyslipidemia to reduce the risk of cardiovascular disease beginning in childhood [5], but currently, there is a lack of evidence for benefits of universal screening versus selective screening, making the first one controversial [6, 7].…”

Characteristics of Children Referred to a Lipid Clinic Before and After the Universal Screening Guidelines

“…Our study results suggest that many primary care physicians may not be performing routine universal lipid screening in their pediatric patients, a trend that is consistent with prior studies. [12][13][14][15][16][17] Alternatively, it is possible that referring providers were already screening for lipid concerns in the pre-guideline period. We did not obtain information from the referring physician on familiarity with the guideline, agreement with following what is proposed in the guideline, nor did we assess the level of implementation or having access to systems that facilitate guideline compliance.…”

“…11 Because many general pediatricians are not trained in the management of lipid-lowering medications, the NHLBI guidelines recommend that children with suspected primary dyslipidemia be referred to or managed in conjunction with a pediatric lipid specialist. 11 Overall physician adherence to the universal screening guideline has been low, [12][13][14][15][16][17] but even a modest increase in lipid screening will lead to a higher rate of abnormal lipid screen results, and also likely lead to more pediatric lipid clinic referrals for the management of primary dyslipidemia diagnoses, due to the high prevalence of familial hypercholesterolemia (FH; occurring in about 1 in 250-500). [18][19][20][21] Given that the purpose of universal screening is to detect patients whose primary dyslipidemia previously went unrecognized, it is plausible that the clinical characteristics of children seen in lipid clinics have changed after the adoption of the new guidelines.…”

Universal Lipid Screening Among 9- to 11-Year-Old Children: Screening Results and Physician Management

“…During the 12-month-long QI project, physician ordering of lipid screening increased from a baseline of 6.2% in 2013 to 84.8% in 2014, and 20.1% of children who completed screening had an abnormal result. 17 Abnormal screens were associated with being overweight/obese, Black, or Hispanic. Participating pediatricians raised concerns about the long-term follow-up of children with abnormal screens and the impact of universal screening, and questioned whether more targeted screening could be more effective.…”