Improving Preteen Lipid Screening Rates at Well-Child Visits Through Quality Improvement Methods

Universal lipid screening is recommended for all pediatric patients aged 9 to 11 years based on 2011 guidelines; however, current screening rates remain low. Our aim was to increase universal lipid screening rates in patients aged 9 to 11 years at our pediatric primary care practices from 5% to 50%. Baseline screening rates were obtained from May 2019 to April 2021. Provider education and electronic medical record (EMR) clinical decision support (CDS) were introduced in May 2021. Point-of-care (POC) testing was implemented at 1 site in May 2021 and 2 additional sites in May 2022. Provider feedback was performed at 1 site in February 2022, followed by ongoing quarterly provider feedback for all 3 sites in July 2022. Data were collected through April 2023. Rates were plotted on monthly statistical process control charts. Lipid results were analyzed to determine the number of abnormal test results and compared before and after POC testing introduction using χ2 tests. Baseline testing rates ranged from 1% to 10%, which increased to 18% to 60% at completion of the study period. POC testing and provider feedback were the interventions with the most significant impact, whereas education and EMR CDS alone did not lead to a meaningful increase in screening rates. The proportion of eligible visits with abnormal lipids identified increased from 1.3% to 4.2% after introduction of POC testing. POC testing and provider feedback are effective strategies to improve universal lipid screening rates and increase the identification of children with abnormal lipids.