Lead levels plummet with intensive case management

Parent education is the key to initiative

When Horizon/Mercy compiled the six-month outcomes report for its program to reduce the level of lead in its young members’ blood, the figures were so astonishing that the state epidemiologist monitoring the program checked them himself.

"It was amazing. In just six months, the lead level of members in the group we were monitoring had dropped from an average of 20 to an average of 16. It’s all due to the impact of the provider, the public health department, and the parents working together," says Pamela Persichilli, RNC, director of clinical operations for the Trenton, NJ-based insurer.

New Jersey law mandates that any child in the Medicaid population with a blood level of 10 or above must be under case management.

Through an Internet link with the laboratory, the case management department is able to upload the members’ lead levels into its computer system, which generates a list of members with elevated levels of lead in their blood.

In the first year, the system identified 955 members with levels of lead in their blood of 10 and above.

Members with a blood lead level of 20 and above receive intensive case management with monthly follow-up. Case managers follow up every three months with members with a level of 10 to 19.

If a child’s blood level is 7 or above, the case managers notify the parents and educate them on how the child could be exposed to lead.

"Although this level isn’t considered toxic, we feel like we should monitor it and make sure it’s not going up," says Giavanna Ernandes, RN, MSN, APNC, team leader for disease management and the lead program.

The case managers make sure the children get checked every three months for lead levels.

They educate the parents about proper diet and possible causes of lead in the blood. They arrange for the public health department to check for lead in the paint, ductwork, soil, and water.

"We monitor the members’ diet to make sure the children are getting high levels of calcium and iron that will help reduce the lead level. We encourage them to give their children cheese, yogurt, and milk," Ernandes adds.

They instruct parents on avoiding lead exposure through simple measures such as hand washing.

"In many cases, the children are being exposed to lead in the soil outside. They are playing outside and putting their hands in their mouths," Ernandes adds.

When the program started, the average blood level of children in the program was 20. After six months of case management intervention, the average had dropped to 16.

"We have found that through education and follow up, the blood lead levels are coming down," Ernandes says.