P2B174: Adherence to CDC Recommendations for Screening of Newly Arrived Refugees Supported by Clinical Decision Support: Rate of Screening and Opportunities for Improvement

Purpose/Objectives: Refugee children should receive healthcare screening after arrival in the US for treatable asymptomatic conditions and to promote public health. Guidance on appropriate screening is provided by the Centers for Disease Control and Prevention (CDC). Support for refugee health screening has existed as clinical decision support (CDS) within our electronic health record (EHR) since the establishment of the Children’s Hospital of Philadelphia Refugee Health Program in 2011. With guidance from a 19 institution advisory panel this CDS was updated in 2018 (Figure 1) to align with workflows and facilitate dissemination between organizations. Evaluating the rates to guidance adherence will help identify targets for future quality improvement initiatives.We sought to evaluate adherence to CDC recommendations for refugee health screening with the updated CDS in order to determine targets for future interventions.

Design/Methods: Using the CDC recommendations for screening of newly arrived refugees we developed a definition of screening adherence. Components of this definition were evaluated by subject matter experts to identify the appropriate timeframes for screening after arrival and characteristics of patients for whom recommendations would or would not be appropriate. Laboratory evaluations for patients seen in our health system who met the definition of a refugee patient were obtained from the EHR. A random sample of 20% of patients without completed screenings was further evaluated via manual chart review. Rates of screening after the CDS update were compared to our baseline rates. Statistical analysis was conducted to evaluate for changes in adherence to CDC guidance.

Results: CDC recommendations for the newly arriving refugee and rates of screening before and after implementation of the CDS are summarized in Table 1. For the 567 patient seen in the Refugee Health Program, high rates of adherence to guidance was noted. For the 295 patients arriving before CDS updates 90% received all initial screening and for the 272 patient arriving after CDS updates 89% received all initial screenings. A small increase in repeat lead testing rate was observed, but continued to be below target and this was identified as a target for process improvement. No statistically significant differences were noted, despite recent surges in refugee patients. Manual chart review validated our data extraction process and confirmed that all patients evaluated should have been offered screening.

Conclusion/Discussion: Adherence to CDC guidance for initial screening of newly arrived refugees remains high after the implementation of updated CDS. Further support is clearly needed for completion of screenings that are intended to occur after the initial domestic medical visit, such as follow up lead testing. Sites without extant CDS for refugee health screening that seek to improve screening rates could implement this system within their EHR and use the metric we developed to evaluate adherence to CDC guidance.