Kansas

About the program

The State of Kansas received $564,885 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.

The strategies focus on:

• Ensuring blood lead testing and reporting
• Enhancing blood lead surveillance
• Improving linkages to recommended services

To learn more about these efforts in Kansas, contact the program below.

Kansas Department of Health & Environment

Kansas Childhood Lead Poisoning Prevention Program

1000 SW Jackson St.

Topeka, KS 66612

Phone: 866-865-3233

Success story: funding year 3

New partnership improves linkages to recommended services in Kansas

Challenge

The Kansas Childhood Lead Poisoning Prevention Program (KS CLPPP) had challenges with staffing capacity and the ability to ensure case management and linkages to services for children with higher blood lead levels (BLLs) across the state. For several years, state oversight of local investigation and case management activities was provided by one staff person. As a result, the program's capacity to provide coaching to local investigators and for developing collaborations to link patients to services was considerably limited.

Intervention

To address this challenge, KS CLPPP leveraged funds from two additional sources to develop a new Environmental Health Regional Medical Investigator Program (RMI Program) in February 2023. These additional sources were the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities cooperative agreement and the CDC-RFA-OE22-2203, Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems cooperative agreement. The RMI program effectively expanded KS CLPPP's ability to monitor new cases of children with higher BLLs and ensure these cases were routed to local public health investigators. The RMI Program's work has increased the distribution of case investigation information to local public health investigators, including follow-up expectations, the types of supporting services children with higher BLLs may need, and when to make referrals to those services. Through continued oversight by the RMI program, coordinated efforts have been made to ensure that case investigations and ongoing follow up meet state recommended standards for children with blood lead poisoning, including connecting them to services. With this expanded capacity, the KS CLPPP and RMI Programs have also been able to engage in collaboration with the Kansas Department of Health and Environment Division of Health Care Finance (DHCF). These collaborations have facilitated a standardized procedure to refer children enrolled in Medicaid with BLLs >10 µg/dL to their Managed Care Organization (MCO) for case management. Previously, because MCOs do not systematically receive all blood lead laboratory results for clients, MCOs were not informed when Medicaid-enrolled children had BLLs that required case management unless a provider specifically requested assistance.

Impact

As a result of program collaboration, 67 children who receive Kansas Medicaid were referred for MCO case management between February 2023 and December 2023. Home environmental assessments were arranged for two of these cases, paid for by the MCO, which otherwise would not have been completed. At least two children received housing support services from their MCO. Anecdotal evidence from weekly case reviews demonstrates that MCO case managers are now communicating with caregivers of children with lead poisoning about the availability of additional social supports, making it more likely that families will receive these services. These additional social supports can include transportation assistance for medical appointments, enhanced nutrition education and resources, and assistance with housing challenges (temporary alternate housing and assistance obtaining grants for home repairs).

Funding for this work was made possible in part by NUE2EH001410, NH75OT000072, and NE11OE000106 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily Reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 2

Improving data processing in Kansas

Challenge

Kansas uses a disease surveillance system called EpiTrax to collect, store, and manage blood lead level test results and perform case management oversight. This system was designed for infectious diseases and modified to accept reportable conditions such as blood lead. Approximately 60,000 records are entered into the dynamic system each year by reporting healthcare facilities and laboratories. Hundreds of users access the system, including local health departments.

Although much work has been done to improve data processing and quality, transforming records collected by the EpiTrax surveillance system into usable data products is complex and has historically been inefficient. Data standardization and formatting issues result in errors, variations, and missing or misplaced values. Furthermore, up to one third of all records are duplicates and difficult to identify. The existing process was functional but needed to be objectively evaluated and significantly improved.

Intervention

In October 2022, a new data analyst reviewed the workflow process with assistance from the programmatic team. Two main areas were targeted for quality improvement: duplicate records and address cleaning and geocoding. New coding packages were written to accurately identify duplicate records and resolve differences among duplicates with conflicting values. A new method of comparing the prevalence of duplicates and data ambiguities across quarters was instituted. Scripts for address cleaning and geocoding, which is the most time and resource intensive part of the workflow process, were assessed and redesigned. Because addresses are not standardized or validated by the system, scripts had to be created to anticipate many different types of potential errors and deviations from the acceptable address formats that were imported into the system.

Cleaned addresses are processed through a contracted vendor's application programming interface for geocoding. The geocoding vendor assesses charges for each address submitted, therefore it is important to submit only unique addresses that will likely geocode. Advanced software tools were created to rapidly search the EpiTrax system for a valid address and to pre-validate addresses in bulk using the online U.S. Postal Service address lookup tool as a new step in the process. This helped to reduce the number of addresses that were submitted but failed geocoding. Additional improvements to the data processing workflow included consolidating and streamlining all data and scripts and creating a written procedure manual that details the data processing steps and allows for versioning.

Impact

The program enhanced blood lead surveillance through the application of continuous quality improvement to plans and processes for surveillance data collections, quality, and dissemination. As a result:

• Staff hours needed to process quarterly data for submissions to the CDC were reduced
• Processing time was reduced by approximately 50%
• Quarterly lead data are now more readily available for routine and descriptive analyses
• Data quality control processes have been improved through a multi-phased assessment process
• The percentage of addresses geocoded with high accuracy increased from 20% to 25%
• Costs decreased
• Numerous data issues were resolved as part of the initial in-depth evaluation

Funding for this work was made possible in part by CDC-RFA-EH21-2102 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Automating processes for strengthening surveillance in Kansas

Challenge

Blood lead test results are required to be submitted to the Kansas Department of Health and Environment (KDHE) as a notifiable condition. Test results at or above 5 μg/dL were entered into the disease surveillance system called EpiTrax that was developed to manage infectious disease surveillance. Affected children were then referred to local health departments for investigation. Non-elevated tests, which accounted for most of the test results, were stored separately in a makeshift MS-Access database with limited ability to retrieve information. Conducting epidemiological surveillance was very challenging because a consolidated and cleaned dataset to capture the extent of the childhood lead poisoning problem in Kansas was not available.

Intervention

New tools, processes, and optimized queries were created to make the elevated blood lead test results retrievable from the databases. The Kansas Environmental Public Health Tracking senior epidemiologist provided in-kind support to create scripts to automate the collection, cleaning, and management of the disparate blood lead data sets. Non-elevated blood lead test results were cleaned and stored in a newly created database to ensure that the test results would be accessible and properly formatted for analysis and data submission purposes. A new epidemiologist was hired in September 2019 to use the updated and cleaned blood lead dataset to conduct analyses to identify high-risk areas, work on predictive modeling, create data stories for stakeholders, and provide epidemiological support for local health departments.

Impact

A large volume of previously disorganized and non-analyzed data was cleaned, properly formatted, and consolidated into a new database capable of being queried. Approximately 90% of the blood lead data for the past 4 years is now accessible and can be used for surveillance and analytical purposes. Because of this effort, the program can provide additional information to partners to make better-informed decisions to prevent childhood blood lead poisoning.

Funding for this work was made possible in part by NUE2EH001406 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.