Routine laboratory screening recommended for children entering foster care can carry high costs and questionable medical benefits. A new study, published online in Pediatrics, suggests that targeted screening may be both a more clinically-meaningful approach and a way for hospitals to reduce costs.
Researchers identified costs for each screening test using published Medicaid reimbursement rates. The authors found, for example, that the cost of screening for chlamydia in the population studied was less than the cost of failing to diagnose and treat infected patients. The cost of treating active cases of tuberculosis, on the other hand, would be less than the cost of routine screening for the whole population. The authors suggested that more targeted screening for tuberculosis in may be appropriate.
The findings suggest that routine screening for anemia, lead (in children 6 months to 6 years old), and chlamydia and gonorrhea in sexually active adolescents is useful and more cost-effective. More targeted screenings may be appropriate for hepatitis B and C, tuberculosis, HIV and syphilis -- meaning hospital leaders looking to tighten their purse strings may want to consider such methods when making decisions about screenings for those particular conditions.
The researchers studied data between 2012 and 2015 from the medical records of nearly 2,000 children and young adults under 21 years. They were in the legal custody of Jobs and Family Services, the child protective agency of Hamilton County, Ohio, and seen at the Cincinnati Children's foster care clinic. The clinic evaluates children in the region when they enter foster care and at every change in placement.
Clinic visits include a medical record review, physical examination and laboratory screening to test for hepatitis B and C, syphilis, tuberculosis and HIV. Clinicians collect hemoglobin concentrations for all children and measure lead levels in children 6 months to 6 years. They screen those 12 and older who were sexually active for gonorrhea and chlamydia.
Nearly five percent of those screened were identified to have anemia, 2.9 percent infectious disease, and 2.6 percent had elevated lead levels. Seven percent of teens tested positive for chlamydia. The prevalence for hepatitis B and C, syphilis and tuberculosis was less than 1 percent, and there were no cases of HIV.
Routine screening is generally accepted when the tools are sensitive and specific and early detection improves outcomes, the researchers said. But hospital costs should be reasonable in relation to the anticipated benefits.