Nebraska

The State of Nebraska received $350,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022 to September 29, 2023.

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 Nebraska, contact the program below.

Nebraska Department of Health and Human Services
301 Centennial Mall S FL s-3rd NE
Lincoln, NE 68508
Phone: 888-242-1100, ext. 3

Success Story 2023

Increasing Electronic Blood Lead Reporting in Nebraska

Challenge

While most blood lead laboratory results are reported electronically in Nebraska, approximately 20% are reported by fax or mail. Laboratory reports submitted via automated electronic reporting are more quickly entered into the surveillance system and allow local public health departments to start case management in an efficient timeframe. Annually, thousands of blood lead laboratory reports must be entered manually, which slows response time for follow-up testing and case management.

Intervention

To increase electronic reporting among clinics and providers that use point-of-care devices, the Nebraska Department of Health and Human Services (NDHHS) Nebraska Childhood Lead Poisoning Prevention Program (NECLPPP) started a three-phase intervention. Phase I adapted the Nebraska COVID-19 Laboratory Results Upload Portal to facilitate the use of alternate reporting methods for blood lead results using file formats such as CSV, XLS, and XLSX. Phase II involves enhancing the portal’s user interface and data quality flagging. Phase III involves expanding the use of the application portal across the state of Nebraska.

Phase I was completed in the summer of 2022. NECLPPP partnered with Douglas County, a large county health department, to pilot the Laboratory Results Upload Portal in May 2022. The initial goal focused on five facilities, which include Women Infants and Children (WIC) clinics, Federally Qualified Health Centers (FQHCs), and family medicine clinics.

Impact

At the end of Phase I, 14 facilities were engaged in electronically uploading data, which included four WIC clinics, two FQHCs, and eight family medicine clinics that predominately serve Black, Hispanic, and low-income individuals in communities that are served by these clinics.

In 2022, there was an 8% increase in electronic blood lead laboratory reporting due to the upload project. During January–September 2022, the Laboratory Results Upload Portal uploaded 2,649 blood lead laboratory results (2,578 capillary and 71 venous laboratory results) into Nebraska’s surveillance system. Of those 2,649 laboratory results, 189 were at or above the blood lead reference value of 3.5 μg/dL, which resulted in prompt case management and confirmatory/follow-up testing recommendations. Due to the success of Phase I, NECLPPP plans to onboard additional clinics for electronic reporting with the goal of eliminating fax and paper reporting. NECLPPP will begin Phases II and III by October 2023.

Funding for this work was made possible in part by NUE2EH001419 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success Story 2021

Establishing a Case Management Protocol with Existing Resources in Nebraska

Challenge

It’s estimated that one-third of Nebraska’s housing stock was built before 1978 and contains lead-based paint. Low-income and minority children are particularly at risk for lead exposure and lead poisoning, as they are more likely to live in older housing. Early identification of lead-exposed children and prompt linkages to supportive services are critical to reducing lead poisoning’s detrimental effects. Case management for lead-exposed children is key to monitoring compliance with blood lead testing, medical follow-up, medical treatment, and referral to early intervention services. While the Nebraska Department of Health and Human Services has collaborative arrangements with local health departments across the state to provide follow-up for lead-exposed children, some children need more intensive clinical case management above the local health department’s capacity.

Intervention

Nebraska has a robust Medicaid-managed care system encompassing a statewide network of case management teams among three managed care organizations (MCOs). Upon confirmation that all parties adhere to HIPAA regulations, the Nebraska Childhood Lead Poisoning Prevention Program (NeCLPPP) collaborated with the Division of Medicaid and Long-Term Care (MLTC) to access the N-Focus application, which houses Medicaid enrollment data for the state. With access to this information, NeCLPPP and MLTC developed the following protocol for medical case management referral for children enrolled in an MCO plan: 

Step 1: Using Nebraska’s Blood Lead Surveillance System, NeCLPPP identifies children eligible for case management based on a confirmed venous blood lead level (BLL) of ≥5 μg/dL or several elevated capillary blood lead tests of ≥5 μg/dL with no confirmatory venous testing. NeCLPPP checks in N-Focus to see if that child is enrolled in Medicaid.

Step 2: If the child is enrolled in Medicaid, NeCLPPP notifies MLTC staff members, who forward a referral to the case management team of the MCO serving that child.

Step 3: The MCO reports the status of the referrals back to MLTC and NeCLPPP every month.

Impact

Within the first five months of initiating this protocol, 21 children received intensive clinical case management services who otherwise would not have had access. Because NeCLPPP’s collaborative and resourceful protocol builds upon existing services of the MCOs, the impact gained from these services came at no additional cost. As the work of NeCLPPP continues to promote BLL testing in vulnerable low-income and minority populations, this protocol will be invaluable for linking children with identified elevated BLLs to these needed services.

Funding for this work was made possible in part by the Cooperative Agreement Number [NUE2EH001364] 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.