Abstract Body (Do not enter title and authors here): Background: Pediatric dyslipidemias are among the most treatable causes of cardiovascular disease in the world. Universal lipid screening is recommended between the ages of 9 and 11 and 17 and 21. Selective screening in younger children is indicated based on the presence of a positive family history of premature coronary artery disease or familial hyperlipidemia. However, according to contemporary estimates, screening for lipid disorders occurs in fewer than 50% of children and adolescents. Health system-wide lipid clinical pathways may improve rates of lipid screening in children and adolescents.

Aim: The SMART aim was to increase lipid screening rates in children and adolescents seen within a primary pare network from 36% to 80% within 12 months.

Methods: A multidisciplinary team of key stakeholders, including preventive cardiologists, primary care leadership, and improvement specialists within an extensive primary care network spanning 38 clinics across three states, led this initiative. Using plan-do-study-act (PDSA) cycles, five change concepts were implemented, including the creation of a clinical pathway. The clinical pathway included universal lipid panel screening for all patients, targeted screening for those with a positive familial hypercholesterolemia questionnaire (or risk factors), and guidance for managing abnormal results. Data was analyzed using statistical process control charts and standard rules were applied to determine special cause variation.

Results: 33,496 patients in the baseline phase (May 2022- December 2023) and 24,944 patients in the intervention phase (January 2024- April 2025) met inclusion criteria. Screening improved from 36% to 69% following interventions 1-3. Preliminary results indicate further improvement toward the goal with implementation of the clinical pathway. Disaggregation of data by age revealed improved screening in the 9-11cohort (37-75%) vs. the 17-21 cohort (29-59%).

Conclusion: Quality improvement methodology improved lipid screening rates within a large pediatric primary care network. Health systems may consider multimodal interventions including physician incentivization, electronic health record reminders, physician interviews, and the development of clinical pathways to improve lipid screening in the pediatric population.