a comprehensive analysis of an ehdi program: a retrospective study vickie thomson, ma ehdi program...
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A Comprehensive Analysis of an EHDI Program: A Retrospective Study
Vickie Thomson, MA
EHDI Program Manager
Colorado Department of Public Health and Environment
Acknowledgements The Colorado Infant Hearing Program would
like to express its gratitude to the Center’s for Disease Control and Prevention for entering into a cooperative agreement to build and maintain a surveillance infrastructure (RFA 05028).
Vickie would like to thank Mathew Christensen, PhD, Stat Analyst and Bill Letson, MD for their vision, support and assistance with this analysis
The Role of Public Health in EHDI Programs Public Health criteria for population
based screening Easy Not detected by other means Interventions available Results in improved outcomes Acceptable cost
10 Essential Public Health Services
Program Evaluation for CDC’s Operating Principles
Using science as a basis for decision-making and action;
Expanding the quest for social equity; Performing effectively as a service
agency; Making efforts outcome-oriented; and Being accountable
Research or Evaluation? State hypothesis Collect data Analyze data Draw conclusions
Engage stakeholders Describe the
program Focus the evaluation Gather credible
evidence Justify conclusions Ensure use and
share lessons learned
Framework for Program Evaluation
Analyzing an EHDI Program
Advisory Committee Improve follow-up Factors associated with missing the
screen, rescreen, & late diagnosis Data integration, hospital surveys Conclusions Plan and implement programmatic
changes for improvement
The Colorado EHDI Follow-up Program:A Historical Perspective
0
10
20
30
40
50
60
70
80
90
1992-96
1999 2000 2001 2002 2003 2004
F/U
Factors that Influenced Improved Follow-up Rates
Pressure from the Pediatric Chapter Champion - Al Mehl, MD
Integration with the EBC Track from screening to diagnosis to early intervention Send accurate MONTHLY reports to hospital
coordinators Letter campaign to parents from missed, failed
screens (EBC provides demographic information)
Colorado Infant Hearing Program
Factors that Affect Screening and Follow-up Rates
Factors Initially Tested Mother’s age Mother’s education Mother’s weight gain Martial status Gestational age Mother Smoke Infant gender Race/ethnicity Hospital Year of birth Birth weight APGAR Scores Urban, rural, frontier populations
Population Results from Hospital Screen
Births 2001-2004 204,694 Screened 200,666 (98 %) Failed 8,124 (4%) Rescreened 6,686 (82%)
Explaining Initial Screening Rates
2002-2004 Screened Not Screened
Total Hospital Births
Hospitals > 98% (N=31)
Birth weight >2500 gms
>7 on APGAR5
195,208
132,741 (68%)
177,639 (91%)
193,255 (99%)
3,712
1,373 (37%)
2,301 (62%)
2,969 (80%)
<2500 Grams &
<7 on APGAR5
529 (.26%) 692 (17%)
USPSTF and NICU Screening “The USPSTF found good evidence that
the prevalence of hearing loss in infants in the newborn intensive care unit and those with other specific risk factors is 10-20 times higher than the prevalence of hearing loss in the general population of newborns. Both the yield of screening and the proportion of true positive results will be substantially higher when screening is targeted at these high-risk infants…”
Conclusions Lack of reporting results Early discharge Significant health problems Out of state residents (7%) Deceased
Recommendations Presentations and education to
neonatologists Enhanced tracking for transfers Enhanced protocols for NICU’s Letters to the medical
home/PCP
Explaining Current Follow-up Rates with Birth Certificate Data
2002-2004 Screened Not Screened
Total 8,124 6,686 (82%) 1,438 (18%)
Mom Educ 13+
Latino
39%
42%
27%
45%
Age at Birth 25+ 60% 50%
Smoked 9% 13%
Hospital >82% (N=28) 54% 29%
Rescreen Percents by Race, Education, and Hospital Program
2001310
328
1471
1243
1122
1012
1114
50
55
60
65
70
75
80
85
90
95
<82% & HS <82% & >HS >82% & HS >82% & >HS
Latino
Non Latino
Percent Rescreened by Race/Ethnicity and Hospital Grouping
Hospital Survey Data1. What is the highest level of care is offered in your hospital?
2. Is an audiologist involved with your hospitals screening program?
3. Level of audiology involvement
4. Who provides the screening?
5. Type of Screening equipment used:
6. Does your hospital provide the outpatient rescreen?
7. For infants that do not pass the initial hearing screen, does your program set up an appointment for a follow-up rescreen prior to discharge?
8. Is there a charge assessed for outpatient rescreening?
2005 Stats Births = 69,487 Screened = 67,451 (97%) Not Passed = 3,154 (4.7%) Rescreened = 2,629 (83.4%) Confirmed Hearing Loss = 128
Demographic for Follow-up Screens
Not Passed = 3,154 (4.7%)
11 Hospitals = 100% Birth Range = 2,4048 - 24
11 Hospitals < 70% Birth Range = 2,729 - 134
Variables Technology
AABR = 60% OAE = 12% AABR/OAE = 30%
Who Screens? Nurses, Medical Assistants, Techs = 58% Volunteers = 30% Audiologists = .5% Contract = 12%
Audiologist Involvement 50% report they have audiology
involvement Consultant to screening 71% of the infants who failed were
born in hospitals affiliated with an audiologist
Follow-up Appointment
Does your Program set up an appointment for infants who fail?
Yes before discharge = 42% No, after discharge = 14% Parents responsibility = 43% Which infants are more likely to
receive the follow-up?
Follow-up ProtocolDoes your hospital provide the outpatient
rescreen? Return to the nursery = 52% Return to audiology in the same hospital =
48% Return to audiology different campus = 2% Do not return to hospital =1% Will the protocol affect the return percent? Charge? 50% yes, 50% no
Failed Screens and Diagnostic Follow-up
What factors are associated with an infant who fails newborn hearing screening and rescreen yet not confirmed with hearing loss by three months of age?
Variables for Analysis Co morbidities – link to birth defects registry Hospital factors Race Ethnicity Gender Mother’s age Mother’s education Mother’s marital status
The Role of Public HealthResearch Based Plans
Identify the gaps and educate the “medical homes” on the importance of follow-up for the NICU and Latino infants
Develop strategies to assist hospitals with protocols to capture these populations
Work with communities to ensure a seamless transition from screening into appropriate diagnostics
The Role of the Medical Home
Included in the hospital recommended protocol and informed of the steps
Informed regarding every outcome from screening, diagnostics, and EI
The Role of our Federal Partners
Continuing to ‘raise the bar’ for EHDI programs
Encourage data integration with newborn screening and immunization
Support the concept of the child health profile to ensure the Medical Home/PCP are informed of outcomes
Outcomes: Happy, Healthy Families
Comprehensive Culturally
Competent Seamless Knowledgeable
Providers Parent to Parent
Support