Universal Newborn Hearing Screening in Colorado by A0934K

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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      Engage stakeholders
   Collect data          Describe the program
                          Focus the evaluation
   Analyze data
                          Gather credible
   Draw conclusions       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
   90
   80
   70
   60
   50
   40                                                   F/U
   30
   20
   10
    0
        1992- 1999   2000   2001   2002   2003   2004
         96
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    195,208         3,712
Hospitals > 98% (N=31)   132,741 (68%)   1,373 (37%)
Birth weight >2500 gms   177,639 (91%)   2,301 (62%)
>7 on APGAR5             193,255 (99%)   2,969 (80%)
<2500 Grams &            529 (.26%)      692 (17%)
<7 on APGAR5
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+           39%           27%
Latino                 42%           45%
Age at Birth 25+       60%           50%
Smoked                 9%            13%
Hospital >82% (N=28)   54%           29%
       Rescreen Percents by Race,
     Education, and Hospital Program
95                                              200 1243
                                 1310
90
                                        1122
85                   328 1114

80

75           1012                                           Latino
      1471
70                                                          Non Latino

65

60

55

50
      <82% & HS     <82% & >HS   >82% & HS     >82% & >HS
Percent Rescreened by
Race/Ethnicity and Hospital Grouping
          Hospital Survey Data
1.   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 Protocol
Does 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 Health
          Research 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

								
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