Presentation on theme: "A Comprehensive Analysis of an EHDI Program: A Retrospective Study Vickie Thomson, MA EHDI Program Manager Colorado Department of Public Health and Environment."— Presentation transcript:
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
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
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
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 Mothers age Mothers education Mothers 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 2001-2004204,694 Screened 200,666 (98 %) Failed8,124 (4%) Rescreened6,686 (82%)
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 2002-2004ScreenedNot Screened Total 8,1246,686 (82%)1,438 (18%) Mom Educ 13+ Latino 39% 42% 27% 45% Age at Birth 25+60%50% Smoked9%13% Hospital >82% (N=28)54%29%
Rescreen Percents by Race, Education, and Hospital Program
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?
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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