Factors that Influence Hospital Screening Programs Vickie Thomson, MA State EHDI Coordinator Mathew Christensen, PhD Colorado Department of Public Health and Environment

Faculty Disclosure Information In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation. This presentation will (not) include discussion of pharmaceuticals or devices that have not been approved by the FDA or if you will be discussing unapproved or "off-label" uses of pharmaceuticals or devices.

The Colorado EHDI Program: A Historical Perspective Started in 1992 as a pilot project Legislated in 1997 Linked the hearing screening results to the Electronic Birth Certificate in 1999 Awarded a CDC Integration grant in 2000 Parent letters sent in 2004

The Colorado EHDI Follow-up Program: A Historical Perspective

Colorado Statistics 2004 Births 69,042 Screened 67,215 (96%) 3,081(4.5%) of infants referred for further testing at hospital discharge 2,665 (86%) have documented follow-up 181 confirmed with permanent hearing loss

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)

Explaining Current Follow-up Rates 2002-2004 Screened Not Screened Total 8,124 6,686 (82%) 1,438 (18%) Mom Educ 13+ 39% 27% Age at Birth 25+ 60% 50% Smoked 9% 13% Hospital >4.7 to 1 54% 29%

Examples of Four Hospitals’ Follow-up Rates 2002-2004 Screened 82% Not Screened 18% Hospital 1 103 (99%) 1 Hospital 2 727 (91%) 40 Hospital 3 509 (72%) 198 Hospital 4 43 (41%) 63

Percent Rescreened by Race/Ethnicity and Hospital Grouping

Explaining Hospitals’ Screening Variation Some hospitals have much higher rates of missed screens than other hospitals. This is a central explanatory factor. Is this due to different types of screening equipment, different screening protocols, screener’s competency, or other factors? Survey program coordinators and screeners.

Explaining Initial Screening Rates 2002-2004 Screened Not Screened Total Hospital Births 200,666 4,028 <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…”

Future Analysis What factors affect whether a child receives an initial or follow-up screen? What factors affect whether an infant is diagnosed by 3 months of age? What are the high risk factors associated with late onset of hearing loss? What factors are associated with infants who pass screening but are later identified with hearing loss? How do our Parent Evaluation Surveys correlate with our findings?

Factors Affecting Hospital Programs Survey of Hospital Coordinators Survey of Screeners Type of equipment Protocol for screening Protocol for follow-up Administrative support Training

Conclusions While the picture overall is less clear for the follow-up than the initial screen, hearing screening programs themselves emerged clearly as the single most important factor for receiving the follow-up screen. Understanding the interactions between race/ethnicity and screening programs’ miss-rates will require further study.