Evaluation of EHDI Follow-Up Protocols in Washington State

National EHDI Conference

March 3-4, 2005

Dalrymple, Beattie, Masse

Outline Background Information Protocol Analysis Conclusions

State of Washington 75,000 births/year 68 Birthing Hospitals 18 Pediatric Audiology Clinics Screening is Voluntary

EHDI in Washington State Developed Tracking and Surveillance System Currently covers 65% of births from 43 hospitals Follow infants from newborn screen through

diagnostic evaluation-- Monitor that each infant is screened

-- Recommend appropriate follow-up care

-- Evaluate outcomes

Data Collection Hospital Birth Rosters Blood Spot Cards Hearing Screening Cards Audiology Diagnostic Information

Follow-Up Protocols System generates multiple follow-up protocols Timed to achieve 1-3-6 Goals Protocol actions consist of:

Letter Fax (if no response from letter) Phone Call (if no response from fax) Close Case (after response from any of the above)

Contact is made through primary care provider Outcome code given at closing of case

Passed Infant passed hearing screen

Referred to Audiologist Infant was referred to an audiologist for further evaluation

Shared PCP shared recommendations for additional evaluation with infant’s parents/guardians

Lost Infant’s parents could not be contacted through PCP

Pending Case is currently on-going

Other Refused, Moved, etc…

Outcome Codes

Protocol Analysis

Purpose of Analysis Assess time-line efficiency Evaluate outcomes Determine workload

Data Live Births from January 1, 2004 through

September 30, 2004 (Q1 through Q3) Total Number of Live Births: 10,856 Data collected from 23 WA hospitals

Common Follow-Up Protocols

(1) Infant was missed

(2) Infant did not pass initial hearing screen

(3) Infant did not pass rescreen

(4) Infant passed but has risk factors

Protocol 1: Infant was missed

Causes Received a blank hearing screening card Missed infant found via program monitoring

Protocol Actions Letter (0 days) Fax (28 days if no response to letter) Call (49 days if no response to fax) Close Case (60 days or after response)

Protocol 1: Infant was missed 498 protocols initiated

Outcome Number %

Passed 228 46%

Referred to Audiologist 9 2%

Shared 144 29%

Lost 42 8%

Pending 62 12%

Other 13 3%

Protocol 1: Infant was missed

Observations Known outcomes for most infants Not all outcomes indicate success Higher number of pending cases Protocol timing is appropriate Workload generated is high (1/3)

Protocol 1: Infant was missed

Next Steps….. Find ways to reduce missed infants Identify “true” misses

Protocol 2: Infant did not pass initial screen

Causes Patient did not pass initial screen

Protocol Actions Letter (21 days) Fax (49 days if no response to letter) Call (70 days if no prior response) Close Case (81 days or after response)

Protocol 2: Infant did not pass initial screen

661 protocols initiated

Outcome Number %

Passed 370 56%

Referred to Audiologist 67 10%

Shared 143 22%

Lost 49 7%

Pending 15 2%

Other 17 3%

Protocol 2: Infant did not pass initial screen

Observations Known outcomes for most infants Not all outcomes indicate success Protocol timing is not appropriate Workload generated is high (1/2)

Protocol 2: Infant did not pass initial screen

Next Steps…. Adjust protocol timing to reduce workload Continued provider support

Protocol 3: Infant did not pass rescreen

Causes Infant did not pass rescreen

Protocol Actions Letter (0 days) Fax (28 days if no response to letter) Call (49 days if no response to fax) Close Case (60 days if no response to prior actions)

Protocol 3: Infant did not pass rescreen

114 protocols initiated

Outcome Number %

Passed 38 34%

Referred to Audiologist 40 35%

Shared 16 14%

Lost 10 9%

Pending 5 4%

Other 5 4%

Protocol 3: Infant did not pass rescreen

Observations Known outcomes for most infants Not all outcomes indicate success Protocol timing is appropriate Workload generated is low

Protocol 3: Infant did not pass rescreen

Next Steps…. Better diagnostic reporting Continued provider support

Protocol 4: Infant passed but has risk factors

Causes Risk factors reported on hearing screening card

Protocol Actions Letter (0 days) Fax (28 days if no response to letter) Call (49 days if no prior response) Close Case (60 days or after response)

Protocol 4: Infant passed but has risk factors

120 protocols initiated

Outcome Number %

Referred to Audiologist 25 21%

Shared 56 47%

Incorrect Reporting 10 8%

Lost 12 10%

Pending 16 13%

Other 1 1%

Protocol 4: Infant passed but has risk factors

Observations Known outcomes for most infants Different standard for “success” Protocol timing is not appropriate Workload generated is low Accuracy of reporting is unknown

Protocol 4: Infant passed but has risk factors

Next Steps…. Increase accuracy of reporting Further evaluation of risk factors as indicators Adjust protocol timing

Summary Known outcomes for most infants Not all outcomes indicate success Timing should be evaluated Workload should be consider

Conclusions Protocols need to be flexible Protocols need to be evaluated Workload needs to be manageable Don’t lose focus of the goal

Contact Information

WA DOH EHDDI Program

Nancy Dalrymple, MPH

Catie Beattie, MS

Rich Masse, MPH

E-mail: ehddi2@doh.wa.gov

Website: www.doh.wa.gov/ehddi