Reducing Lost to Follow Up Percentages In EHDI Programs: The Role of Audiology Michael Dybka, Ph.D., CCC-A, FAAA Director Newborn Hearing Screening Program Department of Otolaryngology Audiology Services St. Elizabeth s Medical Center Brighton, MA Jana L. Ziegberman, Au.D., CCC-A, FAAA Coordinator Newborn Hearing Screen Program Pediatric Audiologist, Department of Otolaryngology Boston Medical Center Boston, MA
Congenital, permanent hearing loss is estimated to occur in: 1-3/1000 infants in well baby nurseries 2-4% of infants in neonatal intensive care units
The Good News Early Hearing Detection and Intervention (EHDI) programs are charged with: Identifying permanent hearing loss before 3 months of age Provision of appropriate intervention services before 6 months of age. UNHS is provided to 92-95% of babies in the United States and its territories.
The Bad News CDC data from 2010 show that 39.4% of the 58,202 infants who failed their initial hearing screen NEVER received their follow-up diagnostic services or they were not documented. Additionally, 24.2% of infants with hearing loss lacked any record of receiving Early Intervention services.
We Can Do Better!!!!!!
Long Short Term Follow-up term Follow -up Lost to System Lost to Follow-up Lost to Documentation
The Problems Terminology ASHA Task Force The variability in terminology presents difficulties in tracking and documenting infant data. Short term follow-up Confirmation of the diagnosis and connection of infants and parents to treatment. Long term follow-up Ongoing management, evidence based treatment, and program evaluation. Lost to Follow-up Need to define durational parameters. Lost to Documentation Unknown status infant may have referred; however diagnostic or intervention status is not known. Lost to System Combines LTF and LTD may help reduce confusion and increase effectiveness of follow-up strategies.
The Problems Lack of Timely Diagnosis, Provision of Services, and Documentation Charles J. Homer, MD, the co-founder, CEO, and president of the National Initiative for Children's Healthcare Quality There are a significant number of kids who are appropriately followed up, but their follow-up is not documented, and there are likely still some children falling through the cracks who need services and aren t getting them and aren't diagnosed at an appropriate age.
The Problems Most states require hospitals to report screening results to their respective state health departments. Many, if not most, states do not require audiologists to report diagnostic test results. The move from inpatient hospital screening to outpatient diagnosis may be responsible for lost to documentation and lost to system errors.
The Problems Follow-up and documentation can pose problems when an infant is discharged from the hospital: Name changes Address and phone number changes Failure to document and communicate with pediatrician Missed Diagnostic Audiology appointment Transportation difficulties Failure to understand the importance of the Diagnostic Audiology appointment Non-English speakers may not understand the discharge instructions
Is there a common thread that can lead to solving these problems?
Audiology Consistent Presence Throughout UNHS and EHDI Programs UNHS Hospital Hearing Screening Audiology Early Intervention Interaction with Providers Counseling Communication Choices Amplification Management Plan
Audiologists are not always aware of how critical their role is in both facilitating the testing and documenting and communicating the results. (Charles J. Homer, MD.) No other profession is as visible and involved in the process as audiology.
Reducing Lost to Documentation Through Audiology Taking a Leadership Role Counseling by an audiologist at the time of a hearing screen refer in the nursery or after a short period of time after the refer. Counseling by an audiologist when the hearing loss is identified at the diagnostic audiologist evaluation. Management, tracking, and communicating with other service providers. Assuming a larger role for reporting and documentation to state agencies.
Counseling By An Audiologist At The Time Of A Screen Refer in the Nursery Essential to developing a relationship with the parents and generating a commitment to the diagnostic evaluation. Reduce parental anxiety Explanation of what a screening is and is not Explanation of the diagnostic evaluation Obtain additional history information Schedule diagnostic audiologic evaluation, if not already scheduled Provide audiologist s contact information Contact established with pediatrician
Counseling By An Audiologist When Hearing Loss Is Identified At The Diagnostics Audiologic Evaluation Counseling regarding presence of hearing loss Counseling dealing with acceptance of hearing loss Informational non-biased session/s exploring communication options Informational non-biased session/s regarding amplification/ci options Facilitating referral to other medical specialties Facilitating enrollment in Early Intervention programs Communication with pediatrician Generating Audiological management plan Build a trusting relationship with the family
Management, Tracking, and Communicating With Other Service Providers Communicate with local EI programs and schools who serve your patients. Request progress or IFSP reports Discuss hearing loss as it relates to academic progress Management of communication choice, if not provider communicate with service provider. Amplification and Cochlear Implants ASL, Oral Communication, Total Communication, Cued Speech Communicate with pediatrician and other medical specialties Act as a coordinator for services
Assuming A Larger Role For Reporting And Documentation To State Agencies If your state DPH does not require reporting of Diagnostic Audiology Evaluation, become an advocate for CHANGE! Establish an alliance with medical, educational, and allied health professional to encourage timely documentation of follow-up activities. Become a resource for locating lost documentation
Conclusions The 2010 CDC for Lost to documentation is not acceptable: 39.4% undocumented diagnostic audiology reports 24.2% no record of services for children with hearing loss We have seen today that audiology has a consistent presence and is a common thread throughout the process Audiology can play a significant role in reducing documentation errors. It is our professional responsibility to respond to these challenges.
WE CAN Thank AND you!!!! WILL DO BETTER!!!!