Targeting OB Offices to Improve Family Understanding of UNHS Susan Wiley, M.D. Maureen Sullivan-Mahoney CCC-A, FAAA March, 2005

Goal of the Project To determine if brief educational information in the prenatal setting of an OB’s office affects a family’s understanding and follow-through with hearing screening results.

Overview of Project IRB approval Informational brochures and posters were placed in OB offices. Families for 500 sequential births in the newborn nursery at an urban hospital well versed in UNHS were surveyed.

Getting our OB’s on board The newborn nursery director of an urban birthing hospital identified 4-5 OB offices and prenatal centers willing to participate in a pilot study. Prenatal centers were selected to try to gain a breadth of patient populations

Initial Contact Offices were contacted by phone to set up a brief (no more than 10 minute) informational session about the project. Lunch was provided to the offices during the informational setting.

Office Participation Offices were asked to participate in the following: –Hang a poster in the waiting room or exam rooms –Hand out UNHS brochures to all women delivering in the next 1-2 months –Offered video for waiting room

Common Questions by OB’s Why are you targeting us and not pediatricians? How is screening performed? What are the outcomes associated with early identified hearing loss? What are some of the newer technologies for children with hearing?

Demographics of OB sites an urban practice serving primarily patients with Medicaid and no insurance. This office had 5 sites with 700 deliveries per year. a 6 physician group serving primarily middle to upper SES insured patient population. This practice delivers approximately 1100 babies per year. a 4 physician group serving primarily a middle SES patient population. This practice has approximately 600 deliveries per year.

The Birth Hospital Urban hospital with 6500 births/year. UNHS program implemented since 2000 Referral rate under 2% with OAE followed by AABR We met with the nurse manager of the newborn nursery unit. Questionnaires were placed in newborn packets and nursing staff was encouraged to either have families fill it out at the hospital for a drop off box or send it in to the mailing address.

Results 500 questionnaires were given to 500 sequential newborn nursery admissions. 87 questionnaires were returned (17.4% response rate). Of those responding, 39 (45%) were from the sites targeted for an educational intervention and 48 (55%) were from sites without an intervention.

Results for entire group (N=87) (17.4% response rate) Postcard QuestionN (%) 1.Talked to Doctor40 (46%) 2.Read Posters46 (53%) 3.Received Results83 (95%) 4.Received Brochures82 (94%) 5.Watched Video10 (11%) 6.Understand Results81 (93%) 7.Feel informed79 (81%)

Results Based on Intervention Postcard Question Project Clinic Other p-value N=39N=48 Talked to Doctor20 (51%)20 (42%) 0.40 Read Posters26 (67%)20 (42%) 0.03 Received Results38 (97%)45 (94%) 0.62 Received Brochures38 (97%)44 (92%) 0.37 Watched Video5 (13%)5 (10%) 0.75 Understand Results39 (100%)42 (87.5%) 0.04 Feel informed39 (100%)40 (83%) 0.008

Summary of Results Women from the project clinic sites were more likely to have read the handouts and/or posters on hearing screening from the Dr. office. They were more likely to have reported to understand the results from the hearing screening. They were more likely to feel informed about their infant’s hearing.

Costs TIME Food Expenses Mileage to offices Posters (relatively cheap…used poster board and color printer…approximately $30 for posters) Indirect cost to Ohio Department of Health –UNHS brochures (would be similar demand as newborn hospitals if used uniformly)

Cautions and Interpretation The results of this survey are limited by the low response rate of the questionnaire. Of families willing to return the survey, their overall understanding of UNHS results and their child’s hearing are encouraging.

Conclusion It would appear that informing families before they are in the process of delivering their baby improves their understanding of their child’s hearing screening results.

Special Thanks Funding through a mini-grant from the American Academy of Pediatrics Reena Kothari CCC-A Jareen Meinzen-Derr MPH Constance Block, RN Barbara Warner, MD