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 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 infants parents/guardians Lost Infants 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 OutcomeNumber% Passed22846% Referred to Audiologist92% Shared14429% Lost428% Pending6212% Other133%

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 OutcomeNumber% Passed37056% Referred to Audiologist6710% Shared14322% Lost497% Pending152% Other173%

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 OutcomeNumber% Passed3834% Referred to Audiologist4035% Shared1614% Lost109% Pending54% Other54%

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 OutcomeNumber% Referred to Audiologist2521% Shared5647% Incorrect Reporting108% Lost1210% Pending1613% Other11%

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 Dont lose focus of the goal

Contact Information WA DOH EHDDI Program Nancy Dalrymple, MPH Catie Beattie, MS Rich Masse, MPH Website: