Honigfeld, Dandrow, Freyre-Calish OAE in Pediatric Practice: Improving Hearing Screening within the Medical Home Lisa S. Honigfeld, PhD, CT Center for Primary Care; Ann Dandrow, Gabriela Freyre-Calish, – AJ Pappanikou Center for Developmental Disabilities

Honigfeld, Dandrow, Freyre-Calish This project was funded by: the Office of Special Education Programs, United States Department of Education, Grant #324T990006, Enhanced Child Find Through Newborn Hearing Screening through a grant to the University of Connecticut AJ Pappanikou Center for Developmental Disabilities. Opinions expressed are those of the researchers and do not necessarily represent the position of the U.S. Department of Education, Office of Special Education Programs.

Honigfeld, Dandrow, Freyre-Calish Enhanced Child Find through Newborn Hearing Screening Brochure on services available in Connecticut Video: A Parents Guide to Newborn Hearing Screening Video: A Parents Guide: Early Intervention for Infants and Young Children with Hearing Loss Medical Record Tracking Tool for Newborn Hearing Screening

Honigfeld, Dandrow, Freyre-Calish Guidelines for Hearing Screening in Primary Care Practice Babies who meet Task Force at risk criteria All four year olds (AAP Guideline) Children with persistent OME (>3 months) Parental/Caregiver concern regarding speech, language, hearing Follow-up of hospital newborn hearing screening refers (not ideal for primary care setting)

Honigfeld, Dandrow, Freyre-Calish Barriers to Hearing Screening Current methods: pilot audiometry, Cooperation Some kids are too young Referrals take time and parental follow-up Office routine Confusion over role/limit of Universal Newborn Hospital Screening Confusion over schools role

Honigfeld, Dandrow, Freyre-Calish ProHealth Physicians 200 providers: MDs, DOs, APRNs, PAs 80 practice sites Primary care: internists, family physicians, pediatricians In one electronic network: , shared files, billing 350,000 patients About 1 million patient encounters in a year (includes lab tests)

Honigfeld, Dandrow, Freyre-Calish Baseline Data – for pediatric and family medicine practices only All four year old visits All patients with OME for three or more months All hearing screens performed (92552, 92567,92583, 92587)

Honigfeld, Dandrow, Freyre-Calish Hearing Screening at the 4 year will visit 13 of 39 practices billed hearing screening with well child visit –Why so few? Payable by insurance Dont do or do and dont bill Decision to only include those practices that bill

Honigfeld, Dandrow, Freyre-Calish Hearing Screening at the 4 year well child visit: 7/02 through 6/03 Servicing Practicespecialty 4 Yr Well Visits with Hearing ScreenTotal 4 Yr visits % 4 Yr Visits with Hearing Screen Practice AFamily Practice122525% Practice BFamily Practice189619% Practice CPediatrics % Practice DPediatrics122046% Practice EPediatrics % Practice FPediatrics % Practice GPediatrics % Practice HPediatrics % Practice IPediatrics % Practice JPediatrics % Practice KPediatrics % Practice LPediatrics % Practice MPediatrics %

Honigfeld, Dandrow, Freyre-Calish OAE Screenings Performed in 3 Practices – 1/04 to 6/04 CHILD'S AGE # OF TESTS DONE % OF ALL TESTS DONE % DONE With WCC % DONE FOR OME # not with 4/5 WCC or for OME <162%67%33%3 1206%20%60%7 2134%23%54%3 3155%20%53% %72%28% %80%20%0 672%14%86%0 752%20%80%1 893%33%56%3 >8186%33%67% %25

Honigfeld, Dandrow, Freyre-Calish Hearing Screening at the 4 Yr Visit: with OAE after 6 months PracticeBaseline Rate Rate After OAE Change Practice F18%42%+24% Practice I66%79%+13% Practice J (after 2 months only) 68%61%-7% Practice L83%88%+5%

Honigfeld, Dandrow, Freyre-Calish Hearing Screening and Persistent OME: Before and after OAE Practice F: 7% to 46% Practice I: 8% to 19% Practice L: 18% to 32%

Honigfeld, Dandrow, Freyre-Calish OAE Screens not with 4 or 5 Well Child Visit and not for OME 24 cases selected for review Medical record abstraction 10 result of parental concern about speech, language, or hearing 3 failed school hearing test 9 OME (less than 3 months) 1 international adoption with no hearing screening 1 unevaluable Results of 22 screens performed for parental concerns, OME less than 3 months, or failed test at school: 8 referred in at least one ear

Honigfeld, Dandrow, Freyre-Calish Conclusions OAE is feasible in pediatric practice Can increase rate and accuracy of routine screening in accordance with AAP Guidelines Tremendous asset for screening with OME and making treatment and referral decisions Also useful for addressing parental concerns Child health providers need support and education regarding hearing screening in primary care