1. Procedural Issues in Operating Successful Newborn Hearing Screening Programs

2. Organizing the Hospital Program
Who’s in charge?
Who will do the screening
Should screening be done with parents present?
Regular coordination meetings
Making sure every baby is screened

3. Communicating with Parents
Results of the screening test
Pass
Refer
Inpatient versus outpatient
Importance versus alarm
When to communicate results
What does the screening test really mean?
Screening versus diagnosis
Late onset hearing loss
Cultural competent information and support

4. Information for Parents of Children Identified with Hearing Loss
Coordination with the family’s medical home
Referral to a pediatric audiologist
Unbiased information about communication options
Family to family support

5. Communicating with Physicians
Individual contact to explain program and why it is important
Grand Rounds, Committee Meetings, and screening demonstrations.
What were the results for their babies?
Physicians are the key to effective follow-up
What is a medical home?
Medical management issues

6. Communicating with the Hospital
Recording results in the child’s medical record
Documenting successes and difficulties of the program
Regular reports to hospital administrators

7. Training Initial “hands-on” training
Don’t train more people than you need
Regular supervision
Retraining to accommodate staff turnover

8. Keeping Refer Rates Low
Schedule screening when babies are in best behavioral state
Make a second effort prior to discharge
Minimize noise and confusion
Regular supervision and assistance
Swaddling
Back-up equipment and supplies

9. What Does “Refer Rate” Really Mean
What Does “Refer Rate” Really Mean? For 1000 Babies: # Referred for Diagnostic Evaluation
Inpatient screening only with
AABR: ………………….. 20 to 40 (2% to 4%)
OAE: ……………………. 50 to 80 (5% to 8%)
OAE and AABR: ………. 10 to 30 (1% to 3%)
Inpatient and Outpatient Screening
AABR: ……………………5 to 10 (0.5% to 1%)
OAE:……………………….5 to 10 (0.5% to 1%)

10. Data and Patient Information Management
Information is power!
Benefits of computer-based data management
Should you design your own, modify an existing system, or purchase a commercial product?
Safeguarding your data

11. Rate Per 1000 of Permanent Childhood Hearing Loss in UNHS Programs
Sample Prevalence % of Refers
Site Size Per with Diagnosis
Rhode Island (3/93 - 6/94) 16, %
Colorado (1/ /96) 41, %
Utah (7/ /94) , %
Hawaii (1/ /96) 9, %

12. Tracking "Refers" is a Major Challenge
(continued)
Initial Rescreen
Births Screened Refer Rescreen Refer
Rhode Island
53,121
52,659
5,397
4,575
677
(1/ /96)
(99%)
(10%)
(85%)
(1.3%)
Hawaii
10,584
9,605
1,204
991
121
(1/ /96)
(91%)
(12%)
(82%)
(1.3%)
New York
28,951
27,938
1,953
1,040
245
(1/96-12/96)
(96.5%)
(7%)
(53%)
(0.8%)

13. Purposes of an EHDI Data System
Research
Program Improvement
and Quality Assurance
Screening
Diagnosis
Intervention
Medical, Audiological and
Educational

14. Nature and Use of Information is Different For:
Hospitals
State Departments of Health
National Agencies

15. Computerized Patient/Data Management for Hospital-based UNHS Programs
Tracking/scheduling related to screening, follow-up,
diagnosis, and intervention
Communication with stakeholders (e.g., parents,
physicians, audiologists)
Reporting to funding and administrative agencies
Program management and quality control

16. Requirements of New Jersey Newborn Hearing Screening Program
Provide literature to parents about implications of hearing loss
Complete modules 3, 5, & 6 of the EBC
By 1/01/2002, screen all babies prior to discharge or before one month of age
Receiving hospitals are responsible for transferred babies
For babies who don’t pass the screen: Hospital responsible for:
Informing parent and giving them a FU report
Giving information about resources to parents
Person doing follow-up must inform Special Child Health Services Registry by 6 mos of age or when complete
Hospitals must establish procedures for follow-up

17. Statewide EHDI Data System
Monitoring program status to identify in-service and technical support needs
Assisting with follow-up for diagnostic and intervention programs (safety net)
Access to data for public health policy and administrative decisions
Linking to other Public Health Information data-bases (e.g., Immunization, WIC, Vital Statistics, Early Intervention, Birth Defects)

18. Resources are available to help

19. Financing the Program
How much does it really cost?

20. Actual Costs of Operating a Universal
Newborn Hearing Screening Program
Cost
Personnel
$ 60,654
Screening Technicians (avg. 103 hrs./week)
Clerical (avg. 60 hrs./week)
Audiologist (avg. 18 hrs./week)
Coordinator (avg. 20 hrs./week
Fringe Benefits
(28% of Salaries)
16,983
Supplies, Telephone, Postage
12,006
Equipment
5,575
Hospital Overhead
(24% of Salaries)
14,557
TOTAL COSTS
$110,775
Cost Per Infant Screened = $110, ,253 = $26.05 :
Maxon, A. B., White, K. R., Behrens, T. R., & Vohr, B. R. (1995) Referral rates and cost efficiency in a universal newborn
hearing screening program using transient evoked otoacoustic emissions (TEOAE).
Journal of the American Academy
of Audiology , 6 ,

21. CDC Cost Study (1997)
Multi-center pilot UNHS cost study using 6 hospitals (one
each in CO, GA, LA, TN, UT, and VA).
Cost estimates based on self-report questionnaires with site
visits to 4 of 6 sites.
Standardized estimates used for equipment and overhead
costs.
Grosse, S. (September, 1997).
The costs and benefits of universal newborn hearing screening
. Paper presented to the Joint
Committee on Infant Hearing, Alexandria, VA.

22. Results of CDC Cost Study
3 Hospitals
3 Hospitals
Cost category
using TEOAE
using AABR
Staff time
$13.04
$10.73
Equipment
0.91
2.63
Supplies
0.51
9.33
Overhead
3.49
3.34
Total Cost
$17.96
$26.03
(Range)
($15-$22)
($22-$30)
Initial refer rate 8% 2%
Screening minutes per child
31.4
42.9
Audiologist minutes per child
17.0
5.4

23. Financing the Program How much does it really cost?
Will insurance pay for newborn hearing screening?
Is new born hearing screening cost beneficial?
Alternative sources of funding