Post on 05-Feb-2016
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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 1-3-6 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 infant’s parents/guardians
Lost Infant’s 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
Outcome Number %
Passed 228 46%
Referred to Audiologist 9 2%
Shared 144 29%
Lost 42 8%
Pending 62 12%
Other 13 3%
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
Outcome Number %
Passed 370 56%
Referred to Audiologist 67 10%
Shared 143 22%
Lost 49 7%
Pending 15 2%
Other 17 3%
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
Outcome Number %
Passed 38 34%
Referred to Audiologist 40 35%
Shared 16 14%
Lost 10 9%
Pending 5 4%
Other 5 4%
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
Outcome Number %
Referred to Audiologist 25 21%
Shared 56 47%
Incorrect Reporting 10 8%
Lost 12 10%
Pending 16 13%
Other 1 1%
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 Don’t lose focus of the goal
Contact Information
WA DOH EHDDI Program
Nancy Dalrymple, MPH
Catie Beattie, MS
Rich Masse, MPH
E-mail: ehddi2@doh.wa.gov
Website: www.doh.wa.gov/ehddi