Transcript Procedural Issues in Operating Successful Newborn Hearing Screening Programs Organizing the Hospital Program • Who’s in charge? • Who will do the screening •

Procedural Issues in Operating Successful
Newborn Hearing Screening Programs
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
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
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
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
Communicating with the Hospital
• Recording results in the
child’s medical record
• Documenting
successes and
difficulties of the
program
• Regular reports to
hospital administrators
Training
• Initial “hands-on” training
• Don’t train more people
than you need
• Regular supervision
• Retraining to accommodate
staff turnover
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
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%)
Data and Patient
Information Management
• Information is power!
• Benefits of computerbased data management
• Should you design your
own, modify an existing
system, or purchase a
commercial product?
• Safeguarding your data
Rate Per 1000 of Permanent Childhood Hearing Loss in
UNHS Programs
Site
Sample
Size
Prevalence
Per 1000
% of Refers
with Diagnosis
Rhode Island (3/93 - 6/94)
16,395
1.71
42%
Colorado (1/92 - 12/96)
41,976
2.56
48%
Utah (7/93 - 12/94)
4,012
2.99
73%
Hawaii (1/96 - 12/96)
9,605
4.15
98%
Tracking "Refers" is a Major Challenge
(continued)
Initial
Refer
Rescreen
Rescreen
Refer
Births
Screened
Rhode Island
(1/93 - 12/96)
53,121
52,659
(99%)
5,397
(10%)
4,575
(85%)
677
(1.3%)
Hawaii
(1/96 - 12/96)
10,584
9,605
(91%)
1,204
(12%)
991
(82%)
121
(1.3%)
New York
(1/96-12/96)
28,951
27,938
(96.5%)
1,953
(7%)
1,040
(53%)
245
(0.8%)
Purposes of an EHDI Data System
Research
Program Improvement
and Quality Assurance
Screening
Diagnosis
Intervention
Medical, Audiological and
Educational
Nature and Use of Information is
Different For:
Hospitals
State Departments of Health
National Agencies
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
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
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 databases (e.g., Immunization, WIC, Vital Statistics,
Early Intervention, Birth Defects)
Resources are available to help
www.infanthearing.org
Financing the Program
• How much does it really cost?
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)
Supplies, Telephone, Postage
Equipment
Hospital Overhead (24% of Salaries)
TOTAL COSTS
Cost Per Infant Screened = $110,775
16,983
12,006
5,575
14,557
$110,775
4,253
= $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, 271-277.
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.
Results of CDC Cost Study
Cost category
Staff time
Equipment
Supplies
Overhead
Total Cost (Range)
Initial refer rate
3 Hospitals
using TEOAE
$13.04
0.91
0.51
3.49
$17.96 ($15-$22)
3 Hospitals
using AABR
$10.73
2.63
9.33
3.34
$26.03 ($22-$30)
8%
2%
Screening minutes per child
31.4
42.9
Audiologist minutes per child
17.0
5.4
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