Should Newborn Hearing Screening be the Standard of Care in the United States

1
Procedural Issues in Operating Successful Newborn
Hearing Screening Programs
2
Organizing the Hospital Program

• Whos 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 familys 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 childs medical record
• Documenting successes and difficulties of the
  program
• Regular reports to hospital administrators

7
Training

• Initial hands-on training
• Dont 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?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 1000 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

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

(1/93 - 12/96)

(99)

(10)

(85)

(1.3)

Hawaii
10,584
9,605

1,204

991

121
(1/96 - 12/96)

(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 dont 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
www.infanthearing.org
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
16,983
(28 of Salaries)
Supplies, Telephone, Postage
12,006
Equipment
5,575
Hospital Overhead
14,557

(24 of Salaries)
TOTAL COSTS
110,775
Cost Per Infant Screened 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.
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