site visits as a tool for improving ehdi programs new jersey early hearing detection &...

SITE VISITS AS A TOOL FOR SITE VISITS AS A TOOL FOR IMPROVING IMPROVING

EHDI PROGRAMSEHDI PROGRAMS

New Jersey Early Hearing Detection & Intervention Program

New Jersey Department of Health & Senior ServicesTrenton, New Jersey

Kathy Aveni, RNC, MPH Nancy Schneider, M.A., CCC-A, FAAA

Research Scientist Audiologist

Linda Biando, MSN, RN Karyn Dynak, BAPublic Health Consultant Data Processing Programmer

NJ Dept. of Health & Senior Services, National EHDI Conference - Atlanta GA, March 3, 2005

NJ EHDI Program HistoryNJ EHDI Program History

1977: Original newborn screening legislation introduced into NJ law (P.L. 1977, c.19)

1980: NJ Department of Health began hearing screening of newborns utilizing a “risk-based” screening approach

Hospitals informed the NJDHSS of all children both with risk factors to hearing loss

NJDHSS sent parents a letter (age 5 months post nursery d/c) to remind them of the importance of audiologic follow-up

5/00 – 12/01: Phase in period towards UNHS in NJ

Infants with risk factors must undergo an physiologic screening <d/c beginning May 2000, with plan for UNHS by Jan. 1 2002

1/1/02: Universal hearing screening is required by NJ law (P.L. 2001, c.373NJSA 26:2-101 et seq) & Rules (NJAC 8:19 subchapter 1)


Current NJ EHDI ProgramCurrent NJ EHDI Program(until April, 2005) (until April, 2005)

Responsibility for ensuring screening and follow-up occur are under the purview of the birthing hospital

EHDI Program guidelines recommend periodic monitoring of infants for delayed onset hearing loss

In-patient hearing screening results and risk factor indicators are forwarded to the NJ EHDI Program via the Electronic Birth Certificate (EBC) No child shall be screened for hearing loss if the parent objects on the grounds that screening conflicts with religious tenets


EHDI Reporting ProcessesEHDI Reporting Processes

In-patient hearing screening data forwarded to NJ EHDI from EBC via the Bureau of Vital Statistics & Registration

Individuals performing outpatient screening and/or diagnostic audiologic testing report results via the NJ EHDI Newborn Hearing Follow-Up Report

NJ EHDI adds outpatient data (including Lost to Follow-Up info.) into database

NJ EHDI compiles data collected from the EBC & outpatient reports to generate Quarterly Reports which are sent to each birthing hospital for comparing hospital and State statistics and allowing review and reconciliation and data and identification of infants still requiring follow-up


Role of the NJ EHDI Team to Role of the NJ EHDI Team to enhance UNHS in NJ: enhance UNHS in NJ:

To work with hospitals, audiologists, healthcare providers, parents, EI services, community

agencies and others to ensure EHDI goals are metTHROUGH THE USE OF:

Annual site visits Collaboration with the BDR and EI Quarterly reports to all birthing hospitals Training to EBC staff on accurate and timely reporting Outreach to the audiology and pediatric communities Collaboration with parent support services Establishment of a Hearing Evaluation Council representing

medical, family and community members


NJ EHDI Site Visits: Why?NJ EHDI Site Visits: Why?

“Meet & Greet the players” (putting faces to written names)

Establish relationship with each facility & NJ EHDI

Increase compliance by boosting motivation

Answering questions that staff may have re: EHDI goals & NJ EHDI reporting requirements

Increase communication both within the hospital between departments & staff and to outpatient audiology facilities

Provide essential information & updates on what NJ EHDI is doing to assist them in the UNHS process


NJ EHDI Site Visits: Who?NJ EHDI Site Visits: Who?

hospital CEO nursery staff chief of pediatrics chief of neonatology in-house audiologists EBC data entry clerk MCH Director MCH Consortia

representative

Invitation extended to members of each department in each birthing hospital who are in any way related to their UNHS Program


NJ EHDI Site Visits: When?NJ EHDI Site Visits: When?

• General NJ EHDI site visits began in 2003– 2003: 64 hospitals visited – 2004: 63 hospitals visited

• Audiology site visits began in 2004– 41 additional site visits made exclusively to audiologists in

addition to the 63 2004 EHDI visits

• Visits conducted in summer/autumn (1 – 2 visits per day)• 2003 visits scheduled for 2 hours in duration with 2004

visits reduced to 1 hour• Audiology visits scheduled from 1 to 1 ½ hours each

birthing facilities64 in total

NJ EHDI NJ EHDI Site Visits: Site Visits: Where?Where?


NJ EHDI Site Visits: What?NJ EHDI Site Visits: What?

General site visit presentations consist of: Introduction Review of EHDI goals and “Best Practices” Summary of birthing facility’s responsibilities Provide clarification & updates on NJ legislation Clarify reporting requirements for both in-pts. & out-pts. Review summary report from previous year’s site visit Comparison between Statewide v. hospital statistics Offer suggestions for UNHS Program improvement Report on current NJ projects to aid UNHS programs Provide information re: Case Management & Parent

Support Services


NJ EHDI Site Visits: What? NJ EHDI Site Visits: What? (continued)(continued)

Chart review for Q & A Observation of a newborn hearing screening

Screening protocol Screening environment Screening technique Screening documentation

Hospital’s are sent a site visit summary which includes: Status of hospitals current UNHS performance Recommendation for areas needing improvement A Site Visit Evaluation survey for NJ EHDI QA purposes


Rationale for Separate Audiology Site Visits (2004)

General NJ EHDI Team site visits (<2004):– Typically included only 1 representative from “hospital-

based” audiology programs– Time constraints did not allow for discussion specific to

pediatric audiology issues. No outreach made to audiologists at non-birthing hospitals, private practices or otolaryngology offices

Opportunity to review the audiologists’ role in the goals of the NJ EHDI program & NJ EHDI reporting concerns

To obtain direct feedback on how NJ EHDI services can be improved for both practitioners and patients


NJ Audiology Statistics

As of 12-04 there are: 427 NJ licensed audiologists 522 NJ licensed hearing aid dispensers

includes both hearing aid dispensers & dispensing audiologists

35 of 63 birthing facilities offer in-house audiology services

Results (N = 202) of a statewide survey to all audiologists & hearing aid dispensers reveal:

16 comprehensive audiology facilities 89 facilities offering select pediatric services 80 do not provide pediatric audiology services at

all


Components of the 2004 Audiology Site Visits

Reviewed NJ EHDI Program’s goals and legislation Discussed purpose of reporting responsibilities to NJ EHDI

Program and SCHS Registry Provision of pertinent evidenced-based documentation re:

need for ear-specific testing; protocols for screening & diagnostic assessment

Obtained feedback from practicing audiologists regarding all aspects of the current NJ EHDI Program

Reviewed statewide and national services for families of children with diagnosed hearing loss

SCHS Case Management; Parent-to-Parent; NJ Division of the Deaf and Hard of Hearing; NJ Hearing Healthcare Directory; pertinent websites for families of children with hearing loss


2004 Audiology Site Visit Summary

40 audiology visits (101 audiologists) to birthing & rehabilitation hospitals; ENT practices, etc. completedFollow-up QA surveys sent to site visit audiologists

Feedback overwhelmingly favorable with the following concerns/questions noted:

Follow-up protocol for children presenting with risk factors for hearing lossDefining “lost to follow-up”Improving reporting form for outpatient visits to minimize paperworkImproving hospital staff parental counseling for

infants with “refer” results on screening

Birthing Facilities64 in total

Birthing Facilities w/Audiology Departments

35 in total

Audiology Site Visits


2004 Audiology Site Visit Summary

Since completion of site visits, both quality & quantity of Newborn Hearing Follow-Up Reports has improved in terms of:

Ear specific information Referral for timely evaluation of children with atresia Shortened timeline for recall (as per ASHA

Guidelines)Audiology feedback has contributed to modifications in the NJ EHDI outpatient reporting form and SCHS Registry as well as development of State Audiology Guidelines and a statewide Hearing Healthcare Directory Audiologists from various clinical venues now have a voice in the NJ EHDI Program


Site Visit Chart Review Results

• Charts reviewed during 2004 were for 2002/2003 births with known diagnosed hearing loss.

• Purpose - to verify accuracy of EBC data on inpatient results and risk indicators.


Chart Review FindingsACTUAL:

EBC: Refer, -risk Refer, +risk No, -risk No, +risk Pass, -risk Pass, +risk

Refer, -risk 40 20 - - - -Refer, +risk - 8 - - - -No, -risk 3 1 5 3 - -No, +risk - - - 2 - -Pass, -risk 15 3 - - 6 5Pass, +risk 1 - - - - 1

Incorrectly appear to be late-onset True late-onsetSummary:Results (only) correct on 80% of this sample of 113 chartsRisks factors (only) correct on 71%Risk and results correct (green cells) on 55%


Chart Review – Lessons Learned

• Chart reviews are a useful tool for verifying data accuracy and learning about risk factors

• EBC data quality is a cause for some concern• Hospital nursery staff are very unaware of which

“stigmata and syndromes” are “associated with hearing loss”

• Risk indicators are not always clear even in the medical record. Ex: Unclear family hx (conflicting notes in med. record, IVF w/ donor egg), congenital syphilis dx.

• Record review of birth chart only will not identify risk factors not evident at birth


New Jersey Statistics – 3Q 2004New Jersey Statistics – 3Q 2004

Inpatient ScreeningOutpatient Follow-up for Infants Missing

or Referring on Inpatient Screening

Dis-charged Babies

Dis-charged & Screened

Dis-charged & Failed Screen-ing

Dis-charged & Any Risk Factor

Discharged & Risk Factor for Progressive or Late-Onset Hearing Loss

Number of Babies Requir-ing Follow-Up

% with Follow-Up Visit Reported

% Report-ed Lost to Follow-Up

% Needing Follow-Up

NJ Total - 2002 110419 97.1% 4.5% 6.9% 2.7% 8004 33.5% 7.6% 58.9%

NJ Total - 2003 111867 98.1% 4.6% 6.7% 2.7% 7200 45.9% 7.7% 46.4%

NJ Total 1st Q 2004 26588 98.8% 4.3% 7.1% 3.0% 1436 50.1% 8.8% 41.1%

NJ Total 2nd Q 2004 27907 98.9% 4.5% 6.6% 2.6% 1555 48.7% 6.0% 45.1%

NJ Total 3rd Q 2004 28521 98.6% 4.3% 6.2% 2.6% 1582 30.7% 2.4% 66.9%


Impact of Site VisitsThree site visit cohorts

20%

30%

40%

50%

60%

70%

2003Q1 2003Q2 2003Q3 2003Q4 2004Q1 2004Q2 2004Q3

Fo

llow

-Up

Rate

2003 Q2

2003 Q3

2003 Q4


Impact of Site VisitsPre- and Post-Visit Follow-Up Rates

0%

20%

40%

60%

80%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

x

y

Group 1

Group 2

Group 3


Impact of Site Visits

Significant decrease in

follow-up rates

No significant change

Significant increase in

follow-up rates

Cohort 1 1 3 1

Cohort 2 5 15 6

Cohort 3 1 22 8


Acknowledgements

• Statistical assistance for this presentation was provided by Charles E. Denk, PhD, Research Scientist, NJDHSS, MCH Epidemiology program

site visits as a tool for improving ehdi programs new jersey early hearing detection &...

Documents

nj ehdi team

ehdi visits visits

general nj ehdi site

total nj ehdi site visits

current nj ehdi program

nj ehdi program history

nj infants

nj legislation