Expanding the Role of Educational Audiologists After a Failed Newborn Hearing Screening: A Quality Improvement Study.

Purpose Lack of timely and proximal access to diagnostic hearing evaluation using auditory brainstem response (ABR) testing hampers the effectiveness of Early Hearing Detection and Intervention (EHDI) programs in the United States. This study measured the impact of a state-based quality-improvement (QI) project that provided diagnostic ABR equipment and training to educational audiologists distributed throughout Iowa in regional special education centers. Method We used de-identified administrative data generated by the state EHDI program to analyze markers of access to early hearing health care for infants in a preproject condition ("Baseline") compared to the implementation of diagnostic ABRs at the regional special education centers ("QI Project"). Results Our findings revealed that the QI Project was associated with improvements in timeliness of first hearing evaluation, distance traveled for first hearing evaluation, and likelihood of receiving on-guideline audiology care during the first hearing evaluation. Conclusions Following the onset of the QI Project, infants and their families had greater access to initial hearing evaluation after failed newborn hearing screening. This improvement could have cascading effects on timeliness of later intervention among those with confirmed permanent childhood hearing loss.

Restructuring Data Reported from Jurisdictional Early Hearing Detection and Intervention (EHDI) Programs: A Pilot Study.

OBJECTIVE: To assess the feasibility, benefits, and challenges surrounding individual-level versus aggregate data reporting by jurisdictional EHDI programs to the Centers for Disease Control and Prevention (CDC). METHOD: Using data reported to CDC by three jurisdictions in 2011, descriptive statistics were used to assess the feasibility of collecting and reporting individual-level data. Comparisons were made on what can be learned from individual-level data as opposed to CDC's aggregate survey data. RESULTS: Individual-level data provided a detailed overview of the population served, services received, and variations across jurisdictions in data collection, reporting, and quality monitoring practices. Several challenges and areas needing improvement were identified: variations in (1) data standardization; (2) data collection and reporting procedures; and (3) protocols for recommended follow-up services. CONCLUSIONS: Using individual-level data, CDC was able to perform in-depth statistical analyses and learn more about each jurisdiction's population, their EHDI process, and challenges to data collection, tracking, and surveillance efforts. As a result, CDC was able to provide more targeted technical assistance. All of the above would not be feasible using aggregate survey data. The pilot study demonstrated that individual-level data reporting to CDC is feasible and offers many opportunities for both CDC and jurisdictional EHDI programs.

Reporting Newborn Audiologic Results to State EHDI Programs.

OBJECTIVES: All US states and territories have an Early Hearing Detection and Intervention (EHDI) program to facilitate early hearing evaluation and intervention for infants who are deaf or hard of hearing. To ensure efficient coordination of care, the state EHDI programs rely heavily on audiologists' prompt reporting of a newborn's hearing status. Several states have regulations requiring mandatory reporting of a newborn's hearing status. This is an important public health responsibility of pediatric audiologists. Reasons for failing to report vary. DESIGN: The Early Hearing Detection and Intervention-Pediatric Audiology Links to Services (EHDI) facility survey was used to inform reporting compliance of audiology facilities throughout the United States. The survey was disseminated via articles, newsletters, and call-to-action notices to audiologists. RESULTS: Among 1024 facilities surveyed, 88 (8.6%) reported that they did not report newborn's hearing findings to their state EHDI program. Not knowing how to report to the state EHDI program was the most frequently chosen reason (60%). However, among the 936 facilities that were compliant with the reporting requirements, 51 estimated that they reported less than two-third of all hearing evaluation results (5.4%). Some facilities did not report a normal-hearing result and some failed to report because they assumed another facility would report the hearing results. CONCLUSIONS: Survey results indicated that audiologists were compliant reporting hearing results to the state EHDI programs. However, there is room for improvement. Regular provider outreach and training by the state EHDI program is necessary to ensure those who are not reporting will comply and to clarify reporting requirements for those who are already compliant.

High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review.

PURPOSE: In this study, we examined the association between risk factors for hearing loss and early childhood hearing status (normal hearing, congenital hearing loss, or delayed-onset hearing loss). Follow-up rates of audiologic care following passed or referred birth screens for children with risk factors were also examined. METHOD: A retrospective data review was completed on 115,039 children born from 2010 to 2012. Data analyses included prevalence rates, odds ratios, and Fisher exact tests of statistical significance. RESULTS: Ninety percent of children were born with no risk factors for hearing loss; of those, 99.9% demonstrated normal hearing by 3 years of age. Of the 10% of children born with risk factors, 96.3% demonstrated normal hearing by age 3, 1.4% presented with congenital hearing loss, and 2.3% demonstrated permanent hearing loss by age 3. Factors that placed children at the highest risk of congenital hearing impairment were neurodegenerative disorders, syndromes, and congenital infections. Factors that placed children at the highest risk of developing permanent postnatal hearing loss were congenital cytomegalovirus, syndromes, and craniofacial anomalies. CONCLUSIONS: Certain risk factors place a child at significantly greater risk of congenital hearing impairment or developing permanent hearing loss by age 3. Follow-up diagnostic testing should remain a priority for children with certain risk factors for hearing loss.