Transcript Slide 1

Increasing Follow-up:
What Works?
Presenters:
Elizabeth Seeliger, Connie Stevens and Rebecca Martin
March 6, 2012
EHDI National Meeting – St. Louis, MO
Making the case: 72% LTFU
749
400
258
91
14
928
Moved to a
Regional Follow-up Model
Question: What Kind of Outreach
Reduces Loss to Follow-up?
A. Medical Home Outreach?
B. Parent-to-Parent (GBYS Follow-Through)
Outreach?
C. WIC Collaboration?
D. Community Outreach & Screenings?
E. All of the above
Answer: All of the above
3-Step-Follow-Up Protocol:
• Identified 320 babies at-risk for
loss to follow-up
• 276 cases resolved
• 14% loss to follow-up rate
Identifying Babies
in Need of Follow-up
One Month Timed Out
Procedures
Step 1:
Medical
Home
Outreach
Monday: Identify Kids at Risk
(infants who are greater than
30 days of age
& timed-out in WE-TRAC)
Tuesday-Wednesday:
Medical Home Outreach
(Data Clean Up)
STEP 1: Medical Home Outreach:
• 156/320 cases resolved
• 49% success rate with pass/pass results
• 11 cases needed additional follow-up
Monday: Identify Kids at Risk
Tuesday-Wednesday: Data Clean Up
(infants who are greater than 30 days of age
& timed-out in WE-TRAC)
(see one month timed out action
sheet in WSB manual)
Step 2:
Parent-toParent
Outreach
Guide contacts
family & guides
them into
traditional care
Guide keeps case
& monitors WE-TRAC
to determine if
follow up has
occurred
Thursday: Assign to GBYS
Place WIC A Alert
If Guide can’t reach
family,
send letter
&
transfer to ROS
Guide contacts
health care orgs &
family to determine
next steps
Guide contacts family
& if they won’t/
can’t access traditional
care, send letter &
transfer to ROS
If no follow-up imminent,
GBYS sends letter &
transfers to ROS
Discussion with Parents During
Phone Support
1. “We already went to the next appointment.”
2. “My baby hears just fine.”
3. “My doctor tested the baby at the well-baby
visit.”
4. “My baby only referred on one ear.”
5. “Why did my baby refer on the screen?”
6. “What will happen at the next appointment?”
7. “Why can’t I wait?”
Is Parent-to-Parent Support
Effective?
STEP 2: Guide By Your Side
• Resolved 106 of 153 cases
• 69% success rate
• 5 cases received appropriate follow-up
& await diagnostic testing
One Month Timed Out
Procedures
Step 1:
Medical
Home
Outreach
Monday: Identify Kids at Risk
(infants who are greater than
30 days of age
& timed-out in WE-TRAC)
Thursday:
Assign to Guide By Your Side Parent Guide
Place WIC A Alert
Tuesday-Wednesday:
Medical Home Outreach
(Data Clean Up)
If in WIC B site, place WIC B alert
refer directly to the ROS (bypass GBYS)
WIC A : HEARING SCREENING ALERT: Baby did not pass newborn hearing screening and needs follow-up.
Give family Hearing Screening Follow-up Letter and review it when you interact w/family.
WIC B: HEARING SCREENING ALERT: Baby did not pass newborn hearing screening. Wisconsin Sound
Beginnings can conduct a hearing screen with baby's next WIC appointment. Call xxx-xxx-xxxx to coordinate
care.
Tuesday-Wednesday:
Medical Home Outreach
Monday: Identify Kids at Risk
Thursday: Assign to GBYS
If in WIC B site,
place WIC B alert
Place WIC A Alert
GBYS follows case
& if not resolved
GBYS sends letter &
Transfers to ROS
Guide can’t reach
family, sends letter
& transfers to ROS
Guide contacts family & if they won’t/
can’t access traditional care
sends letter & transfers to ROS
Case transferred
to ROS
Step 3:
Regional
Outreach
ROS contacts local
Public Health
Department
ROS contact family &
arrange for home visit
or
Help family get into
traditional care
If family is in WIC B
site, ROS coordinate
screen with WIC visit
Is WIC Outreach Effective?
• Have only had 2 babies who fit in the WIC B and 1
month T/O Protocol so not enough evidence to support
yet.
• Babies have been found based on information in the
WIC database.
• Sample of babies indicates 35 out of 45 of the babies
at risk were in the WIC database.
• Advantage of the local public health agencies / WIC
clinics are now aware of hearing screening and need
for follow-up
• Some WIC clinics not in WIC B are proactively
following these babies
Is Community Hearing
Screening Effective?
• Each ROS received 12-20 cases
• 12 of 40 cases resolved
• 30% success rate
• Factors influencing success:
– Staffing issues
– Urban vs Rural
– Age of baby
Summary
• 80/20 principle applies
• Regionalized, multi-faceted outreach is
necessary.
• No single approach meets the needs of every
family.
• Each outreach step is effective and “meets
families where they are at.”
• Even with strategic, intensive outreach there
will be LTFU
More Information?
Elizabeth Seeliger
(608) 267-9191
[email protected]
Connie Stevens
(608) 266-0917
[email protected]
Rebecca Martin
(608) 261-7654
[email protected]