Transcript Effective Hearing Screening Practices in Health Care

Effective Hearing Screening Practices
in Health Care Settings
Randi Winston, William Eiserman, Lenore Shisler
Partnerships
The EAR Foundation of Arizona
The Nina Mason Pulliam Foundation
– Local funding resource in Arizona
– Provided funding for:
– program development
– 11 OAE screeners
– implementation of 5 CHC clinics
Partnerships
Arizona Association of Community Health Clinics
• Community Health Centers (CHC's) provide primary health
care in rural and medically underserved areas. Health care
services offered include Family Practice, Internal Medicine,
Pediatric, Obstetrical, Dental and ancillary health care.
• There are thirty-four not-for-profit, community-based,
primary care organizations in Arizona with over 100 sites
located throughout the state.
• Community Health Centers are not-for-profit providers,
governed by boards whose members are citizens of the
communities they serve. Governed by a system that
ensures quality of care is upheld. Centers all over the state
catering to underserved populations.
Partnerships
National Center for Hearing Assessment
and Management
• Protocol development
– based on experience with Hearing Head Start
Project
• Training Materials
– Modification of already established training
materials
• Training Process
Rationale for Ongoing Periodic
Screening
Birth to Three
• Although all newborns in Arizona are
screened at birth, as many as 40% are
lost to follow up in between the first and
second screens
• Babies missed in the hospital screening
programs
• Babies born outside of AZ that never had
a screen
Rationale for Ongoing Periodic
Screening
Birth to Three
• Babies born with risk factors for late onset
and progressive losses
• Babies born with milder forms of losses
that were not identified by hospital
screening program
• Infants and children that acquire chronic
otitis media
Rationale for Ongoing Periodic
Screening
Community Health Care Settings
• High volume clinics
• Provides a safety net to catch kids that have
fallen through the cracks
• Early childhood screenings are an established
part of well-child visits
• Current screening methods are unreliable
• New technology makes it feasible for nonaudiology staff to conduct screenings
• Eliminates need for referrals to PCPs thus
minimizing steps for follow-up
Protocol Development Objectives
Community Health Care Settings
• Importance of incorporating screening into already
established activities
• Simple, sensible format and guide for screeners and
physicians to follow
• Establishment of “no brainer” protocols
– Periodicity protocols
• How often should screenings be conducted
– Well child visit
– JCIH risk indicators for late onset and
progressive hearing loss, parental concerns,
speech delays, OM
– Screening protocols
• Follow-up on kids not passing OAE
Hearing Screening Form
Shisler and
Eiserman
Training and Implementation
Community Health Care Settings
• Set up trainings in each of the clinics
• Meet with physicians
– Education
– Determine protocols
• Conduct staff training
• Data collection to monitor screening
outcomes
• Track reimbursement outcomes
Challenges to Consider
Community Health Care Settings
• Significant time constraints
– staff training issues
– physician training and education
– Environment is often chaotic; difficult to complete
screening session on kids that are noncompliant.
– completion of recommended screening protocol
– keeping track of kids that need follow-up and that
need to be screened more often
Challenges to Consider
Community Health Care Settings
• Staff turnover
– Physicians
– Medical assistants
• Language barriers
• Methods often used for middle ear
assessment
• Care coordination methods
Future Developments
Funding provided to NCHAM by the Oticon Foundation
• The Oticon Foundation is currently providing funding to
NCHAM to develop physician and staff training materials
promoting continuous OAE screening in healthcare
settings, including:
• A video for EHDI Coordinators or others to use when
making presentations to physicians.
• An overview pamphlet/booklet for physicians summarizing
the main points and protocol.
• A set of written and video materials for training medical
staff (nurses and medical assistants).
• Checklists for physicians/staff covering the logistics of
implementing continuous OAE screening.
Conclusion
Implementations Considerations
• Data reporting to a central tracking program
• Coordination of activities related to screening
– Program maintenance
– Training new staff
– Care coordination for follow ups (ensuring
families come back for rescreens)
• Equipment sharing in busy offices
• Equipment reliability
• Reimbursement Issues
Conclusion
Essential Elements
• Well trained staff
– Physicians and screening staff
• Screening activities
• Follow-up and referrals
• Plan in place for training new staff
• Program Management
• Equipment that is dependable
• Protocol to guide screening activities