Transcript Improving Hearing Screens of Young Children: OAE in Pediatric

OAE in Pediatric Practice:
Improving Hearing Screening within the
Medical Home
Lisa S. Honigfeld, PhD, CT Center for Primary Care;
Ann Dandrow, Gabriela Freyre-Calish, – AJ
Pappanikou Center for Developmental Disabilities
Honigfeld, Dandrow, Freyre-Calish
• This project was funded by: the Office of Special
Education Programs, United States Department
of Education, Grant #324T990006, Enhanced
Child Find Through Newborn Hearing Screening
through a grant to the University of Connecticut
AJ Pappanikou Center for Developmental
Disabilities. Opinions expressed are those of the
researchers and do not necessarily represent
the position of the U.S. Department of
Education, Office of Special Education
Programs.
Honigfeld, Dandrow, Freyre-Calish
Enhanced Child Find through
Newborn Hearing Screening
• Brochure on services available in Connecticut
• Video: A Parent’s Guide to Newborn Hearing
Screening
• Video: A Parent’s Guide: Early Intervention for
Infants and Young Children with Hearing Loss
• Medical Record Tracking Tool for Newborn
Hearing Screening
Honigfeld, Dandrow, Freyre-Calish
Guidelines for Hearing Screening in
Primary Care Practice
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Babies who meet Task Force at risk criteria
All four year olds (AAP Guideline)
Children with persistent OME (>3 months)
Parental/Caregiver concern regarding speech,
language, hearing
• Follow-up of hospital newborn hearing screening
refers (not ideal for primary care setting)
Honigfeld, Dandrow, Freyre-Calish
Barriers to Hearing Screening
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Current methods: pilot audiometry,
Cooperation
Some kids are too young
Referrals take time and parental follow-up
Office routine
Confusion over role/limit of Universal Newborn
Hospital Screening
• Confusion over schools’ role
Honigfeld, Dandrow, Freyre-Calish
ProHealth Physicians
• 200 providers: MDs, DOs, APRNs, PAs
• 80 practice sites
• Primary care: internists, family physicians,
pediatricians
• In one electronic network: email, shared files,
billing
• 350,000 patients
• About 1 million patient encounters in a year
(includes lab tests)
Honigfeld, Dandrow, Freyre-Calish
Baseline Data – for pediatric and
family medicine practices only
• All four year old visits
• All patients with OME for three or more
months
• All hearing screens performed (92552,
92567,92583, 92587)
Honigfeld, Dandrow, Freyre-Calish
Hearing Screening at the 4 year will
visit
• 13 of 39 practices billed hearing screening with
well child visit
– Why so few?
• Payable by insurance
• Don’t do or do and don’t bill
• Decision to only include those practices that bill
Honigfeld, Dandrow, Freyre-Calish
Hearing Screening at the 4 year
well child visit: 7/02 through 6/03
Servicing Practice
specialty
4 Yr Well Visits
with
Hearing
Screen
Total 4 Yr visits
% 4 Yr Visits
with Hearing
Screen
Practice A
Family Practice
12
252
5%
Practice B
Family Practice
18
96
19%
Practice C
Pediatrics
14
2284
1%
Practice D
Pediatrics
12
204
6%
Practice E
Pediatrics
36
240
15%
Practice F
Pediatrics
419
2375
18%
Practice G
Pediatrics
220
584
38%
Practice H
Pediatrics
198
348
57%
Practice I
Pediatrics
1104
1674
66%
Practice J
Pediatrics
1723
2528
68%
Practice K
Pediatrics
1630
2170
75%
Practice L
Pediatrics
2293
2755
83%
Practice M
Pediatrics
252
276
91%
Honigfeld, Dandrow, Freyre-Calish
OAE Screenings Performed in 3
Practices – 1/04 to 6/04
# OF
TESTS
DONE
CHILD'S
AGE
% OF ALL
TESTS DONE
% DONE
With WCC
% DONE
FOR OME
# not with 4/5
WCC or for
OME
<1
6
2%
67%
33%
3
1
20
6%
20%
60%
7
2
13
4%
23%
54%
3
3
15
5%
20%
53%
2
4
125
39%
72%
28%
0
5
104
32%
80%
20%
0
6
7
2%
14%
86%
0
7
5
2%
20%
80%
1
8
9
3%
33%
56%
3
>8
18
6%
33%
67%
6
322
100%
Honigfeld, Dandrow, Freyre-Calish
25
Hearing Screening at the 4 Yr Visit:
with OAE after 6 months
Practice
Baseline
Rate
Rate After
OAE
Change
Practice F
18%
42%
+24%
Practice I
66%
79%
+13%
Practice J (after 2
68%
61%
-7%
83%
88%
+5%
months only)
Practice L
Honigfeld, Dandrow, Freyre-Calish
Hearing Screening and Persistent
OME: Before and after OAE
• Practice F: 7% to 46%
• Practice I: 8% to 19%
• Practice L: 18% to 32%
Honigfeld, Dandrow, Freyre-Calish
OAE Screens not with 4 or 5 Well Child
Visit and not for OME
24 cases selected for review
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Medical record abstraction
10 result of parental concern about speech, language, or hearing
3 failed school hearing test
9 OME (less than 3 months)
1 international adoption with no hearing screening
1 unevaluable
Results of 22 screens performed for parental concerns, OME less than
3 months, or failed test at school: 8 referred in at least one ear
Honigfeld, Dandrow, Freyre-Calish
Conclusions
• OAE is feasible in pediatric practice
• Can increase rate and accuracy of routine
screening in accordance with AAP Guidelines
• Tremendous asset for screening with OME and
making treatment and referral decisions
• Also useful for addressing parental concerns
• Child health providers need support and
education regarding hearing screening in
primary care
Honigfeld, Dandrow, Freyre-Calish