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Evaluation of EHDI Follow-Up Protocols in Washington State

Evaluation of EHDI Follow-Up Protocols in Washington State. National EHDI Conference March 3-4, 2005 Dalrymple, Beattie, Masse. Outline. Background Information Protocol Analysis Conclusions. State of Washington. 75,000 births/year 68 Birthing Hospitals 18 Pediatric Audiology Clinics

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Evaluation of EHDI Follow-Up Protocols in Washington State

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  1. Evaluation of EHDI Follow-Up Protocols in Washington State National EHDI Conference March 3-4, 2005 Dalrymple, Beattie, Masse

  2. Outline • Background Information • Protocol Analysis • Conclusions

  3. State of Washington • 75,000 births/year • 68 Birthing Hospitals • 18 Pediatric Audiology Clinics • Screening is Voluntary

  4. EHDI in Washington State • Developed Tracking and Surveillance System • Currently covers 65% of births from 43 hospitals • Follow infants from newborn screen through diagnostic evaluation -- Monitor that each infant is screened -- Recommend appropriate follow-up care -- Evaluate outcomes

  5. Data Collection • Hospital Birth Rosters • Blood Spot Cards • Hearing Screening Cards • Audiology Diagnostic Information

  6. Follow-Up Protocols • System generates multiple follow-up protocols • Timed to achieve 1-3-6 Goals • Protocol actions consist of: • Letter • Fax (if no response from letter) • Phone Call (if no response from fax) • Close Case (after response from any of the above) • Contact is made through primary care provider • Outcome code given at closing of case

  7. Outcome Codes

  8. Protocol Analysis

  9. Purpose of Analysis • Assess time-line efficiency • Evaluate outcomes • Determine workload

  10. Data • Live Births from January 1, 2004 through September 30, 2004 (Q1 through Q3) • Total Number of Live Births: 10,856 • Data collected from 23 WA hospitals

  11. Common Follow-Up Protocols (1) Infant was missed (2) Infant did not pass initial hearing screen (3) Infant did not pass rescreen (4) Infant passed but has risk factors

  12. Protocol 1: Infant was missed • Causes • Received a blank hearing screening card • Missed infant found via program monitoring • Protocol Actions • Letter (0 days) • Fax (28 days if no response to letter) • Call (49 days if no response to fax) • Close Case (60 days or after response)

  13. Protocol 1: Infant was missed • 498 protocols initiated

  14. Protocol 1: Infant was missed • Observations • Known outcomes for most infants • Not all outcomes indicate success • Higher number of pending cases • Protocol timing is appropriate • Workload generated is high (1/3)

  15. Protocol 1: Infant was missed • Next Steps….. • Find ways to reduce missed infants • Identify “true” misses

  16. Protocol 2: Infant did not pass initial screen • Causes • Patient did not pass initial screen • Protocol Actions • Letter (21 days) • Fax (49 days if no response to letter) • Call (70 days if no prior response) • Close Case (81 days or after response)

  17. Protocol 2: Infant did not pass initial screen • 661 protocols initiated

  18. Protocol 2: Infant did not pass initial screen • Observations • Known outcomes for most infants • Not all outcomes indicate success • Protocol timing is not appropriate • Workload generated is high (1/2)

  19. Protocol 2: Infant did not pass initial screen • Next Steps…. • Adjust protocol timing to reduce workload • Continued provider support

  20. Protocol 3: Infant did not pass rescreen • Causes • Infant did not pass rescreen • Protocol Actions • Letter (0 days) • Fax (28 days if no response to letter) • Call (49 days if no response to fax) • Close Case (60 days if no response to prior actions)

  21. Protocol 3: Infant did not pass rescreen • 114 protocols initiated

  22. Protocol 3: Infant did not pass rescreen • Observations • Known outcomes for most infants • Not all outcomes indicate success • Protocol timing isappropriate • Workload generated is low

  23. Protocol 3: Infant did not pass rescreen • Next Steps…. • Better diagnostic reporting • Continued provider support

  24. Protocol 4: Infant passed but has risk factors • Causes • Risk factors reported on hearing screening card • Protocol Actions • Letter (0 days) • Fax (28 days if no response to letter) • Call (49 days if no prior response) • Close Case (60 days or after response)

  25. Protocol 4: Infant passed but has risk factors • 120 protocols initiated

  26. Protocol 4: Infant passed but has risk factors • Observations • Known outcomes for most infants • Different standard for “success” • Protocol timing is not appropriate • Workload generated is low • Accuracy of reporting is unknown

  27. Protocol 4: Infant passed but has risk factors • Next Steps…. • Increase accuracy of reporting • Further evaluation of risk factors as indicators • Adjust protocol timing

  28. Summary • Known outcomes for most infants • Not all outcomes indicate success • Timing should be evaluated • Workload should be consider

  29. Conclusions • Protocols need to be flexible • Protocols need to be evaluated • Workload needs to be manageable • Don’t lose focus of the goal

  30. Contact Information WA DOH EHDDI Program Nancy Dalrymple, MPH Catie Beattie, MS Rich Masse, MPH E-mail: ehddi2@doh.wa.gov Website: www.doh.wa.gov/ehddi

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