Pennsylvania’s EPIC-EHDI Physician Outreach Initiative

1. Pennsylvania’s EPIC-EHDI Physician Outreach Initiative Robert C. Cicco, M.D.- President, Pennsylvania Chapter, American Academy of Pediatrics; Neonatologist, West Penn Hospital, Pittsburgh, PA Diane L. Sabo, Ph.D.- Clinical Director of Audiology, Children’s Hospital of Pittsburgh, Pittsburgh, PA Robert F. Staver-Public Health Program Manager, Pennsylvania Department of Health, Harrisburg, PA

2. Why physician education? • Essential for success of the program • Families refer to their Primary Care Physician (PCP) for advice • Key component to follow up is PCP

3. Need for EDHI Education • Knowledge of the program and program goals • Knowledge of the guidelines • Roles of the professionals

4. Goal: Find best way to get physicians to recognize the importance of EHDIBarriers: • Geographical uniqueness of PA – state has large urban centers in east and west with large rural mid-section and north central area. • Large number of small hospitals with birthing centers. • “Old School” disbelievers still exist.

6. What is EPIC? • Educating • Physicians • In The • Community

7. Advantages Of An EPIC Model • Presenters model a multidisciplinary and team- oriented approach. • Learning takes place in a local hospital or office setting so that problems unique to that hospital (or practice) can be addressed. • Presenters are most often from the local community and are familiar with the people they’re teaching. • Goal of presentations is to affect positive change and not just present information.

8. EPIC Programs In PA • Existing • EPIC-IEP—Immunizations • EPIC-SCAN—Suspected Child Abuse and Neglect • EPIC-IC—Medical Home • Clean Air—Tobacco Cessation • New • EPIC-EHDI—Early Hearing Detection and Intervention • Proposed • Obesity • Emergency Preparedness • Asthma

9. Pennsylvania’s 3-year EPIC-EHDI project was . . . • Conceived as a multi-faceted outreach strategy to inform pediatricians and PCPs about the importance of EHDI consistent with the Medical Home model. • An outgrowth of an existing PA AAP Medical Home grant. • Proposed as a key feature in PA DOH’s grant application to HRSA/MCHB for UNHSI funding as the primary means of program outreach to physicians. • Formulated in cooperation with PA AAP using multi-disciplinary input from PA DOH’s Infant Hearing Screening Advisory Committee.

10. Three-year Contract between PA-AAP and PA DOH Total amount ~ $452,000 • EPIC Team Training (1½-day team training seminar at beginning of project -- $15,000 • Teleconferences (one per year) -- $18,000 • Grand Round Presentations (26 per year, includes travel, lodging & honorariums) -- $93,000 • Technical Assistance (up to 15 per year) -- $12,000 • CDs , Video & Audiotapes, web dev. -- $27,000 • Education & Outreach Materials -- $79,000 • Salaries & Administration -- $208,000

11. Steps in Organizing the Program • Establish Multidisciplinary Advisory Committee • Develop Content Goals and Objectives • Determine Optimal Learning Modalities • Identify EPIC Team Members • Plan Training Session for EPIC Team Members

12. Steps in Organizing the Program cont. • Identify Target Hospitals/Practices • Market Program to Target Audience • Conduct Educational Programs and Incorporate Improvements and Adjustments Based on Audience Feedback • Evaluate Effectiveness of Educational Programs

13. Formulating the Content . . . • Full-day work session with Infant Hearing Screening Advisory Committee to plan content. • Attention paid to all perspectives: parents, PCPs, audiologists, hospital staff and public health administrators. • Inventory taken of key themes and messages. • Trial run and critique of prototype presentation during team training workshop. • Development of teleconference script dialogue followed by rehearsal and team critique.

14. Pennsylvania’s EPIC-EHDI Initiative is a multi-faceted educational approach, utilizing . . • Hospital-Based Grand Rounds Presentations • Mentoring and Technical Assistance • Audio Teleconference • Training Video • Web Based Learning Modules Resource • Parent Packets available in offices This concept allows educational goals to be achieved in a number of learning formats.

15. Hospital-Based Grand Rounds • Presentations made by 4-person EPIC teams. • Goal to provide 26 presentations each year for three years, which would cover over half of PA hospitals over the course of 3 years. • Attendees receive CMEs for participation. • Presentations geared towards physicians but attendees often also include hospital staff.

16. Mentoring and Technical Assistance • EPIC team members available in their local community. • Address problems such as: • Hospital referral rates too high or too low. • Hospitals not sending timely reports to state DOH. • PCPs not making timely referrals for diagnostic evaluations or to EI. • Technical assistance may occur either in person or by phone. • Can be provided in a potentially less threatening • manner if done by local colleague.

17. Audio Teleconference • Teleconference produced as part of PA-AAP’s monthly ongoing “Let’s Talk” educational series. • Presented as a scripted panel discussion in contrast to the more didactic Grand Rounds presentations. • Panel participants with same disciplines as EPIC team members (physician, audiologist, parent and DOH staff member). • Audio CD distributed to every PCP practice in Pennsylvania.

18. Training Video • Produced from a model Grand Rounds presentation and includes all audiovisuals used in this presentation. • Distributed to all PCP practices in PA to allow practices to view presentation even if they have not attended the Grand Rounds.

19. Web Based Modules • Allows use of multimedia audio and visual files. • Through these modules, learner can go into more depth in areas such as: • Components of a diagnostic evaluation • Accessing the EI system • Communication options • Understanding the coordinating role of DOH • Learners can work through modules at their own pace.

20. Parent Educational Packets • Allow families to receive additional information concerning the impact of early diagnosis. • Emphasize the need to obtain timely diagnostic evaluations and to follow speech and language milestones for all children.

21. Regional EPIC-style teams are the project’s core strength • Each team consists of a physician, audiologist, parent advocate, and DOH staff member. • Teams received multidisciplinary training during 1½-day workshop in October 2003. Stragglers were trained by teleconference in January 2004. • Team members live in the same regions as the hospitals where Grand Round presentations take place. • DOH actively coordinates with PA-AAP to prioritize training sites based on birthing volume, screening and referral percentages, and infrequent or inconsistent submission of referrals and screening data.

22. EPIC Team Member Roles Physician—conveys importance of EHDI evaluation from a medical perspective, including importance of hearing in child’s development and modeling medical home principles. Audiologist—brings auditory function, diagnosis, and assistive technology perspective; need to report diagnostic results to state DOH; key resource for technical assistance. Parent—gives firsthand description of difficulties in navigating the system, coping with ECHL & EI; presents the personal story. DOH Representative—describes EHDI from a public health program perspective, incl. reporting and follow-up tracking, educational outreach, program guidelines and ongoing program development.

23. Targeting Hospitals Targeted hospitals are based on: • Recommendations from the PA Department of Health • Birthing volume and referral rates • Hospitals interested in the program When targeting hospitals, keep focus off of Newborn Hearing Screening and more on diagnosis, follow-up and the importance of intervention services.

24. Getting the Word Out • Calls to Hospitals • Brochure describing all aspects of the program – sent out to all PA PCPs • Other areas of interest – such as SHIP (State Health Improvement Plan) partners and Early Intervention Services

25. Setting Up Presentations • It is important to work closely with the hospital contact person. • Obtain a list of possible dates from hospital. • Determine the date that is best for hospital and the local presentation team.

26. Necessary Paperwork • Send presenters a confirmation letter along with disclosure form and anything else that needs to be completed. • Send hospital contact person a confirmation letter, evaluation forms, attendance sheet, necessary CME/CEU forms, and participant packets. • Send local PCPs a letter inviting them to the presentation.

27. Participant Packets Currently, our participant packets include the following: • Handout of the slide presentation • List of related websites • Copy of PA Department of Health program guidelines • Copy of the Guidelines for Pediatric Medical Home Providers • Related info. such as the PA phone number for Early Intervention Services

28. Steps in Organizing the Program • Establish Multidisciplinary Advisory Committee • Develop Content Goals and Objectives • Determine Optimal Learning Modalities • Identify EPIC Team Members • Plan Training Session for EPIC Team Members • Identify Target Hospitals/Practices • Market Program to Target Audience • Conduct Educational Programs and Incorporate Improvements and Adjustments Based on Audience Feedback • Evaluate Effectiveness of Educational Programs