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Factors Associated with Lost to Follow-up in Massachusetts

Factors Associated with Lost to Follow-up in Massachusetts. Jessica MacNeil, MPH Massachusetts Department of Public Health March 26, 2007. Snapshot of Massachusetts. 78,000 births annually 51 birth facilities 29 Department of Public Health Approved Audiological Diagnostic Centers (ADCs)

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Factors Associated with Lost to Follow-up in Massachusetts

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  1. Factors Associated with Lost to Follow-up in Massachusetts Jessica MacNeil, MPH Massachusetts Department of Public Health March 26, 2007

  2. Snapshot of Massachusetts • 78,000 births annually • 51 birth facilities • 29 Department of Public Health Approved Audiological Diagnostic Centers (ADCs) • 62 Early Intervention (EI) Programs • All children with hearing loss are eligible for EI services

  3. Massachusetts Statistics - 2005 • 99% screened • 1% referred • 20% diagnosed with hearing loss • 33% of bilateral referrals • 14% of unilateral referrals • 71% referred to Early Intervention (EI)

  4. Lost to Follow-up Diagnostic EvaluationMassachusetts, 2003-2005*

  5. Lost to Follow-up Diagnostic Evaluation Massachusetts vs. U.S., 2004

  6. Lost to Follow-up Early InterventionMassachusetts, 2003-2005*

  7. Strategies to Success • Strong Foundations • Law, regulations, guidelines • Strong Partnerships • Hospitals, ADCs, Early Intervention, Advisory Committee, Vital Records • Strong Systems • Childhood Hearing Data System, EBC, data linkages • Strong Connections • Outreach to families, bilingual staff, parent-to-parent support

  8. Lost to Follow-up:Diagnostic Evaluation

  9. Defining Lost to Follow-up:Diagnostic Evaluation • 2003-2005 births • Did not pass a newborn hearing screening • Did not receive diagnostic results from ADCs • Exclusions: parents declined follow-up/no consent (n=72), deceased (n=13), non-residents/moved out of jurisdiction (n=82), sealed records (n=1) • Analytic sample size: 2,870

  10. Follow-up by Infant Characteristics • Birth weight • ≥2,500 gm (N=2,462) 93% • <2,500 gm (N=408) 91% • Laterality of hearing screening referral • Bilateral (N=685) 92% • Unilateral (N=2,185) 92%

  11. Follow-up by Maternal Characteristics • Race/Ethnicity • White (N=1,803) 94% • Non-white (N=1,067) 90%* • Language • English (N=2,418) 93% • Other (N=452) 90% • Place of Birth • 50 U.S. States (N=1,866) 93% • Foreign-born (N=1,004) 92% *factor associated with lower follow-up, p<.05

  12. Follow-up by Maternal Characteristics • Age • ≥20 years (N=2,657) 93% • <20 years (N=213) 87%* • Education level • ≥HS (N=2,403) 94% • <HS (N=467) 83%* *factor associated with lower follow-up, p<.05

  13. Follow-up by Maternal Characteristics • Region of Residence • Boston (N=545) 94% • Western (N=106) 69%* • Central (N=357) 94% • Northeastern (N=266) 92% • Metro West (N=1,064) 95% • Southeastern (N=532) 89%* *factor associated with lower follow-up, p<.05

  14. Follow-up by Maternal Characteristics • Marital status • Married (N=1,001) 96% • Unmarried (N=1,866) 86%* • Parity • 1 child (N=1,276) 94% • 2 children (N=958) 93% • 3+ children (N=630) 87%* *factor associated with lower follow-up, p<.05

  15. Follow-up by Maternal Characteristics • Insurance • Private (N=1,812) 96% • Public (N=1,055) 86%* • Employment status • Mom & Dad employed (N=1,392) 96% • Dad only employed (N=899) 91%* • Mom only employed (N=177) 90%* • Mom & Dad not employed (N=402) 85%* *factor associated with lower follow-up, p<.05

  16. Follow-up by Maternal Characteristics • Onset of Prenatal Care: • Month 1-3 (N=2,241) 94% • Month 4-6 (N=474) 88%* • Month 6-9 (N=100) 89% • Smoked during pregnancy • No (N=2,657) 93% • Yes (N=213) 83%* *factor associated with lower follow-up, p<.05

  17. Publicly Insured Unemployed: Mom or Dad Both Parents Later prenatal care 2nd trimester Smoked during pregnancy Factors Associated With No Follow-up: Univariate Analysis • Non-white • <20 years • <HS education • Residence in: • Western MA • Southeastern MA • Unmarried • 3+ children

  18. Factors Associated With No Follow-up: Logistic Regression • <HS education aOR = 1.59 (1.14-2.23) • Residence in: • Western MA aOR = 6.49 (3.66-11.50) • Southeastern MA aOR = 2.61 (1.65-4.13) • Unmarried aOR = 2.19 (1.53-3.14) • 3+ children aOR = 1.95 (1.43-2.65) • Publicly insured aOR = 1.91 (1.31-2.77)

  19. Lost to Follow-up: Early Intervention

  20. Defining Lost to Follow-up:Early Intervention • 2003-2005 births • Diagnosed with hearing loss • Not referred to EI services • Data from Early Intervention Information System through December 31, 2006 • Exclusions: moved out of jurisdiction (n=7) • Analytic sample size: 600

  21. Follow-up by Infant Characteristics • Birth weight • <2,500 gm (N=137) 89% • ≥2,500 gm (N=463) 71%* • Laterality of hearing loss • Bilateral (N=371) 84% • Unilateral (N=229) 62%* • Degree of hearing loss • Severe/profound (N=158) 89% • Mild/moderate (N=423) 70%* *factor associated with lower follow-up, p<.05

  22. Follow-up by Maternal Characteristics • Race/Ethnicity • White (N=400) 78% • Non-white (N=200) 70%* • Language • English (N=504) 76% • Other (N=96) 70% • Place of Birth • 50 U.S. States (N=410) 79% • Foreign-born (N=190) 68%* *factor associated with lower follow-up, p<.05

  23. Follow-up by Maternal Characteristics • Age • <20 years (N=52) 75% • ≥20 years (N=548) 77% • Education level • ≥HS (N=488) 77% • <HS (N=112) 68%* *factor associated with lower follow-up, p<.05

  24. Follow-up by Maternal Characteristics • Region of Residence • Boston (N=84) 64%* • Western (N=41) 71%* • Central (N=85) 84% • Northeastern (N=73) 90% • Metro West (N=208) 74%* • Southeastern (N=109) 72%* *factor associated with lower follow-up, p<.05

  25. Follow-up by Maternal Characteristics • Marital status • Married (N=410) 76% • Unmarried (N=188) 74% • Parity • 1 child (N=274) 75% • 2 children (N=197) 77% • 3+ children (N=129) 73%

  26. Follow-up by Maternal Characteristics • Insurance • Private (N=394) 76% • Public (N=205) 74% • Employment status • Mom & Dad employed (N=285) 76% • Dad only employed (N=201) 77% • Mom only employed (N=31) 71% • Mom & Dad not employed (N=83) 72%

  27. Follow-up by Maternal Characteristics • Onset of Prenatal Care: • Month 1-3 (N=466) 76% • Month 4-6 (N=101) 72% • Month 6-9 (N=19) 68% • Smoked During Pregnancy • No (N=558) 75% • Yes (N=42) 83%

  28. Residence in: Boston Western MA Metro West Southeastern MA Factors Associated With No Follow-up: Univariate Analysis • ≥2,500 gm • Unilateral hearing loss • Mild/moderate loss • Non-white • Foreign-born • <HS education

  29. Factors Associated With No Follow-up: Logistic Regression • ≥2,500gm aOR = 3.70 (1.98-6.91) • Unilateral loss aOR = 3.50 (2.31-5.31) • Mild/moderate loss aOR = 3.30 (1.92-5.67) • Foreign-born aOR = 1.92 (1.23-2.99)

  30. From Data to Action • Develop targeted outreach strategies based on results of analysis • Outreach efforts should focus on: • Diagnostic evaluation: • Residents of Western and Southeastern MA • Unmarried, 3+ children, publicly insured, <HS education • Early Intervention: • Unilateral and mild/moderate losses • Foreign-born mothers, normal birth weight

  31. From Data to Action • Improve communication with hospitals and diagnostic centers • Educate providers on the importance of follow-up • Collaborate with other state programs and support services to reach out to high-risk families

  32. Conclusions • In MA, 8% of infants referred for diagnostic evaluation became lost to follow-up • Risk factors: maternal characteristics • 75% of children with hearing loss were referred to Early Intervention • Risk factors: infant characteristics

  33. Conclusions • Overall, follow-up in MA is significantly higher than the national average • Continue to analyze data to determine where to prioritize outreach efforts

  34. Acknowledgements • Janet Farrell, Program Director • Chia-Ling Liu, Research Analyst • Sarah Stone, Program Coordinator • Martha deHahn, Parent Outreach Specialist • Amarilys Triana, Lost to Follow-up Specialist

  35. Massachusetts Universal Newborn Hearing Screening Program http://www.mass.gov/dph/fch/unhsp/index.htm Newborn.Hearing@state.ma.us 617-624-5959

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