Honigfeld, Dandrow, Freyre-Calish

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

• 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

• 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

CHILD'S AGE

# OF TESTS DONE

% 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% 25

Honigfeld, Dandrow, Freyre-Calish

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 months only)

68% 61% -7%

Practice L 83% 88% +5%

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

• 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