Improving Loss to Follow-up for Newborn Hearing Screening Every state in the nation now has a newborn hearing screening program, and 2007 data from the Centers for Disease Control and Prevention showed that 97% of newborns in the United States were screened for hearing loss. However, 46.1% infants who failed their hearing screening did not receive a diagnostic ... Features
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Improving Loss to Follow-up for Newborn Hearing Screening
Author Notes
  • Ojus Malphurs Jr., PhD, CCC-SLP/A, founded Infant Hearing Services, a private practice in Jackson, Miss., after retiring as director of communicative disorders at the University of Mississippi Medical Center. He was instrumental in beginning a statewide newborn hearing screening program almost 30 years ago. Contact him at ojus@bellsouth.net.
    Ojus Malphurs Jr., PhD, CCC-SLP/A, founded Infant Hearing Services, a private practice in Jackson, Miss., after retiring as director of communicative disorders at the University of Mississippi Medical Center. He was instrumental in beginning a statewide newborn hearing screening program almost 30 years ago. Contact him at ojus@bellsouth.net.×
  • William D. Mustain, PhD, CCC-A, is an associate professor and audiologist at the University of Mississippi Medical Center in Jackson, and has been involved in newborn hearing screening and follow-up services for more 25 years. Contact him at wmustain@umc.edu
    William D. Mustain, PhD, CCC-A, is an associate professor and audiologist at the University of Mississippi Medical Center in Jackson, and has been involved in newborn hearing screening and follow-up services for more 25 years. Contact him at wmustain@umc.edu×
Article Information
Hearing Disorders / Special Populations / Early Identification & Intervention / Features
Features   |   November 01, 2010
Improving Loss to Follow-up for Newborn Hearing Screening
The ASHA Leader, November 2010, Vol. 15, 5-6. doi:10.1044/leader.FTR3.15142010.5
The ASHA Leader, November 2010, Vol. 15, 5-6. doi:10.1044/leader.FTR3.15142010.5
Every state in the nation now has a newborn hearing screening program, and 2007 data from the Centers for Disease Control and Prevention showed that 97% of newborns in the United States were screened for hearing loss. However, 46.1% infants who failed their hearing screening did not receive a diagnostic evaluation and are considered “lost to follow-up” (LTF). The document Loss to Follow-Up in Early Hearing Detection and Intervention, developed by the ASHA Working Group on Loss to Follow-Up, includes a systematic review of the evidence related to LTF and concludes that the available evidence provides neither meaningful direction in identifying the patients/families at highest risk for LTF nor in decreasing that risk (ASHA, 2008).
Mississippi—one of the first five states to pass screening legislation and to screen at least 90% of newborns—is one of only seven states with an LTF rate of less than 10%. The hospital-based screening program in this state began in 1981 at the University of Mississippi Medical Center (UMC) with funding from the Lions Clubs of Mississippi. By 1989, the Lions Club program had expanded to include the 22 largest hospitals, at which more than half of the state’s newborns were delivered (Malphurs, 1989). In 1986 this program received an Outstanding Community Health Promotion Award from the U.S. secretary of health and human services.
The following observations are based on more than 20 years of experience with screening and evaluating hearing in newborns. In the early 1980s, one of the major problems in the hearing screening program was follow-up; in 1986 the Division of Newborn Medicine at UMC volunteered its secretary to schedule outpatient appointments. The “no-show” rate for outpatient visits was high, and it was soon determined that the most effective means of improving follow-up was to test infants before hospital discharge. Infants who did not pass the newborn screening at other hospitals were still scheduled by the division secretary.
In 1998, Ojus Malphurs, who started the infant hearing screening program at UMC, retired. Neonatologists from other hospitals who had referred patients to him at UMC arranged for him to have an office at another hospital. The outpatients were essentially the same; in the new setting, however, an audiologist rather than a secretary scheduled appointments.
Improving No-Show Rates
The private practice had many fewer missed appointments than UMC. This difference may be due to the audiologist speaking directly with parents to schedule the evaluation, rather than a secretary, but also could be the result of reduced time between hospital discharge and scheduled outpatient appointment.
Initially, the audiologist felt uncomfortable scheduling appointments; now the practice is routine and does not seem unusual to parents, who generally appreciate the opportunity to talk with the audiologist who will be testing their child. Occasionally parents ask questions and frequently call if they need to change the appointment or will be late. Nurses from referring hospitals also seem to appreciate having the audiologist talk with parents, possibly because they are relieved not to be required to explain a procedure that may lead to the diagnosis of hearing loss.
Audiologists may feel that they lack the time to schedule their own appointments; however, a modest investment in time talking with parents is repaid many times over if it reduces missed appointments. ASHA’s 2008 Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants and Young Children With Hearing Loss Birth to 5 Years of Age state that “to the extent possible, audiologists should be the professionals who communicate with parents when a baby has not passed a hearing screening.”
Attempts to explain loss to follow-up have focused on factors such as economic status, race, and distance from diagnostic services (ASHA 2008), but none of these factors seem to affect patients at Infant Hearing Services, although 70% receive Medicaid and more than half are from culturally diverse backgrounds. Many families travel distances comparable to crossing a small state in the northeast, such as Rhode Island, which is 40 times smaller than Mississippi. Although the no-show rate at Infant Hearing Services is less than 5%, problems still persist, mostly due to incorrect telephone numbers and addresses. Audiologists are encouraged to contact their referrals for newborn hearing screening failure directly as a means of reducing loss to follow-up.
References
American Speech-Language-Hearing Association. (2008). Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants and Young Children With Hearing Loss Birth to 5 Years of Age [Guidelines]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2008). Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants and Young Children With Hearing Loss Birth to 5 Years of Age [Guidelines]. Available from www.asha.org/policy.×
American Speech-Language-Hearing Association. (2008). Loss to Follow-Up in Early Hearing Detection and Intervention [Technical Report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2008). Loss to Follow-Up in Early Hearing Detection and Intervention [Technical Report]. Available from www.asha.org/policy.×
Centers for Disease Control and Prevention. (2010). Hearing Loss in Children: Data and Statistics. Retrieved October 13, 2010, from http://www.cdc.gov/ncbddd/hearingloss/data.html.
Centers for Disease Control and Prevention. (2010). Hearing Loss in Children: Data and Statistics. Retrieved October 13, 2010, from http://www.cdc.gov/ncbddd/hearingloss/data.html.×
Gaffney, M., Gamble, M., Costa, P., Holstrum, J., & Boyle, C. (2003). Infants tested for hearing loss—United States, 1999-2001. Morbidity and Mortality Weekly Report, 52(41), 981–984. [PubMed]
Gaffney, M., Gamble, M., Costa, P., Holstrum, J., & Boyle, C. (2003). Infants tested for hearing loss—United States, 1999-2001. Morbidity and Mortality Weekly Report, 52(41), 981–984. [PubMed]×
Malphurs, O. (1989). Infant Hearing Screening in Mississippi, Journal of the Mississippi State Medical Association, 30(8), 245–248. [PubMed]
Malphurs, O. (1989). Infant Hearing Screening in Mississippi, Journal of the Mississippi State Medical Association, 30(8), 245–248. [PubMed]×
National Institutes of Health. (1993). Early identification of hearing impairment in infants and young children. Consensus Development Conference Statement, 11(1), 1–24. Retrieved October 25, 2010, from http://consensus.nih.gov/1993/1993HearingInfantsChildren092html.htm.
National Institutes of Health. (1993). Early identification of hearing impairment in infants and young children. Consensus Development Conference Statement, 11(1), 1–24. Retrieved October 25, 2010, from http://consensus.nih.gov/1993/1993HearingInfantsChildren092html.htm.×
Tharpe, A. (2009, March 24). Closing the Gap in EHDI Follow-Up. The ASHA Leader..
Tharpe, A. (2009, March 24). Closing the Gap in EHDI Follow-Up. The ASHA Leader.. ×
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November 2010
Volume 15, Issue 14