EHDI Quality Across the Continuum of Care

Terese Finitzo, PhD, OZ Systems (Funded 2015-2016)

This project will address EHDI quality across the continuum of care in a retrospective sample of 1,000,000 newborns from three EHDI jurisdictions (TX, MD, ND). Its goal is to improve the frequency and quality of newborn hearing screening (NHS) and follow-up data that is reported, and to distinguish and mitigate loss to follow-up (LTF) and loss to documentation (LTD) factors. The need is clear with 95% screened, 2% referred, and 40-50% LTF.  Analyzing large databases is an optimal approach for honing processes across health and early childhood agencies with EHDI program responsibilities. Too many newborns for whom there is a failure in the NHS are not confirmed as recipients of pediatric hearing health care. To improve connection for children and families, this quality improvement project will calculate measures endorsed by the National Quality Forum (NQF 1354,1360, and 1361), which are available in participating states’ EHDI surveillance and tracking information systems provided by OZ Systems. The project will examine each measure for functionality, reliability ,and validity.

Detected challenges to validity and reliability will be delineated and reported. NQF1354 calculates newborns screened before hospital discharge and will serve as a baseline and be assessed for different states, different hospital types, and different race/ethnicity groups. NQF1360 addresses the proportion of newborns who did not pass all screenings, but reportedly received an audiology evaluation before 3 months of age, which is the consensus-derived, evidence-based best practice time frame. We will examine age at initial evaluation and age at diagnosis if we have more than one evaluation. The project will determine the defined elements of NQF measures,  and we will map and transform real world data into rigorous measure definitions. The assumption that current electronic health records (EHRs), EHDI information systems functionality, and state reporting requirements are expected to facilitate efficient data collection, and reduce data collection burden will be examined. With approximately 98% of births captured in the EHDI information systems, the large cohort will provide a ‘real life’ benchmark for future projects. Pediatric audiology clinics will collaborate to provide additional empirical evidence, where needed.