RFA-NR14-01: EHDI Quality Measures

DRDC Solicitation #:  RFA-NR14-01

Project Title: Developmentof quality measures to facilitate reporting of newborn hearing screening and follow-up data by providers to jurisdictional EHDI programs  

Maximum Budget: $125,000 (includes direct and indirect costs of applicant)
NOTE: All budget amounts are subject to the availability of funding.
Project period:  1 year
Anticipated Number of Awards:  1
Project start date:  September 30, 2014

Eligible Applicants:

  • Universities and research institutions,
  • Non-profit organizations
  • Private healthcare consulting companies


Center/Division goal(s) and priorities aligned with this research project:  Division of Human Development and Disability (DHDD) Priority: Ensuring that all newborns are screened and assessed for hearing loss and receive appropriate intervention.

Purpose: Improve the frequency and quality of newborn hearing screening and follow-up data reported by providers to jurisdictional EHDI programs by developing and testing a set of quality measures.

Background:  Currently over 95 percent of infants born in the United States are screened for hearing loss shortly after birth. Approximately 2 percent of those infants are referred for follow-up care, including rescreening and diagnostic testing provided by pediatric audiological providers. According to the CDC EHDI Hearing Screening and Follow-up Survey (HSFS), in 2011 nearly 50% of infants needing care following newborn screening did not have a documented record indicating that they have received the needed service. Documenting how many infants receive recommended follow-up services and how many are lost to follow-up (LFU) is challenging because some infants probably receive follow-up testing but the results are not reported to the jurisdictional EHDI program. In many states provider reporting to the EHDI program is not mandated by law and there is a lack of standardization in how data are classified and reported. Cases in which infants receive the recommended follow-up services but the results are never reported to the EHDI program are referred to as loss to documentation (LTD). Differentiating between LTDs and the true LFUs has been a challenge for EHDI programs and it can result in unreliable follow-up data, which can undermine efforts to ensure all infants with hearing loss are identified and receive early intervention services as soon as possible.

The success of the EHDI tracking and surveillance systems, including more timely, complete and accurate follow-up data, depends on the quality, availability, and equity of care and services provided at sequential points of screening and subsequent follow-up. To help achieve success we have been using quality measures as a way for performance monitoring and measurement of the EHDI process. In August of 2011, the National Quality Forum (NQF) officially endorsed several measures developed by CDC EHDI as Child Health Quality Measures.  One of these measures related to hospital newborn hearing screening was later adopted by the Centers for Medicare and Medicaid Services (CMS) as a Clinical Quality Measure (CQM) in the Clinical Process/Effectiveness domain of the stage 2 EHR Incentive Program. As we work to support and improve the performance and efficiency of EHDI programs across the nation, it is important to develop standardized and meaningful measures to assess the frequency and quality of provider reporting on follow-up care and services.

Describe the potential public impact of this opportunity:

  • Improved frequency and quality of  public health reporting by audiological providers
  • More complete and accurate data available to state EHDI programs for monitoring LFU
  • Improved standardization and consistency for state EHDI program performance measurement
  • Supports the early identification of infants with hearing loss

Special Instructions for applicants:

Successful applications must include the following:

  1. Description of the project plan, including timeline of activities
  2. Description of  prior experience in working with NQF and/or other organization on clinical quality measure development
  3. Plans for pilot testing any developed measure for reliability and validity. Pilot testing must occur at a minimum of two separate audiology clinics in order to facilitate the collection of empirical evidence of the measure’s reliability and validity.  It is recommended that the applicant use the NQF “Guidance for Measure Testing and Evaluating Scientific Acceptability of Measure Properties” (www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116) for planning and conducting the test.
  4. Plans for submission of progress and final reports, and dissemination of findings
  5. Detailed budget, including identification of any sub-contractors
  6. Protection of human subjects

Further, successful applicants will likely:

  1. Have prior experience with developing NQF measures and eMeasures
  2. Have prior knowledge and experience in working with clinical health providers and the reporting of clinical data