1. Why Does It Take So Long To
Complete the Audiologic Process?
Presenters: Ian Ng , MPH Candidate
Thiravat Choojitarom, MD
LA Chapter Champion
Co-authors: Tri Tran, MD, MPH; Mary Jo Smith, BS; Jeanette Webb, M. Ed; Terri Ibieta, M. Ed;
Wendy Jumonville, Audiologist, MS, CCC/A; Melinda Peat, Audiologist, MCD, CCC/A.
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2. EHDI Missions & Goals
• Missions:
- Detect congenital and early acquired hearing loss
- Provide early intervention services to infants and their
families
• Goals:
- Screen for hearing loss before hospital discharge or before
one month of age
- Complete audiologic diagnosis before three months
- Initiate early intervention services before six months
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3. No Documented Hearing Diagnosis
of those not passing newborn hearing screening
%
43.1 45.1
31.6
34.6
0
10
20
30
40
50
60
70
80
90
100
2011 2012
United States
Louisiana
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4. Study Definition of Incomplete
Audiologic Diagnosis
1. Infant fails inpatient newborn screening, and
2. Has visited an audiologist/physician at least one
follow-up service, and
3. Does not yet have a confirmed result
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5. Birth Newborn
Screening
First follow-up
(one follow-up)
C-section
• Race/ethnicity
• Maternal age and
education
• # Previous live
births
• Geography
• Plurality
• Marriage
• Providers
• Facilities
• # Follow-ups
NICU
LBW/PTB
Incomplete
Timeline and Factors Related to Incomplete Audiologic Diagnosis
Incomplete
Last reported follow-up
( more than one follow-up)
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6. How did they get stuck?
Study purpose: Define factors related to
incomplete audiologic diagnosis
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7. Study Question: Are there associations between
incomplete audiologic diagnosis and…
1. Age at newborn screening
2. Time between newborn screening and first follow-up
service
3. Time between first and last follow-up service
4. Total number of follow-up services
Adjusting for demographic variables:
Maternal race Age
Education Marital status
Previous births Geography
Plurality
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8. Data Sources and Linkage
• Data sources:
- 2011-2013 LA EHDI data
- 2011-2013 birth certificate data
• Data linkage:
- Matching variables:
Child’s name and soundex
Child’s DOB
- Additional variables for matched case review:
Birth hospital and mother’s address
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9. Study Criteria
• Inclusion
- Louisiana resident born in state between 2011
and 2013
- Had screening before hospital discharge
- Failed newborn screening
- Had at least one follow-up service
• Exclusion
- Infant died
- Lost to follow up/lost to documentation
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10. Complete diagnosis:
Passed the evaluation on
both ears or has confirmed
hearing loss
6,492
Incomplete diagnosis:
Has not passed the evaluation
on both ears but no confirmed
hearing loss
478
Study Sample Size
Newborn screened
183,411
Failed Passed
9,864 173,547
Eligible follow-up cases
6,970
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11. Analysis Methods
– Logistic regression
– Alpha value = 0.05 for statistical significance
– Software:
Linkpro 3.0 and SAS 9.3 for data linkages
SAS 9.3 for data analyses
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14. Incomplete Audiologic Diagnosis Rate by Predictors
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6.1
25.7
5.0
9.1
21.1
5.8
20.7
19.4
16.8
4.8
19.0
21.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
<30 >= 30 < 30 30 - 90 > 90 < 30 30 - 90 90 -180 > 180 One Two > Two
Age at
newborn
screening
(days)
Time between
screening & first
follow-up (days)
Time between first & last
follow-up (days)
Total follow-up
services
%
15. Predictors
Odds
Ratio
Reference
group
Age at newborn screening >= 30 3.6 < 30 days
Time b/t screening and first
follow-up
30 - 90 1.6 < 30 days
> 90 4.2 < 30 days
Total follow-up services Two 4.0 One
> Two 4.6 One
Predictors Associated with Incomplete Audiologic Diagnosis
Time between first and last follow-up was not found associated.
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16. Demographics Odds Ratio Reference group
Maternal age Under 20 1.7* 35 or older
20 to 34 1.3 35 or older
Education < High school 1.3* > High school
High school 1.4* > High school
Race/Ethnicity White 1.5 Hispanic
Black 1.8* Hispanic
Others 1.2 Hispanic
Geography Rural 1.3* Urban
# Previous live births One 1.2 None
More than one 1.5* None
Demographics Associated with Incomplete Audiologic Diagnosis
* Statistically significant at alpha of 0.05
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17. Conclusions
• Incomplete audiologic diagnosis
remains a problem in Louisiana
(approx.150/year)
• Factors Associated with Incomplete
Diagnosis
- Late newborn screening
- Long periods between screening and follow-up services
- High number of follow-up services
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18. Demographics Associated with
Incomplete Audiologic Diagnosis
- Younger mothers
- Lower educational level
- Non-Hispanic Black
- Rural
- Greater number of children
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20. Timeline and factors related to incomplete
diagnosis
Odds Ratio 3.6 for > 30 days to NBS
Birth Newborn Screening First Follow-up
C-section
- Race/ethnicity
- Maternal age,
education
- Previous live
births
- Geography
- Plurality
- Marriage
- Providers
- Facilities
- # Follow-ups
NICU
LBW/PTB
Incomplete Incomplete
Last follow-up 20
Odds Ratio 1.2 – 1.8
Odds Ratio 4.2 if time > 90 days
Odds Ratio 4.6 if > 2 f/u services
21. Timeline and factors related to incomplete
diagnosis
Odds Ratio 3.6 for > 30 days to NBS
Birth Newborn Screening First Follow-up
C-section
- Race/ethnicity
- Maternal age,
education
- Previous live
births
- Geography
- Plurality
- Marriage
- Providers
- Facilities
- # Follow-ups
NICU
LBW/PTB
Incomplete Incomplete
Last follow-up 21
Odds Ratio 1.2 – 1.8
Odds Ratio 4.2 if time > 90 days
Odds Ratio 4.6 if > 2 f/u services
23. Timeline and factors related to incomplete
diagnosis
Odds Ratio 3.6 for > 30 days to NBS
Birth Newborn Screening First Follow-up
C-section
- Race/ethnicity
- Maternal age,
education
- Previous live
births
- Geography
- Plurality
- Marriage
- Providers
- Facilities
- # Follow-ups
NICU
LBW/PTB
Incomplete Incomplete
Last follow-up 23
Odds Ratio 1.2 – 1.8
Odds Ratio 4.2 if time > 90 days
Odds Ratio 4.6 if > 2 f/u services
24. Possible Factors influencing
Incomplete Diagnosis
Patient
Noncompliance
Inconvenient
Ignorance
Financial
Forgets
PCP involvement
Audiology Involvement
Facility Issue Non-compliant
Not reported correctly
Unable to complete test
Referred service provider
Audiologist training
New database training
reporting
Service
Providers
Providers rescreen too
many times
Ignorant of 1,3,6
Not trained properly
Provider education
Technical assistance
Expanding access
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