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R escreening in the Pediatric Office

R escreening in the Pediatric Office. Brad Golner , MD Jack Levine, MD AAP Task Force on Improving the Effectiveness of Newborn Hearing Screening, Diagnosis and Intervention. GOALS. Rescreening in perspective of 1:3:6 and Medical Home Reducing LTF

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R escreening in the Pediatric Office

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  1. Rescreening in the Pediatric Office Brad Golner, MD Jack Levine, MD AAP Task Force on Improving the Effectiveness of Newborn Hearing Screening, Diagnosis and Intervention

  2. GOALS • Rescreening in perspective of 1:3:6 and Medical Home • Reducing LTF • NYS survey and experiences in other states • Early Childhood Outreach Initiative (ECHO) • Early Head Start • NCHAM links and resources • Chart review • Case report • Billing • AAP task force recommendations • Cautions of using OAE • Discussion

  3. 1:3:6 ALGORITHM

  4. BEFORE ONE MONTH

  5. Ongoing Care – “Bright Futures” • Provide information about hearing, speech and developmental issues • Aggressively treat middle ear disease (tympanometry) • Routine hearing and vision screening (OAE, ABR, Sweep) – Referral to audiologist if failed • Developmental/autism screening – only 20% screen • Referral if parental concern • Refer if risk factor by 24 to 30 months - CMV • Audiological evaluation of developmentally delayed or uncooperative children

  6. Office Rescreening • How common? • 25% of pediatricians rescreen • NYS survey/Regional meetings • Many have OAEs in office • Helpful to parents? Easier? Better? • Who does it and are they trained? • Techs • OAE? ABR? Both? • Initial screen? • NY - 23% • Need to report to State EHDI programs • Only 12% in NY

  7. Eiserman et al. • International Journal of Pediatric Otorhinolaryngology 2008 • Early Childhood Research Quarterly 2007 • Infants and Young Children 2008 • http://www.infanthearing.org/earlychildhood/healthcare.html • Early Head Start Screening • Screened over 4500 children under 3 years and found 5 with permanent bilateral hearing loss and 2 with unilateral – 1.5/1000 • 4 passed newborn screen, 2 were not screened and one never followed up

  8. Successful Programs • Eiserman et al. • Involvement of a pediatric audiologist • Selection of appropriate equipment – screen at 25dB • Adherence to appropriate screening and follow up protocol • Access to training and follow-up technical assistance.

  9. Practicality and Effectiveness • Eiserman et al. • Non-invasive • Objective response from the inner ear • Natural, noisy environments • Sensitivity 85-100%; Specificity 91%- 100% • Measure hearing loss as 25 decibels • Sensitive to mild to profound hearing loss • Frequency range - normal speech and language development • Non-audiologists

  10. Chart Review • DOCUMENT: • Newborn hearing screening results • Follow-up screening/referrals if applicable • Risk factors for hearing loss • Hearing screening results completed in the office • Flagged charts for at risk patients • CUSTOMIZE YOUR EMR SYSTEM FOR ABOVE ITEMS!

  11. Case Report • 4 yr well child exam, no risk, non-compliance with audiometry—OAE/tympanometry • 3yr well child exam, risk factors, parental concerns present • 3.5 yr child failed NBHS, LTFU, speech delay and hearing concerns

  12. Billing • Reimbursement: $11.43-$63.14/occurrence. Average $32/occurrence • Need to have probable cause to screen • Must be linked to appropriate ICD-9 and CPT codes. See www.infanthearing.org/financing/index.html

  13. Rescreening in the Medical Home – AAP EHDI Task Force

  14. Rescreening in the Medical Home

  15. Cautions of Using OAE • False negative results: will not identify auditory neuropathy/dyssynchrony Middle ear pathology, environmental noise, vernix within the ear canal • Must use with tympanometry • Adequate training • Noncompliant child

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