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OAE in Pediatric Practice: Improving Hearing Screening within the Medical Home

OAE in Pediatric Practice: Improving Hearing Screening within the Medical Home. Lisa S. Honigfeld, PhD, CT Center for Primary Care; Ann Dandrow, Gabriela Freyre-Calish, – AJ Pappanikou Center for Developmental Disabilities.

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OAE in Pediatric Practice: Improving Hearing Screening within the Medical Home

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  1. OAE in Pediatric Practice:Improving Hearing Screening within the Medical Home Lisa S. Honigfeld, PhD, CT Center for Primary Care; Ann Dandrow, Gabriela Freyre-Calish, – AJ Pappanikou Center for Developmental Disabilities Honigfeld, Dandrow, Freyre-Calish

  2. This project was funded by: the Office of Special Education Programs, United States Department of Education, Grant #324T990006, Enhanced Child Find Through Newborn Hearing Screening through a grant to the University of Connecticut AJ Pappanikou Center for Developmental Disabilities. Opinions expressed are those of the researchers and do not necessarily represent the position of the U.S. Department of Education, Office of Special Education Programs. Honigfeld, Dandrow, Freyre-Calish

  3. Enhanced Child Find through Newborn Hearing Screening • Brochure on services available in Connecticut • Video: A Parent’s Guide to Newborn Hearing Screening • Video: A Parent’s Guide: Early Intervention for Infants and Young Children with Hearing Loss • Medical Record Tracking Tool for Newborn Hearing Screening Honigfeld, Dandrow, Freyre-Calish

  4. Guidelines for Hearing Screening in Primary Care Practice • Babies who meet Task Force at risk criteria • All four year olds (AAP Guideline) • Children with persistent OME (>3 months) • Parental/Caregiver concern regarding speech, language, hearing • Follow-up of hospital newborn hearing screening refers (not ideal for primary care setting) Honigfeld, Dandrow, Freyre-Calish

  5. Barriers to Hearing Screening • Current methods: pilot audiometry, • Cooperation • Some kids are too young • Referrals take time and parental follow-up • Office routine • Confusion over role/limit of Universal Newborn Hospital Screening • Confusion over schools’ role Honigfeld, Dandrow, Freyre-Calish

  6. ProHealth Physicians • 200 providers: MDs, DOs, APRNs, PAs • 80 practice sites • Primary care: internists, family physicians, pediatricians • In one electronic network: email, shared files, billing • 350,000 patients • About 1 million patient encounters in a year (includes lab tests) Honigfeld, Dandrow, Freyre-Calish

  7. Baseline Data – for pediatric and family medicine practices only • All four year old visits • All patients with OME for three or more months • All hearing screens performed (92552, 92567,92583, 92587) Honigfeld, Dandrow, Freyre-Calish

  8. Hearing Screening at the 4 year will visit • 13 of 39 practices billed hearing screening with well child visit • Why so few? • Payable by insurance • Don’t do or do and don’t bill • Decision to only include those practices that bill Honigfeld, Dandrow, Freyre-Calish

  9. Hearing Screening at the 4 year well child visit: 7/02 through 6/03 Honigfeld, Dandrow, Freyre-Calish

  10. OAE Screenings Performed in 3 Practices – 1/04 to 6/04 Honigfeld, Dandrow, Freyre-Calish

  11. Hearing Screening at the 4 Yr Visit: with OAE after 6 months Honigfeld, Dandrow, Freyre-Calish

  12. Hearing Screening and Persistent OME: Before and after OAE • Practice F: 7% to 46% • Practice I: 8% to 19% • Practice L: 18% to 32% Honigfeld, Dandrow, Freyre-Calish

  13. OAE Screens not with 4 or 5 Well Child Visit and not for OME 24 cases selected for review • Medical record abstraction • 10 result of parental concern about speech, language, or hearing • 3 failed school hearing test • 9 OME (less than 3 months) • 1 international adoption with no hearing screening • 1 unevaluable Results of 22 screens performed for parental concerns, OME less than 3 months, or failed test at school: 8 referred in at least one ear Honigfeld, Dandrow, Freyre-Calish

  14. Conclusions • OAE is feasible in pediatric practice • Can increase rate and accuracy of routine screening in accordance with AAP Guidelines • Tremendous asset for screening with OME and making treatment and referral decisions • Also useful for addressing parental concerns • Child health providers need support and education regarding hearing screening in primary care Honigfeld, Dandrow, Freyre-Calish

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