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Knowing What You Have: Quality Assurance Activities in EHDI Programs. Pam Costa and EHDI Coordinators 2007 EHDI Conference Salt Lake City, UT. CDC Disclaimer.

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knowing what you have quality assurance activities in ehdi programs

Knowing What You Have: Quality Assurance Activities in EHDI Programs

Pam Costa and EHDI Coordinators

2007 EHDI Conference

Salt Lake City, UT

cdc disclaimer
CDC Disclaimer

The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention (CDC) and should not be construed to represent any agency determination or policy.

participating ehdi coordinators
CA-Hallie Morrow

CNMI-Angie Mister

CO-Vickie Thomsom

FL-Ann Filloon

HI-Louella Christensen

KY-Michelle King

IA-Tammy O’Hollearn

MO-Cathy Harbison

NH-Ruth Fox

NJ-Kathy Aveni

OR-Amy Rosenthal

RI-Ellen Amore

SD-Terry Disburg

VA-Pat Dewey

VT-Stacy Jordan

WA-Karin Neidt

WI-Elizabeth Seeliger

WY-Nancy Pajak

Participating EHDI “Coordinators”
why worry about quality assurance
Why Worry about Quality Assurance
  • Accuracy
    • Is the data correct
  • Completeness
    • Are most variables complete for each case
    • Does database represent all “eligibles”
  • Timeliness
    • Is the necessary data in the database when it is needed for all program purposes
improving screening
Improving Screening
  • Screening Techniques
    • Program standards for inpatient/outpatient screeners (CA)
    • Technical assistance to hospitals (CA)
    • Assign an audiologist to each hospital to provide support (IA)
    • Report screener specific rates to identify those with high error rates (CNMI, WA)
  • Screening Information
    • Return improperly completed forms to hospitals for correction (MO)
audiologists
Audiologists
  • Conduct site visits to audiologists (NJ)
  • Develop audiological guidelines
  • Implement audiology bulletin with educational message (CA)
  • NCHAM training
  • Explore licensing to improve quality (CA)
  • If audiologist needs help with pediatric dx. testing, provide “expert” who goes out and gives “Just in time” on site technical support (WI)
early intervention
Early Intervention
  • Establish EHDI/EI Quality Review Team (RI)
    • Quarterly, look at all children with HL for participation in EI
    • Follow-up with family/primary care provider if needed
  • Have EI update the status (OR)
    • Pursue obtaining parental consent for data to be shared (MO)
improving data quality
Improving Data Quality
  • Conduct medical record reviews (NJ,MN,CNMI)
    • compare hearing data to chart data
  • Reconcile reports of HL dx in children who passed screening
    • Have hospital check screening results-late onset or error (NJ)
  • Match to vital records
    • Ensure numerator/denominator characteristics the same
    • More data items
  • Edit/valid range checks
data quality cont
Data Quality cont.
  • Duplicates
    • Have you looked for them
    • Would you recognize them
  • Standardized definitions
  • Does the data make sense
    • Frequencies
    • Do the numbers look like the state; if not, are the differences reasonable
    • Trends-same or different, reasonable?
improving process
Improving Process
  • Establish QA subcommittee as part of Advisory Committee (OR)
  • Develop standards/establish certification for hospitals (CA)
  • Develop Hospital Compliance Manual and rating system based on standards in manual (KY)
    • WI, KY, FL developing a Quality Assurance Toolkit for hospitals; 10 indicators and evaluation tool
  • Use benchmarks to monitor hospital progress and use results to schedule site visits/TA (NH, WI)
improving process cont
Improving Process cont.
  • Use data/achievement towards benchmarks (too high/too low) to identify areas for improvement (CO)
  • Periodic visits to hospitals to review procedures/provide feedback (FL, CO)
  • Phone contact/outreach to hospital staff (VT)
  • Require hospitals to implement quality assurance procedures to determine and evaluate the effectiveness of the program (NJ)
  • One example is to have hospitals compare the screening machine generated reports to the reports reported to the state (hearing results on birth certificates)
improving process cont14
Improving Process cont.
  • Conduct surveys to assess perception/success of process (CO, RI)
  • Send annual customized report to each hospitals, addressing the hospitals success and/or compliance with screening and reporting (VA, VT)
  • Automate as much as you can thru data system
    • Next actions, letters, flagging kids with no actions
  • At Thanksgiving, send cards to all programs thanking them for their efforts (WY)
ensure all babies are screened rescreened
Ensure All Babies are Screened/Rescreened
  • Periodic reports back to hospitals showing screening status (most all)
    • Named lists (NJ, SD, VT, WA, WY)
    • Aggregate data (FL, IA, VA)
  • Review listings in nursery log books (CNMI)
  • Require hospitals to schedule rescreening appointments prior to hospital discharge (CA
  • Link to vital records/metabolic forms (most all)
reduce loss undocumented results
Reduce Loss/Undocumented Results
  • Policy
    • Develop tracking and monitoring procedure manual showing next steps/responsibilities (CA)
    • Require reporting by audiologists, medical professionals, or others who may have contact with child
    • For providers who do not report results as required, contact them, and if there is no improvement, then send them a letter asking for a corrective action plan, with copy to licensing (CA)
reduce loss undocumented cont
Reduce Loss/Undocumented cont.
  • Determine extent of loss/undocumentation
    • Conduct data analysis to locate weak/problem areas
      • Concentrate resources targeting this population (MA)
  • Outreach to submitters
    • Follow-up with diagnostic centers
    • Track what audiologist child referred to; contact to obtain results if not entered (SD)
reduce loss undocumented cont20
Reduce Loss/Undocumented cont.
  • Outreach to families
    • Letters/phone calls to parents when child is missed or hasn’t returned (MO, WY)
    • Provide phone support to families of babies that don’t pass to help them navigate follow-up process (WI)
  • Try to find new address/information out on child; see if other agencies (such as WIC) will look up child to see if they have new address information (VA)
do you have everyone
Do You Have Everyone
  • Reasonableness of numbers
    • Part C
    • National data estimates
  • Link/use other databases
    • Hospital discharge (cochlear implants)
    • Infectious disease
    • Medicaid
    • Birth defects
    • Part C
      • Parental consent
      • Work with another agency which might also have these results that can share with Health Department
timeliness
Timeliness
  • What you can affect
    • Checking for duplicates
    • Reports back to hospitals
    • Linking to birth/metabolic other source documents
  • Provide feedback to submitters
    • Quarterly reports include information on timeliness of submission (VA)
slide25

Thank You

pcosta@cdc.gov