Hearing Coordination Centers:

A Model to Improve Loss to Follow-up

Hallie W. Morrow, MD, MPH, FAAPCalifornia Department of Health

ServicesSacramento, CA

Faculty Disclosure Information

• In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation.

• This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA or discussion of unapproved or “off-label” uses of pharmaceuticals or devices.

Hearing Coordination Centers

• Responsible for one or more geographic service areas

Hearing Coordination CenterStaff

• Director• Audiologist• Registered Nurse• Clerical Support• Parent

Hearing Coordination CenterActivities

• Hospital Certification– Certify and re-certify hospitals as

meeting standards

• Quality Assurance Monitoring

Hearing Coordination CenterActivities

• Infant Tracking and Monitoring– Collect data

• All infant information and results reported on paper reporting forms

– Track appointments for individual infants– Contact providers if no results are

received– Generate correspondence to infant’s PCP

Hearing Coordination CenterActivities

• Infant Tracking and Monitoring (cont.)– Refer to local EPSDT program if infant

no shows appointments or provider cannot contact the family

– Contact all families of infants identified with hearing loss

– Assure referral to EI has been made

Tracking and MonitoringProcedure Manual

• Flowcharts spell out tracking and monitoring activities

• Define when to close a case• Specify content of letters to families

and providers• Describe contact attempts with

providers

Tracking and Monitoring Procedure Manual

• Outpatient Screen Required– Appointment has been scheduled– No appointment scheduled– Referral to local EPSDT program

• Diagnostic Evaluation Needed– Reporting form received– Reporting form not received– No appointment scheduled

Tracking and Monitoring Procedure Manual

• Hearing Loss Identified• Nursery Transfers

– Within an HCC’s geographic service area– Outside an HCC’s geographic service

area– To a long term care facility– To a non-certified unit or NICU

• Infants Who Reside Outside of California

Flowchart #2C-Diagnostic Evaluation Needed-No Appointment Scheduled

Revised 4-05

Diagnostic evaluation not scheduled

CCS referral made

CCS referral not made

Family declined services

HCC contacts CCS re: auth and provider info. HCC contacts

outpatient screener or NICU re: responsibility to refer to CCS

Send case closure letter #8 to PCP & family.

Close case

HCC makes referral to CCS

Family declines CCS services

CCS sends copy of auth to HCC

HCC contacts dx provider to find out when appt. is scheduled (not HCC responsibility to schedule appt.).

Appt. scheduled

Go to flowchart #2

Appt. not scheduled

HCC sends appt. not scheduled letter #2 to PCP and family

HCC re-contacts DX provider in one month

Appt. scheduled

Go to flowchart #2

Appt. not scheduled

HCC contacts PCP, CCS and family re: svcs. from another provider?

Appt. scheduled

No appt. scheduled and/or no intention to schedule appt.

Send case closure letter #9 to PCP & family.

Send appt. not scheduled letter #1 to PCP and family.

Close case

Receive info on DX provider

No info. received after 1 month

HCC contacts PCP (2 attempts)

Send case closure letter #9 to PCP and parents

Close case

CCS does not issue auth due to parental non-compliance

Send case closure letter # 19

Close case

Last Name First Name AKA DOB MR# Tx From Tx Date Still Anticip Date of Pass Refer* Tx Miss*Inpt. D/C Date Screen AU Out*

Comments:

* Submit Infant Reporting Form and Medical Record Face Sheet

Phone Number: ( ) - Best Time to Contact: ___________________________________

Completed By Signature Date

California Newborn Hearing Screening ProgramStatus Information on Transfer (Tx) Babies

Hospital/NICU Name HereDate: / /2003

California Program Data 2004

  WBN % NICU % Total

# admissions WBN 343,711 89%   343,711

# discharges NICU     44,322 11% 44,322

Statewide Total         388,033

California Program Data 2004

  WBN % NICU % Total %

# screened 334,022 97% 40,074 90% 374,096 96.4%

# refer 6,458 1.9% 1,016 2.5% 7,474 2.0%

# waived 2,249 0.7% 35 0.1% 2,284 0.6%

# missed 1,306 0.4% 361 0.8% 1,667 0.4%

California Program Data 2005

(Preliminary)

  WBN % NICU % Total %

# screened 344,037 98% 41,222 92% 385,259 98%

# refer 6,889 2.0% 996 2.4% 7,885 2.0%

# waived 1,340 0.4% 23 0.1% 1,363 0.3%

# missed 1,130 0.3% 260 0.6% 1390 0.4%

California Program Data 2004

  WBN % NICU % Total %

Hearing Loss ID’d 400 0.12%  299 0.75%  699 0.19%

By 3 mo of age 303 76% 180  60%  483   69%

IFSP initiated 211 53% 157  53%  368  53% 

By 6 mo of age 159 75% 114  73%  273  74% 

PCP ID’d 914 90% 942 85% 1856 87%

California Program Data 2004

Total %

Lost to follow-up 762 5.7%

Appointments not scheduled 273 36%

Additional Information

• Information about the California Newborn Hearing Screening Program and the Hearing Coordination Centers is available at:

www.dhs.ca.gov/nhsp