Success in Minimizing Loss-to-Follow-up

Hallie W. Morrow, M.D., M.P.H.

Challenges in California

• Size

• Diversity

• Mobility

Size

• Population of California

•34,000,000

• Population of Los Angeles County

•9,500,000

• Population of Alpine County

•1,200

Size

• 540,000 Births per year

• 320 Birthing hospitals

•Largest – 7300 deliveries

•Smallest – 60 deliveries

Diversity

• Geographic

• Race/ethnic

• Linguistic

Geographic Diversity

• Large metropolitan areas

Geographic Diversity

• Large metropolitan areas

• Agricultural areas

Geographic Diversity

• Large metropolitan areas

• Agricultural areas

• Mountains

Geographic Diversity

• Large metropolitan areas

• Agricultural areas

• Mountains

• Desert

Geographic Diversity

• Large metropolitan areas

• Agricultural areas

• Mountains

• Desert

• Coastal

Race/Ethnic Diversity

• 47% Non-Hispanic White

• 32% Hispanic

• 11% Asian/Pacific Islander

• 6% African American

• 1% American Indian

• 3% Other

Linguistic Diversity

• 33% of Californians speak a language other than English in the home

• 20% of Californians have Limited-English-Proficiency

• 50% of low-income Californians have a primary language other than English.

Linguistic Diversity

• 1,570,000 students speak a language other than English in the home

• 105 languages are spoken in Fresno County schools

Mobility

• Urban

• Migrant workers

• Mexican border

Infrastructure

Infrastructure

• Interwoven with the Title V CSHCN and the EPSDT programs

• Inpatient and outpatient provider standards

• Hearing Coordination Centers

• Single point of referral to IDEA Part C

Hearing Coordination Centers

• Serve specific geographic areas

• Certify and re-certify hospitals as meeting standards

• Collect data

• Track appointments for individual infants

Hearing Coordination Centers

• Contact providers if no results are received

• Refer to local EPSDT program if infant no shows appointments or provider cannot contact the family

Hearing Coordination Centers

• Generate correspondence to infant’s PCP

• Contact all families of infants identified with hearing loss

Hearing Coordination Centers

• Assure referral to EI has been made

• Quality assurance monitoring

Referral to Early Intervention

• Created single point of referral for all California children 0-3 years of age with a hearing loss

Data Management

• No statewide data management system

• Each HCC developed Access database

• All infant information and results reported on paper reporting forms

                                    

California Program Data 2004

(Preliminary)

WBN % NICU % Total

# admissions WBN 342,530 89% 342,530

# discharges NICU 43,814 11% 43,814

Region Total 386,344

175 Hospitals participating

California Program Data 2004

(Preliminary)

WBN % NICU % Total %

# screened 332,735 89% 39,860 11% 372,595 96.4%

# refer 6,327 1.9% 1,134 2.8% 7,461 2.0%

# waived 2,246 0.7% 35 0.1% 2,281 0.6%

# missed 1,239 0.4% 400 1.0% 1,639 0.4%

California Program Data 2004

(Preliminary)WBN % NICU % Total %

Hearing loss ID'd 303 0.09% 220 0.55% 523 0.14%

By 3 mo of age 238 79% 164 75% 402 77%

IFSP initiated 136 45% 91 41% 227 43%

By 6 mo of age 118 87% 75 82% 193 85%

PCP ID'd 839 84% 798 77% 1637 81%

California Program Data 2004

(Preliminary)

Total %

Lost to Follow-up 756 5.80%

Provider non-reporting 364 48%

Summary

• Infrastructure!

• Receive and review individual infant data in real time

• Take action if not getting appropriate services