Measuring Early Hearing Detection and Intervention (EHDI) Quality across the Continuum of Care

Xidong Deng,Terese Finitzo,Subhash Aryal

doi:10.5334/egems.239

Abstract

Improving quality measurement while reducing costs helps public health programs identify and better support critical aspects of the care and services delivered to the patients they serve. This is true for state-based early hearing detection and intervention (EHDI) programs as they strive to develop robust clinical quality measures to help track the quality of hearing health services provided during the EHDI processes. Leveraging today’s electronic health records and public health surveillance system functionalities, state reporting requirements facilitate and yield efficient collection and analysis of data for quality measurement. In this study, we tested three EHDI quality measures endorsed by the National Quality Forum using a retrospective sample of more than 1,100,000 newborns from 3 states using electronic health data available in the state EHDI Information Systems (EHDI-IS). The results of the analysis reported herein from a large multi-state cohort provide a “real life” benchmark for future quality improvement projects and of where EHDI stands today. Reflecting on these findings, suggestions are posed for enhancing the EHDI quality measures in future updates.

Highlights

Congenital hearing loss affects two to three infants per 1,000 live births and, if undetected, can delay speech, language, and cognitive development [1]
Circumstances of parent refusal of screening is typically documented in the early hearing detection and intervention (EHDI)-IS that was used in this project, so that the element can be extracted for this measure
Because EHDI programs were relatively new at that time, the year 2000 position statement included benchmarks based on existing data and suggested others in areas for which published data were not available

Summary

Introduction

Congenital hearing loss affects two to three infants per 1,000 live births and, if undetected, can delay speech, language, and cognitive development [1]. The goal of state-based early hearing detection and intervention (EHDI) programs is to facilitate early identification and maximize language and literacy for children who are deaf or hard of hearing (D/HH). The newborn nursery provides a near universal, captive population to achieve this goal. Hospital point of care screening has been in place for nearly two decades. The success of EHDI programs depends on the availability, quality, and equity of care and services provided not just during the nursery-based screening but at sequential points of screening and follow-up, including diagnostic evaluations and enrollment into early intervention. The benefits of early hearing detection accrue when these subsequent steps are timely and efficient. Recent national surveys show gaps in the process and indicate that additional improvements may be helpful [2]

Methods

Results

Discussion

Conclusion