Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program

被引:13
作者
Deem, Kenneth C. [1 ]
Diaz-Ordaz, Ernesto A. [1 ]
Shiner, Brian [2 ]
机构
[1] SUNY Buffalo, Dept Otolaryngol Head & Neck Surg, Buffalo, NY 14260 USA
[2] Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH USA
关键词
neonatal screening; hearing loss; early intervention; health care quality; access; and evaluation; quality improvement; FOLLOW-UP; DEMONSTRATION PROJECT; CHILDREN; LANGUAGE; STATE; INTERVENTION;
D O I
10.1542/peds.2011-0912
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND AND OBJECTIVES: Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality assurance protocols, but many hospitals lack the time and resources to initiate this process. We studied a practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs. METHODS: We determined screening processes and quality indicators for UNHS programs at 4 hospitals through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. The sessions identified improvement opportunities and proposed system changes for immediate implementation. RESULTS: Hospitals screened 21 957 newborns for hearing loss. Screening rates were >99% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also increased referrals to Early Intervention Child Find services on the basis of our finding that these referrals increased the likelihood of diagnostic follow-up fourfold. We could not fully assess indicators of hearing aid eligibility and enrollment in early intervention services due to insufficient documentation. CONCLUSIONS: Review of nursery and audiology records successfully established most quality indicators for the UNHS programs we studied. Feedback of quality indicators identified multiple improvement opportunities and facilitated endorsement of immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program. Pediatrics 2012; 129: e157-e164
引用
收藏
页码:E157 / E164
页数:8
相关论文
共 29 条
[1]  
[Anonymous], 1995, PEDIATRICS, V95, P152
[2]   Statistical process control as a tool for research and healthcare improvement [J].
Benneyan, JC ;
Lloyd, RC ;
Plsek, PE .
QUALITY & SAFETY IN HEALTH CARE, 2003, 12 (06) :458-464
[3]   CONTINUOUS IMPROVEMENT AS AN IDEAL IN HEALTH-CARE [J].
BERWICK, DM .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (01) :53-56
[4]   Levels of neonatal care [J].
Blackmon, L ;
Batton, DG ;
Bell, EF ;
Denson, SE ;
Engle, WA ;
Kanto, WP ;
Martin, GI ;
Stark, AR .
PEDIATRICS, 2004, 114 (05) :1341-1347
[5]   Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs [J].
Busa, Jackie ;
Harrison, Judy ;
Chappell, Jodie ;
Yoshinaga-Itano, Christine ;
Grimes, Alison ;
Brookhouser, Patrick E. ;
Epstein, Stephen ;
Mehl, Albert ;
Vohr, Betty ;
Gravel, Judith ;
Roush, Jack ;
Widen, Judith ;
Benedict, Beth S. ;
Scoggins, Bobbie ;
King, Michelle ;
Pippins, Linda ;
Savage, David H. .
PEDIATRICS, 2007, 120 (04) :898-921
[6]  
*CDCP, NAT EHDI GOALS
[7]  
Finitzo T, 2000, PEDIATRICS, V106, P798, DOI 10.1044/1059-0889(2000/005)
[8]   Newborn Hearing Screening and Follow-up: Are Children Receiving Recommended Services? [J].
Gaffney, Marcus ;
Green, Denise R. ;
Gaffney, Claudia .
PUBLIC HEALTH REPORTS, 2010, 125 (02) :199-207
[9]   A multicenter evaluation of how many infants with permanent hearing loss pass a two-stage otoacoustic emissions/automated auditory brainstem response newborn hearing screening protocol [J].
Johnson, JL ;
White, KR ;
Widen, JE ;
Gravel, JS ;
James, M ;
Kennalley, T ;
Maxon, AB ;
Spivak, L ;
Sullivan-Mahoney, M ;
Vohr, BR ;
Weirather, Y ;
Holstrum, J .
PEDIATRICS, 2005, 116 (03) :663-672
[10]   Language ability after early detection of permanent childhood hearing impairment [J].
Kennedy, CR ;
McCann, DC ;
Campbell, MJ ;
Law, CM ;
Mullee, M ;
Petrou, S ;
Watkin, P ;
Worsfold, S ;
Yuen, HM ;
Stevenson, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 354 (20) :2131-2141