15th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 13-15, 2016 • San Diego, CA
3/14/2016 | 2:00 PM - 2:30 PM | Topical Session 2 | Pacific Salon 4/5 | 5 - Medical Home
Quality Improvement within the Medical Home: Improved Care of Newborns Not Passing Newborn Hearing Screening
Background: Quality improvement (QI) strategies implemented via the medical home may improve loss-to-follow-up for children who do not pass their newborn hearing screen. The goal of this project was to use QI learning collaborative methodology to improve care within the medical home to support children who do not pass their newborn hearing screen.
Methods: A multi-disciplinary expert group developed project aims focusing on documentation and discussion of newborn hearing screening results and risk factors for late onset hearing loss. Data were collected by teams and entered into the AAP Quality Improvement Data Aggregator. Teams completed narrative reports to identify qualitative information contributing to practice and systems-level and improvements.
Results: The 6 participating pediatric practices varied on characteristics including geography, , practice models (small/mid-size private practices, federally qualified health center, large multi-specialty practices), and family socio-demographics (predominantly public/private insurance, limited English proficiency).
Practices developed tracking strategies and optimized electronic medical record (EMR) systems, including development of audiology risk factor history collection tools, smart phrases for providers, and streamlining codes to identify patients with risk factors for hearing loss.
Practice teams have been working for 3 months and have accomplished a 131% improvement (32% to 74%) in discussing screening results with families, a 180% improvement (25% to 70%) in documenting risk factors, and a 522% improvement (9% to 56%) in discussing risk factors with families. Although the sample size is small, there has been a 67% improvement (60% to 100%) in the percent of children with a completed audiological exam by 3 months of age.
Qualitative information indicated barriers in implementing documentation of discussions with families as well as the slow pace of working with EMR support personnel for rapid improvements.
Early findings from the QI initiative are encouraging for improving care related to EHDI within the medical home.
- At the end of the session, participants will be able to identify the major barriers for pediatric clinicians in providing comprehensive EHDI care to patients.
- At the end of the session, participants will be able to describe strategies that can be implemented to improve pediatric clinician EHDI practice.
- At the end of the session, participants will be able to discuss the importance of the primary care clinician conducting conversations with parents and family members regarding hearing screening results, the identification of risk factors, and the need for timely follow-up care.
Presentation:
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CART:
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Presenters/Authors
Robert Cicco
(POC,Primary Presenter,Author), PA Chapter, American Academy of Pediatrics, rcicco@aap.net;
Robert Cicco, MD served as the Associate Director of the Neonatal Intensive Care Unit at the Western Pennsylvania Hospital in Pittsburgh, PA for 33 years and was active in the Neonatal Follow-Up Program before recently retiring. Previously, Dr. Cicco practiced general pediatrics for a number of years and this experience gave him a greater appreciation of the important role of families. Dr. Cicco is a past president of the Pennsylvania Chapter, American Academy of Pediatrics (PA AAP) and a long time AAP EHDI Chapter Champion. He been the Pediatric Advisor for the PA AAP’s EHDI Program for 14 years and is also a member of the national EHDI Advisory Committee. He has served on many state and national committees, including the PA Infant Hearing Screening Advisory Committee.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.
Leslie Lestz
(Co-Presenter), Family Signs Parent, lklestz@gmail.com;
Dr. Leslie Katz Lestz graduated cum laude from Harvard University with a degree in English and American Literature. She received her MD in 1998 at Emory University School of Medicine. She completed her Pediatric residency at Children's Medical Center of Dallas in 2001. She is currently a General Pediatrician at TLC Pediatrics of Frisco. Dr. Lestz accepted an appointment from the American Academy of Pediatrics in February 2014 to serve as the AAP Chapter Champion for the EHDI program for Texas. In addition, she serves on several state committees through the Texas Department of State Health Services including the Deaf and Hard of Hearing Leadership Council and the Medical Home Workgroup. She lives in Dallas, TX with her husband and 3 children, ages 14, 12 and 9. Two of her children are hard of hearing and Dr. Lestz was also diagnosed with a bilateral mild hearing loss last year.
ASHA DISCLOSURE:
Financial -
Nonfinancial -
Julia Richerson
(Co-Presenter), Family Health Centers of Louisville, jricherson@fhclouisville.org;
Dr. Richerson is from Mayfield, Kentucky and attended Transylvania University and medical school at the University of Kentucky. She completed her residency in pediatrics at Cedars Sinai Medical Center in Los Angeles. After residency she joined the White House Clinic in McKee Kentucky, where she served as pediatrician and medical director. She is currently with Family Health Centers in Louisville where she has been for the past 11 years as pediatrician and also served as medical director.
She currently serves on the Board of the Kentucky Primary Care Association, Mama2Mama and Little Ears Hearing Center and the Executive Committee of the Kentucky Chapter of the American Academy of Pediatrics (AAP). She chairs the Child Health Committee of Passport Health Plan. She is on community faculty at UK and UofL Colleges of Medicine. She serves as a member of the AAP Committee on Practice and Ambulatory Medicine at the national level.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.
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ASHA DISCLOSURE:
Financial -
Nonfinancial -
Amanda Norton
(Co-Presenter,Author), A. Mandatory Inc, altn14@gmail.com;
Amanda Norton serves as the Quality Improvement Advisor for the American Academy of Pediatrics Early Hearing Detection and Intervention Program Quality Improvement Project.
ASHA DISCLOSURE:
Financial -
Receives Consulting fee for Teaching and speaking,Consulting from AAP.
Receives Consulting fee for Teaching and speaking,Consulting from NCHAM.
Nonfinancial -
No relevant nonfinancial relationship exist.