18th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 3-5, 2019 • Chicago, IL
Factors Associated with Loss to Follow-Up to Diagnosis in Infants Referred After Initial Hearing Screening
Loss to follow-up (LFU) to diagnosis is a persistent obstacle to the delivery of timely and effective intervention for infants with hearing loss. Tennessee’s LFU rates among infants who failed screening remained at 18% for the 2016 births despite implementation of quality improvement initiatives and a significant improvement from previous years—LFU rates ranged from 28–30% for infants born from 2012 through 2015.
This study investigated demographic and socioeconomic factors associated with LFU to inform efforts to further reduce LFU. Risk factors were selected based on a literature review and the data were fit with a logistic regression model including two-way interactions. 6,029 infants born from 2016-2017 who failed hearing screening were included. Infants born to mothers with high school or lower education were found to have 36% greater odds of LFU than those born to mothers with at least some college education. Other risk factors exhibited interactions so it was not possible to examine the magnitude of simple main effects individually. Odds ratios were estimated for the combination of multiple variables, with US-born white mothers living in metro areas with annual household income >=25,000 and private insurance as the reference group. The highest odds ratios were among US-born low-income African Americans residing in non-metro areas: 6.1, 6.5 and 7.6 for those on Medicaid, private insurance and other insurance, respectively. Foreign-born status of mothers was found to be protective again LFU across the board, and this effect was more evident among African Americans than among whites.
These findings can guide future recommendations and implementation of evidence-based interventions to ensure that all Tennessee infants with hearing loss have equal access to follow-up care. One action could be the collaboration with income-based state assistance programs to provide education and support to mothers having difficulty navigating the follow-up process.
- 1. Understand the risk factors associated with loss to follow-up to hearing diagnosis
- 2. Apply the findings from the study to her/his state’s newborn hearing screening program
- 3. Learn about the Tennessee Newborn Screening Program and its efforts in improving hearing follow-up
Poster:
18878_10359YinmeiLi.pdf
Presenter: John Maxwell
John Maxwell is a graduate student at Middle Tennessee State University working toward an MS in Professional Science with a concentration in Healthcare Informatics. He worked as a 2018 Summer Graduate Intern for the TN Department of Health Newborn Screening Program. His areas of interest include population health, quality assurance, data analysis, SAS and SQL programming, and database design. He received BS degrees in Kinesiology and Respiratory Therapy from Indiana University and has 14 years of clinical experience as a respiratory therapist and sleep technologist.
ASHA DISCLOSURE:
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Dr. Yinmei Li is the lead epidemiologist in the Perinatal, Infant and Pediatric Care section of the Family Health and Wellness division of the Tennessee Department of Health and has been in this role since 2014. Before joining the FHW division, she worked for three years as the chronic disease epidemiologist and then expanded her scope of work to include maternal and child health and injuries as the director of the Surveillance, Epidemiology and Evaluation section for 8 years with the TDH. She received an MD equivalent degree from Shanghai Medical College, Fudan University in China, and a Master’s degree in Experimental Statistics, a Master’s degree in Epidemiology, and a PhD in Veterinary Medical Sciences from Louisiana State University.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.