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Published on: January 23, 2017
Evaluating loss to follow-up in newborn hearing screening in Massachusetts
Chia-ling Liu1, Janet Farrell, Jessica R MacNeil
1Center for Community Health, Massachusetts Department of Public Health, Boston, Massachusetts, USA. liu_chialing@yahoo.com
Insights
11% of Massachusetts infants lost audiology follow-up, and 25% missed early intervention. Risk factors included maternal race, insurance, smoking, and region, aiding targeted resource allocation for infant hearing loss services.
Area of Science:
- Pediatrics
- Public Health
- Audiology
Background:
- Early identification and intervention are crucial for infants with hearing loss.
- Understanding loss to follow-up (LTFU) is vital for optimizing service delivery.
- Massachusetts has systems to track hearing screening and intervention for infants.
Purpose of the Study:
- To examine loss to follow-up (LTFU) in diagnostic and intervention services for Massachusetts infants and children with hearing loss.
- To identify risk factors associated with LTFU for audiology evaluation and early intervention.
Main Methods:
- Utilized data from the Massachusetts Childhood Hearing Data System and Early Intervention Information System (2002-2003).
- Calculated LTFU rates for audiology evaluation and early intervention services.
- Estimated associations between maternal/infant factors and service use using relative risks and confidence intervals.
Main Results:
- 11% of infants who did not pass hearing screening were lost to audiology follow-up.
- 25% of children with diagnosed hearing loss did not receive early intervention services.
- Higher LTFU risk for audiology linked to nonwhite mothers, public insurance, smoking during pregnancy, and specific geographic regions.
Conclusions:
- Massachusetts demonstrates generally high follow-up rates for infant hearing services.
- Analysis identifies high-risk subgroups for LTFU, enabling targeted resource allocation.
- Prioritizing resources for at-risk infants can improve service access and outcomes.
Objective:
The purpose of this work was to examine loss to follow-up on the use of diagnostic or intervention services for Massachusetts infants and children screened or diagnosed with hearing loss and risk factors for becoming lost to follow-up.
Methods:
We used data from the Massachusetts Childhood Hearing Data System and Early Intervention Information System. We calculated the percent use of audiologic evaluation for Massachusetts infants born in 2002-2003 who did not pass hearing screening and Early Intervention services for those with hearing loss. We generated crude and adjusted relative risks, as well as confidence intervals, to estimate associations of maternal and infant factors with the use of audiologic evaluation and early intervention services. Factors evaluated included child's birth weight and hearing screening or diagnostic results and maternal age, race or ethnicity, marital status, smoking status during pregnancy, educational attainment, health insurance, and residence region.
Results:
In 2002-2003, 11% of Massachusetts children who did not pass hearing screening became lost to follow-up on the audiologic evaluation, and 25% of those with hearing loss did not receive early intervention services. Children were at higher risk of becoming lost to follow-up on audiologic evaluation if their mothers were nonwhite, covered by public insurance, smokers during pregnancy, or residing in western, northeastern, or southeastern Massachusetts compared with those in the Boston region. Of children with hearing loss, those with a unilateral or mild or moderate degree of hearing loss, normal birth weight, or living in the southeastern or Boston region were more likely to go without early intervention services.
Conclusions:
Massachusetts has excellent follow-up rates overall. Our analyses allow the program to prioritize limited resources to subgroups of infants who are at high risk of becoming lost to follow-up.
