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Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial
Matthew L Bush1, Zachary R Taylor1, Bryce Noblitt1
1Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky.
Insights
Patient navigators significantly reduced nonadherence to audiological testing after failed newborn hearing screening. This intervention also improved parental knowledge of follow-up recommendations for infant hearing healthcare.
Area of Science:
- Audiology
- Public Health
- Healthcare Interventions
Background:
- Newborn hearing screening identifies infants with hearing loss.
- Follow-up audiological diagnostic testing is crucial for timely intervention.
- Nonadherence to recommended follow-up testing can delay diagnosis and treatment.
Purpose of the Study:
- To evaluate the effectiveness of a patient navigator intervention.
- To decrease nonadherence to audiological testing after abnormal newborn hearing screening.
- To compare the intervention group with the standard of care group.
Main Methods:
- Randomized controlled trial involving guardian-infant dyads.
- Infants with abnormal newborn hearing screening were randomized.
- Primary outcome: nonadherence to diagnostic audiological testing within 6 months.
Main Results:
- Nonadherence was significantly lower in the patient navigator arm (7.4%) versus standard care (38.2%).
- Follow-up testing occurred significantly earlier in the navigator arm (67.9 days vs. 105.9 days).
- Patient navigation improved parental knowledge of hearing loss diagnosis recommendations.
Conclusions:
- Patient navigation effectively reduces nonadherence to audiological follow-up.
- The intervention enhances understanding of infant hearing loss diagnostic recommendations.
- Patient navigation shows potential to improve timely infant hearing healthcare delivery.
Objectives/Hypothesis:
To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care.
Methods:
Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing.
Results:
Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004).
Conclusions:
Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation.
Level Of Evidence:
1b. Laryngoscope, 127:S1-S13, 2017.
