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Communities Helping the Hearing of Infants by Reaching Parents (CHHIRP) through patient navigation: a hybrid
Matthew Bush1, Miranda Hatfield2, Marissa Schuh2
1Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA matthew.bush@uky.edu.
Insights
Patient navigation improves adherence to infant hearing diagnosis after failed newborn screening. This intervention aims to reduce communication impairments and socioeconomic effects associated with infant hearing loss.
Area of Science:
- Neonatal sensory disorders
- Public health interventions
- Implementation science
Background:
- Infant hearing loss affects 1.7 in 1000 births in the USA, leading to communication and socioeconomic challenges.
- Early Hearing Detection and Intervention (EHDI) standards require diagnosis by 3 months, but adherence is a challenge.
- Patient navigation (PN) shows promise in improving adherence but needs testing in diverse settings.
Purpose of the Study:
- To test the effectiveness of PN in reducing non-adherence to infant hearing diagnosis after failed newborn screening.
- To examine implementation outcomes and influencing factors of PN in EHDI clinics.
- To determine the cost-effectiveness of PN for third-party payers.
Main Methods:
- A community-engaged, type 1 hybrid effectiveness-implementation trial using a stepped-wedge design.
- Intervention delivered in state-funded EHDI clinics, guided by a community advisory board.
- Study duration: April 2019 - March 2024, NCT03875339.
Main Results:
- Effectiveness of PN in decreasing non-adherence to infant hearing diagnosis.
- Identification of implementation outcomes and factors influencing PN adoption.
- Cost-effectiveness analysis of PN from a payer perspective.
Conclusions:
- PN can improve adherence to timely infant hearing diagnosis, mitigating negative health and socioeconomic impacts.
- Community engagement is crucial for successful implementation and scale-up of PN interventions.
- Findings will inform the development of effective EHDI programs to maximize public health impact.
Introduction:
As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings.
Methods And Analysis:
The proposed research is a community-engaged, type 1 hybrid effectiveness-implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHDI clinics. Guided by our community advisory board and partners, we aim to (1) test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, (2) investigate implementation outcomes and factors influencing implementation and (3) determine the cost-effectiveness of PN from the perspective of third-party payers. The study will be conducted from April 2019 until March 2024.
Ethics And Dissemination:
This protocol was approved by the University of Kentucky Institutional Review Board. Although all research involving human subjects contains some risk, there are no known serious risks anticipated from participating in this study. We will seek to disseminate our results in a systematic fashion to patients, key stakeholder, policymakers and the scientific community. Our results will impact the field by partnering with communities to inform the scale-up of this innovative patient supportive intervention to create efficient and effective EHDI programmes and maximise public health impact.
Trial Registration Number:
Clinicaltrials.gov (Pre-results phase): NCT03875339.
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