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Impact of Patient Navigation on Time to Intervention for Deaf and Hard-of-Hearing Children
Michael M Lindeborg1, Kendyl Naugle2, Michelle A Wong1
1Department of Otolaryngology, University of California, San Francisco, USA.
Insights
A patient navigator significantly speeds up early intervention for deaf and hard-of-hearing (DHH) children. This improves timely enrollment in educational services and medical clearance for hearing devices.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Early identification of pediatric hearing loss is critical for child development.
- Many deaf and hard-of-hearing (DHH) children miss recommended early intervention timelines.
- Current enrollment in early intervention by 6 months is only 44.5%.
Purpose of the Study:
- To evaluate the impact of a patient navigator intervention on the time to intervention for pediatric hearing loss.
- To assess if a patient navigator can reduce delays in accessing crucial services for DHH children.
Main Methods:
- A pre-post cohort study was conducted at a tertiary children's hospital.
- Compared newly-identified DHH children receiving a patient navigator intervention with a pre-intervention cohort.
- Measured time to early intervention enrollment, medical clearance for amplification, and hearing aid/cochlear implant activation.
Main Results:
- Children receiving the patient navigator intervention had significantly shorter times to Early Intervention enrollment (36 vs. 77 days) and medical clearance (18 vs. 53 days).
- The intervention was associated with a higher proportion of children receiving timely medical clearance (81.8% vs. 55.0%) and Early Intervention enrollment (82.9% vs. 57.1%).
- No differences were observed in time to medical intervention; race, language, or insurance did not correlate with delays.
Conclusions:
- A patient navigator intervention significantly reduces the time from hearing loss identification to educational intervention and medical clearance.
- The intervention increases the proportion of DHH children accessing Early Intervention services, aligning with quality milestones.
- Patient navigators are effective in expediting care for pediatric hearing loss.
Objective:
Early identification of pediatric hearing loss is crucial for development. Only 44.5% of deaf and hard-of-hearing (DHH) children are enrolled in early intervention by the recommended age of 6 months. This study evaluated the impact of a patient navigator on time to intervention for pediatric hearing loss.
Study Design:
Pre-post cohort study.
Setting:
Tertiary children's hospital.
Methods:
We compared a prospective cohort of newly-identified DHH children who received the Patient Navigator Intervention to a retrospective preintervention cohort. Study endpoints included time to (1) Enrollment in Part C Early Intervention (education intervention); (2) Medical clearance for amplification; (3) Hearing aid fitting or cochlear implant activation.
Results:
76 newly-identified DHH children received the Patient Navigator Intervention and 47 children did not. Children who received the intervention had a significantly shorter time to Early Intervention enrollment (36 vs 77 days, P = .011) and medical clearance for amplification (18 vs 53 days, P = .001). This remained significant after controlling for hearing loss severity and neighborhood disadvantage. There was no difference in time to medical intervention. Race, household language, or health insurance were not associated with delays. The intervention was associated with a higher proportion who received timely medical clearance (55.0% vs 81.8%, P = .003) and enrollment in Early Intervention (57.1% vs 82.9%, P = .013).
Conclusions:
A patient navigator significantly decreased the time from hearing loss identification to educational intervention and medical clearance. Additionally, the intervention increased the proportion who achieved Early Intervention services in accordance with nationally recognized Early Hearing Detection and Intervention quality milestones.
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