Hearing screenings in newborns are a first step to identifying hearing loss, but to confirm and treat hearing problems follow-up audiological testing is required. Clinicians, however, often encounter nonadherence by parents and guardians as an obstacle to completing further testing. University of Kentucky investigators, including faculty from the University of Kentucky College of Public Health, undertook a study of whether use of a patient navigator could increase adherence for necessary follow-up audiological testing in children who fail initial hearing screenings. Their findings appear in the Sept. 2017 issue of The Laryngoscope.
[Photos: Dr. Christina R. Studts (left) and Dr. Philip M. Westgate]
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.
Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants who were nonadherent to diagnostic follow-up during the first six months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4 percent vs. 38.2 percent) (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).
Investigators conclude that 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.
Authors include: Dr. Philip M. Westgate, UK College of Public Health department of biostatistics, as well as Ms. Julie A. Jacobs, and Dr. Christina R. Studts, both of the UK CPH department of health, behavior and society.