Roundtable Topic: Effective strategies for linking EHDI to the Medical Home provider
Session: 4:15 PM
Moderator: Sharon Fleischfresser
Participants: Sharon Fleischfresser (WI), Patricia Heu (HI), Pat Rice (MN), Joyce E. Brooks (DC), Leslie Ellwood (VA), Bob Cicco (PA), Carol Hassler (VT), Jennie Cook (MD)
Communication/linkages between hospital screening programs, Primary Care Providers (PCPs), audiologists, and EI programs
- At the hospital level, there is a problem with having no information or inaccurate information about who the PCP/medical home is. Within the hospital nursery there may be a better opportunity to get face-to-face information about who the PCP is for children who refer. In comparison to metabolic screening programs, hearing screening programs need a more well-established outreach function. One option to consider would be to add a fee to metabolic screening to pay for tracking hearing screening referrals.
- There is also a problem for PCPs in finding out if the screening was done and what the result was. The best approach might be to have the screening program actually call the PCP if a child refers.
- There is an additional barrier for the PCP in finding out the results of audiologic diagnostic tests.
- There is generally little involvement of PCPs in IFSPs--in PA only about 2% of pediatricians are involved in writing the IFSP--and many don't want to be. Also, most of the EI terms are unfamiliar to physicians (Boys Town website will be helpful for this.) Better linkages are needed for every condition between Part C and the PCP--the situation is similar to the difficulties of linking the PCP and sub-specialists.
- If the PCP acts as a medical home, reimbursement for being a care coordinator is an issue.
Options for Educating PCPs:
- PA gets 200-300 people for noon-time teleconferences on their office computers.
- Use AAP's EPIC to educate pediatricians in the community.
What Pediatricians don't know, but need to know:
- What the hearing test is all about.
- The validity of the test for their hospitals and what an acceptable refer rate is.
- What to say to a parent when a screen is positive (i.e., don't use the word "fail") and what to do from there. It might be helpful to include the protocol for what should happen next in the hospital screening program letter that reports a child's results. This could inform the PCP of the child's outcomes and simultaneously serve as a reminder of the next step in the screening/diagnostic process.
- What is going to happen with the information--is it going to the state?
- Who to refer to/where the diagnostic centers are--what the criteria for a pediatric diagnostic evaluation are. Certifying audiologists is a political "hot potato," but programs might approach that issue by creating a list of audiologists who have attended trainings, have equipment, etc. It would be nice for PCPs to be able to go to a website and click on a list of audiologists qualified to work with young children.
- What the protocols are--especially if they have to write the the HMO for an out-of-network referral. VA has a medical protocol outlined on their website that helps the physician know what to do (http://www.vahealth.org/hearing/protocols.pdf)
- When and how to refer to Part C--only after diagnostics have been completed? Or is it appropriate to refer infants who did not pass the screening and need to have a diagnostic evaluation performed since that may actually assist Part C in their child find efforts? On VA's Part C website (http://www.earlyintervention-va.com/referring.htm), it is possible to make a direct on-line referral to Part C.
There is a need to repeat the information as most PCPs won't encounter an infant with a hearing loss every year.
Additional topics raised:
- Educate childbirth educators who would, in turn, inform parents and thus raise expectations of parents getting to diagnostics
- Educate the public through public service announcements which could also increase the likelihood that parents would engage in follow-up.
- Have Health Departments create linkages from their websites to the best websites on hearing loss and EHDI.