Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 288-294 (doi:10.1542/peds.2006-2454)
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ARTICLE

Medical Home for Children With Hearing Loss: Physician Perspectives and Practices

Carol Dorros, MDa, Ellen Kurtzer-White, AuDa,{dagger}, Marianne Ahlgren, PhDa, Peter Simon, MD, MPHa and Betty Vohr, MDb

a Rhode Island Department of Health, Providence, Rhode Island
b Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island

OBJECTIVE. Our goal was to evaluate Rhode Island pediatricians' view of themselves as the medical home for infants and young children with permanent hearing loss.

METHODS. An observational study was conducted between September 2001 and March 2002. A survey of knowledge, beliefs, and practices relative to newborn hearing screening was sent to Rhode Island pediatricians practicing primary care for children aged birth to 5 years. The data set consisted of 107 (52%) of the eligible physicians.

RESULTS. Seventy-two percent of the pediatricians reported caring for 1 to >5 patients with permanent hearing loss within the past 5 years. Sixty-three percent of the pediatricians reported that the professional who has primary responsibility for follow-up planning for these children is the primary care physician, and 59% agreed that they were the medical home for their patients with hearing loss. However, only 43% agreed that their practice was well informed of services for their patients, and only 45% felt well informed about paths of follow-up. Sixty-three percent of the pediatricians agreed that they should coordinate care, but only 41% reported that they do coordinate care most of the time or always. The pediatricians' preferred methods for receiving educational information were resource guide (85%), grand rounds (75%), or journal articles (73%).

CONCLUSIONS. By contrasting pediatricians' medical home beliefs with actual reported care-coordination practices, we show that there is a disconnect between beliefs and practice. The survey demonstrated that physician belief ratings were consistently higher than the practice ratings, which suggests that the motivation exists but that additional educational efforts and strategies for enhanced care coordination are needed to develop an effective, seamless medical home for children with permanent hearing loss.

Key Words: care coordination • EHDI • medical home • newborn hearing screening • physician knowledge • physician education

Abbreviations: HL—hearing loss • EHDI—Early Hearing Detection and Intervention • CSHCN—children with special health care needs • IFSP—individualized family service plan • IEP—individualized education program

Accepted Mar 22, 2007.


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