Published online January 10, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. e335-e343 (doi:10.1542/peds.2006-3540)
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ARTICLE

Evaluating Loss to Follow-up in Newborn Hearing Screening in Massachusetts

Chia-ling Liu, RN, MPH, ScD, Janet Farrell, BA, Jessica R. MacNeil, MPH, Sarah Stone, BBA and Wanda Barfield, MD, MPH

Center for Community Health, Massachusetts Department of Public Health, Boston, Massachusetts

OBJECTIVE. The purpose of this work was to examine loss to follow-up on the use of diagnostic or intervention services for Massachusetts infants and children screened or diagnosed with hearing loss and risk factors for becoming lost to follow-up.

METHODS. We used data from the Massachusetts Childhood Hearing Data System and Early Intervention Information System. We calculated the percent use of audiologic evaluation for Massachusetts infants born in 2002–2003 who did not pass hearing screening and Early Intervention services for those with hearing loss. We generated crude and adjusted relative risks, as well as confidence intervals, to estimate associations of maternal and infant factors with the use of audiologic evaluation and early intervention services. Factors evaluated included child's birth weight and hearing screening or diagnostic results and maternal age, race or ethnicity, marital status, smoking status during pregnancy, educational attainment, health insurance, and residence region.

RESULTS. In 2002–2003, 11% of Massachusetts children who did not pass hearing screening became lost to follow-up on the audiologic evaluation, and 25% of those with hearing loss did not receive early intervention services. Children were at higher risk of becoming lost to follow-up on audiologic evaluation if their mothers were nonwhite, covered by public insurance, smokers during pregnancy, or residing in western, northeastern, or southeastern Massachusetts compared with those in the Boston region. Of children with hearing loss, those with a unilateral or mild or moderate degree of hearing loss, normal birth weight, or living in the southeastern or Boston region were more likely to go without early intervention services.

CONCLUSIONS. Massachusetts has excellent follow-up rates overall. Our analyses allow the program to prioritize limited resources to subgroups of infants who are at high risk of becoming lost to follow-up.

Key Words: early hearing detection and intervention • lost to follow-up • early intervention

Abbreviations: MDPH—Massachusetts Department of Public Health • ADC—audiologic diagnostic center • EI—Early Intervention • IFSP—Individualized Family Service Plan • UNHSP—Universal Newborn Hearing Screening Program • EHDI—Early Hearing Detection and Intervention • CHDS—Childhood Hearing Data System • EIIS—Early Intervention Information System • EBC—electronic birth certificate • AE—audiologic evaluation report • FIR—family intake record • ABR—auditory brainstem response • OAE—otoacoustic emission • aRR—adjusted relative risk • CI—confidence interval

Accepted Jul 5, 2007.