Congenital Hearing Loss
Conditions
Keywords
Infant hearing screening, Patient Navigator
Brief summary
Hearing loss is the most common sensory congenital disorder and this condition is diagnosable and treatable. Children that are born with hearing loss have to undergo several hearing tests to diagnose the condition and many families are delayed in receiving this testing or never obtain the needed testing. This research employs a new method for helping children with hearing loss receive timely care by using a patient navigator, who is someone who teaches and provides emotional/social support for the families of these children. The hypothesis of this study is that a patient navigator will hasten the timing of pediatric audiological testing, improve compliance with scheduled appointments, and expand parental knowledge of pediatric hearing loss.
Detailed description
Parents of children who fail infant hearing screening at birth at the University of Kentucky or other hospitals in the area that are receiving follow up diagnostic testing at UK Audiology or the Commission for Children with Special Health Care Needs will be enrolled in the first part of the study and randomized into either a patient navigator group or the standard practice group. We will compare the failure to follow-up for testing rates between groups. Of those enrolled subjects, the age of the children when they obtain diagnostic testing will be assessed and compared between the patient navigator group and the standard practice group. This arm will further quantify the effect of the navigator on diagnostic testing timing. The second arm strives to continue and build upon the first assessment by evaluating hearing follow up in children up to six months of age who are diagnosed with hearing loss. Parents of children born at the University of Kentucky and at other hospitals who are following up as outpatients at UK who are diagnosed with hearing loss will be approached for enrollment. Parents of children in this arm of the study that did not participate in Arm 1 or did participate in Arm 1 but that were randomized to the control group are randomized from the age of enrollment until one year old to a patient navigator group or standard practice group. Parents of children that participated in Arm 1 that were randomized to patient navigation that enroll in Arm 2 will not be randomized and will continue to receive patient navigation. This group of subjects will be assessed to find what follow up is conducted once the child is diagnosed with hearing loss. As in the first arm, the navigator group will have regular phone follow ups with the patient navigator and the standard practice group will not have contact. Both groups will be given or mailed questionnaires, asking them about where they obtained services for the child with regard to hearing follow up and intervention. This will assess the effect of a navigator on parental education and support, timing of diagnostic services, and implementation of interventions with regard to pediatric hearing loss.
Interventions
BEHAVIORALPatient Navigator
The patient navigator group will involve regular phone contact with the patient navigator. The patient navigator will contact the participant by phone to conduct an interview and provide education on infant hearing and diagnostic hearing services. The timing of the subject child's appointment and the instructions of the outpatient auditory brainstem response test are discussed. In the second part of the study, further educational tools are given to parent(s) and discussion of additional follow up mechanisms, including community hearing services and types of interventions for pediatric hearing loss is imparted.
BEHAVIORALStandard scheduling and follow-up
The subjects will have access to discuss any questions or concerns with our office or audiology staff, as is the standard of care practice. They will not be contacted by study personnel or the patient navigator after discharge from the hospital and before the initial diagnostic test or before any subsequent auditory brainstem response test. The patients may contact and be contacted by our clinic staff regarding scheduling or rescheduling of the hearing test, as is standard practice.
Sponsors
National Institute on Deafness and Other Communication Disorders (NIDCD)
National Institutes of Health (NIH)
Matthew Bush, MD
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
(Arm 1): 1. Parents of children who are born at University of Kentucky Medical Center in the postpartum ward whose children are born after 34 weeks gestation and fail hearing screening in one or both ears 2. Parents whose children are receiving follow up testing (due to referral after mandatory newborn hearing screening) at UK Audiology or the Commission for Children with Special Health Care Needs 3. Parents who are willing to be contacted by study coordinators and/or navigator to monitor progress and testing outcomes 4. Parents who are able to speak English or Spanish as the patient navigator will be speaking one of these languages and this will be the primary means of communication over the phone.
Exclusion criteria
(Arm 1): 1. Parents of newborns who are hospitalized past 30 days after birth or who are born prior to 34 weeks gestation (as this may inherently delay diagnostic work-up) 2. Children and parents live outside Kentucky or who will be moving out of Kentucky within the first year of life (they will not be able to be followed closely at our institution) 3. Parents of wards of the state and cases of adoption will be excluded Inclusion Criteria (Arm 2): 1. Children who are 6 months old or less and have been diagnosed with hearing loss in one or both ears through two separate ABR tests. 2. Parents who are willing to be contacted by study coordinators and/or navigator to monitor progress and testing outcomes 3. Parents who are able to speak English or Spanish as the patient navigator will be speaking one of these languages and this will be the primary means of communication over the phone.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who do Not Receive Diagnostic Audiological Testing (Aim 1) | 3 months after birth | This outcome is the number of participants who do not follow-up for diagnostic audiologic testing after a failed newborn hearing screening from the date of randomization to 3 months after birth. |
| Number of Participants Who do Not Receive Hearing Intervention by Six Months of Age (Aim 2) | From the date of hearing loss diagnosis up to 6 months after birth | This outcome is the number of participants who do not follow-up for therapeutic audiological intervention after a diagnosis of infant hearing loss is made from the date of randomization to 6 months after birth. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Weeks Between Birth and Date of Diagnostic Audiological Testing (Aim 1) | From date of randomization to first audiological diagnostic test up to 12 months of age | This outcome is the timing of diagnostic audiological testing after failed newborn hearing screening from the date of randomization until the date of first documented diagnostic audiological testing, assessed up to 12 months after birth. |
| Number of Weeks Between Date of Hearing Loss Diagnosis and Intervention (Aim 2) | From the date of hearing loss diagnosis until up to one year | This outcome is the timing of hearing loss intervention from the date of hearing loss diagnosis until the date of documented hearing loss intervention, assessed up to 12 months. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Standard Scheduling and Follow-up The subjects will have access to discuss any questions or concerns with our office or audiology staff, as is the standard of care practice. They will not be contacted by study personnel or the patient navigator after discharge from the hospital and before the initial diagnostic test or before and after any subsequent auditory brainstem response test. The patients may contact and be contacted by our clinic staff regarding scheduling or rescheduling of the hearing test and any other follow up, as is standard practice.
Standard scheduling and follow-up: The subjects will have access to discuss any questions or concerns with our office or audiology staff, as is the standard of care practice. They will not be contacted by study personnel or the patient navigator after discharge from the hospital and before the initial diagnostic test or before any subsequent auditory brainstem response test. The patients may contact and be contacted by our clinic staff regarding scheduling. | 60 |
| Patient Navigator Group The patient navigator group will involve regular phone contact with the patient navigator. The patient navigator will contact the participant by phone to conduct an interview and provide education on infant hearing and diagnostic hearing services. The timing of the subject child's appointment and the instructions of the outpatient auditory brainstem response test are discussed.
Patient Navigator: The patient navigator group will involve regular phone contact with the patient navigator. The patient navigator will contact the participant by phone to conduct an interview and provide education on infant hearing and diagnostic hearing services. The timing of the subject child's appointment and the instructions of the outpatient auditory brainstem response test are discussed. In the second part of the study, further educational tools are given to parent(s) and discussion of additional follow up mechanisms, including community hearing services and types of interventions for pediatrics. | 46 |
| Total | 106 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 18 | 9 |
| Overall Study | Withdrawal by Subject | 1 | 2 |
Baseline characteristics
| Characteristic | Patient Navigator Group | Total | Standard Scheduling and Follow-up |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 46 Participants | 106 Participants | 60 Participants |
| Age, Continuous | 31 Years STANDARD_DEVIATION 5.3 | 31 Years STANDARD_DEVIATION 5.3 | 31 Years STANDARD_DEVIATION 5.4 |
| Race/Ethnicity, Customized Race/Ethnicity Asian | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Black/African American | 6 Participants | 14 Participants | 8 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Hispanic/Latino | 12 Participants | 22 Participants | 10 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Native American | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Other | 5 Participants | 10 Participants | 5 Participants |
| Race/Ethnicity, Customized Race/Ethnicity White/Caucasian | 23 Participants | 60 Participants | 37 Participants |
| Region of Enrollment United States | 46 participants | 106 participants | 60 participants |
| Sex: Female, Male Female | 44 Participants | 100 Participants | 56 Participants |
| Sex: Female, Male Male | 2 Participants | 6 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 60 | 0 / 46 |
| other Total, other adverse events | 0 / 60 | 0 / 46 |
| serious Total, serious adverse events | 0 / 60 | 0 / 46 |
Outcome results
Primary
Number of Participants Who do Not Receive Diagnostic Audiological Testing (Aim 1)
This outcome is the number of participants who do not follow-up for diagnostic audiologic testing after a failed newborn hearing screening from the date of randomization to 3 months after birth.
Time frame: 3 months after birth
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Standard Scheduling and Follow-up | Number of Participants Who do Not Receive Diagnostic Audiological Testing (Aim 1) | 15 Participants |
| Patient Navigator Group | Number of Participants Who do Not Receive Diagnostic Audiological Testing (Aim 1) | 8 Participants |
Primary
Number of Participants Who do Not Receive Hearing Intervention by Six Months of Age (Aim 2)
This outcome is the number of participants who do not follow-up for therapeutic audiological intervention after a diagnosis of infant hearing loss is made from the date of randomization to 6 months after birth.
Time frame: From the date of hearing loss diagnosis up to 6 months after birth
Population: No data was collected because no patients were recruited into this Aim of the study. None of the study participants (N=106) were found to have hearing loss thus there were not eligible to receive hearing loss treatment and thus not eligible for aim 2.
Secondary
Number of Weeks Between Birth and Date of Diagnostic Audiological Testing (Aim 1)
This outcome is the timing of diagnostic audiological testing after failed newborn hearing screening from the date of randomization until the date of first documented diagnostic audiological testing, assessed up to 12 months after birth.
Time frame: From date of randomization to first audiological diagnostic test up to 12 months of age
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Standard Scheduling and Follow-up | Number of Weeks Between Birth and Date of Diagnostic Audiological Testing (Aim 1) | 7.13 weeks | Standard Deviation 6.02 |
| Patient Navigator Group | Number of Weeks Between Birth and Date of Diagnostic Audiological Testing (Aim 1) | 6.19 weeks | Standard Deviation 3.49 |
Secondary
Number of Weeks Between Date of Hearing Loss Diagnosis and Intervention (Aim 2)
This outcome is the timing of hearing loss intervention from the date of hearing loss diagnosis until the date of documented hearing loss intervention, assessed up to 12 months.
Time frame: From the date of hearing loss diagnosis until up to one year
Population: No data was collected because no patients were recruited into this Aim of the study. None of the study participants (N=106) were found to have hearing loss thus there were not eligible to receive hearing loss treatment and thus not eligible for aim 2.