Shanna Shulman

Evaluation of the Universal Newborn Hearing Screening and Intervention Program

During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection.

The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®

The Centers for Medicare and Medicaid Services (CMS) uses Adult Hospital Consumer Assessment of Healthcare Providers and Systems (Adult HCAHPS®) scores for public reporting and pay-for-performance for most US hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version (Child HCAHPS), a survey of parents/guardians of pediatric patients (<18 years old) who were recently hospitalized. This article describes the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and develop composite measures. We analyzed national field test data of 17 727 surveys collected in November 2012 to January 2014 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.

Poor Preventive Care Achievement and Program Retention Among Low Birth Weight Infant Medicaid Enrollees

OBJECTIVE. In this study, I examined the relative odds of achievement of preventive care goals during the first year of life and retention of Medicaid coverage at the end of the first year among Medicaid-enrolled low birth weight infants. Association with maternal prenatal health promotion was also considered. METHODOLOGY. I used a retrospective case-control design. Low birth weight and normal birth weight infants in the Florida Medicaid program (1995–1999) matched on demographic factors were compared on their relative odds of achievement of preventive care goals and Medicaid program retention using multivariate logistic regression (n = 7510). A subsample of infants with linked maternal claims was used to measure the association of maternal health promotion during the prenatal period. RESULTS. Low birth weight infants had lower relative odds of achieving preventive care goals during the first year and of retaining Medicaid coverage after the first year compared with infants of normal birth weight. However, when maternal health promotion during the prenatal care period was held constant, birth weight was no longer related to achievement of preventive care goals and program retention. Maternal health promotion was positively associated with achievement of preventive goals and program retention for all infants regardless of birth weight. CONCLUSIONS. Some Medicaid-enrolled low birth weight infants are at risk for poor health supervision and poor continuity of care through failure to retain coverage. The disproportionate odds of poor health promotion among mothers of low birth weight infants explain much of this deficit. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.