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Success in Minimizing Loss-to-Follow-up
Hallie W. Morrow, M.D., M.P.H.
Challenges in California
• Size
• Diversity
• Mobility
Size
• Population of California
•34,000,000
• Population of Los Angeles County
•9,500,000
• Population of Alpine County
•1,200
Size
• 540,000 Births per year
• 320 Birthing hospitals
•Largest – 7300 deliveries
•Smallest – 60 deliveries
Diversity
• Geographic
• Race/ethnic
• Linguistic
Geographic Diversity
• Large metropolitan areas
Geographic Diversity
• Large metropolitan areas
• Agricultural areas
Geographic Diversity
• Large metropolitan areas
• Agricultural areas
• Mountains
Geographic Diversity
• Large metropolitan areas
• Agricultural areas
• Mountains
• Desert
Geographic Diversity
• Large metropolitan areas
• Agricultural areas
• Mountains
• Desert
• Coastal
Race/Ethnic Diversity
• 47% Non-Hispanic White
• 32% Hispanic
• 11% Asian/Pacific Islander
• 6% African American
• 1% American Indian
• 3% Other
Linguistic Diversity
• 33% of Californians speak a language other than English in the home
• 20% of Californians have Limited-English-Proficiency
• 50% of low-income Californians have a primary language other than English.
Linguistic Diversity
• 1,570,000 students speak a language other than English in the home
• 105 languages are spoken in Fresno County schools
Mobility
• Urban
• Migrant workers
• Mexican border
Infrastructure
Infrastructure
• Interwoven with the Title V CSHCN and the EPSDT programs
• Inpatient and outpatient provider standards
• Hearing Coordination Centers
• Single point of referral to IDEA Part C
Hearing Coordination Centers
• Serve specific geographic areas
• Certify and re-certify hospitals as meeting standards
• Collect data
• Track appointments for individual infants
Hearing Coordination Centers
• Contact providers if no results are received
• Refer to local EPSDT program if infant no shows appointments or provider cannot contact the family
Hearing Coordination Centers
• Generate correspondence to infant’s PCP
• Contact all families of infants identified with hearing loss
Hearing Coordination Centers
• Assure referral to EI has been made
• Quality assurance monitoring
Referral to Early Intervention
• Created single point of referral for all California children 0-3 years of age with a hearing loss
Data Management
• No statewide data management system
• Each HCC developed Access database
• All infant information and results reported on paper reporting forms
California Program Data 2004
(Preliminary)
WBN % NICU % Total
# admissions WBN 342,530 89% 342,530
# discharges NICU 43,814 11% 43,814
Region Total 386,344
175 Hospitals participating
California Program Data 2004
(Preliminary)
WBN % NICU % Total %
# screened 332,735 89% 39,860 11% 372,595 96.4%
# refer 6,327 1.9% 1,134 2.8% 7,461 2.0%
# waived 2,246 0.7% 35 0.1% 2,281 0.6%
# missed 1,239 0.4% 400 1.0% 1,639 0.4%
California Program Data 2004
(Preliminary)WBN % NICU % Total %
Hearing loss ID'd 303 0.09% 220 0.55% 523 0.14%
By 3 mo of age 238 79% 164 75% 402 77%
IFSP initiated 136 45% 91 41% 227 43%
By 6 mo of age 118 87% 75 82% 193 85%
PCP ID'd 839 84% 798 77% 1637 81%
California Program Data 2004
(Preliminary)
Total %
Lost to Follow-up 756 5.80%
Provider non-reporting 364 48%
Summary
• Infrastructure!
• Receive and review individual infant data in real time
• Take action if not getting appropriate services