Communities Helping the Hearing of Infants by Reaching Parents: The CHHIRP Navigator Trial

社区通过接触父母来帮助婴儿听力：CHHIRP Navigator 试验

• 批准号: 9904600
• 负责人: Matthew Lee Bush
• 金额: $ 58.06万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904600
• 关键词: Address; Adherence; Adoption; Advisory Committees; Age-Months; Behavior Disorders; Birth; Caring; Characteristics; Child; Clinic; Collaborations; Communication impairment; Communities; Community Health; Complex; Congenital Disorders; Cost Savings; Cost effectiveness research; Data; Detection; Development; Diagnosis; Diagnostic; Diagnostic tests; Early Diagnosis; Early Intervention; Education; Effectiveness; Emotional; Employment; Environment; Failure; Family; Feedback; Funding; Health Services Accessibility; Healthcare; Healthcare Systems; Hearing; Hearing Tests; Hybrids; Impairment; Improve Access; Incidence; Individual; Infant; Intervention; Joints; Kentucky; Language Development; Learning; Learning Disorders; Life; Measures; Medical; Methods; Modality; Neonatal; Neonatal Screening; Newborn Infant; Occupational; Outcome; Outpatients; Parents; Patient Care; Patients; Penetration; Preventive service; Process; Public Health; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Self Efficacy; Sensory; Sensory Disorders; Social Development; Speech; System; Testing; Third-Party Payer; Time; Training; Translational Research; United States; cancer care; care systems; childhood hearing loss; cognitive development; community clinic; community intervention; community setting; cost; cost effective; cost effectiveness; cost estimate; deafness; design; disparity reduction; early childhood; economic cost; effectiveness implementation study; effectiveness implementation trial; effectiveness research; effectiveness testing; effectiveness trial; falls; hearing impairment; hearing loss treatment; hearing screening; implementation research; implementation strategy; improved; innovation; intervention program; navigator intervention; peer support; prevent; programs; randomized trial; recruit; research to practice; scale up; screening; social; socioeconomics; standard care; standard of care; trial design

PROJECT SUMMARY As the most common neonatal sensory disorder in the United States, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. The overall lifetime medical, educational, and occupational costs due to deafness is estimated to be over $2.1 billion. Early detection of hearing may prevent language development and learning disorders. National standards dictate that all infants should be screened by 1 month of age, diagnosed by 3 months of age, and initiate treatment by 6 months of age (1-3-6 rule) and no more than 10% of infants should be non-adherent to diagnosis within 3 months after birth. In 2015, 59.4% of U.S. infants failed to obtain a diagnosis within 3 months after abnormal screening. There is a need for the development and implementation of interventions that promote adherence to timely diagnosis and treatment standards. Early infant hearing detection and intervention (EHDI) programs are coordinated on a state level, and the diagnostic process is complex and difficult for parents to navigate. Families of children with hearing loss report that they lack confidence and support in obtaining care for their child. Patient navigator (PN) programs have improved adherence to recommended diagnostic testing in cancer care after the detection of a screening abnormality, resulting in substantial healthcare system cost savings. PNs are trained individuals who mitigate barriers to promote healthcare adherence by educating patients and improving self-efficacy. We have recently demonstrated the PN efficacy to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into EHDI programs, and there is a gap in this field regarding effectiveness and implementation research on interventions to reduce non-adherence. The proposed research is a community-engaged, type 1 hybrid effectiveness- implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHDI clinics. Guided by our community advisory board and partners, we aim to 1) to test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, 2) investigate implementation outcomes and factors influencing implementation, and 3) determine the cost-effectiveness of PN from the perspective of third party payers. This study is significant because it aims to reduce non-adherence to timely infant diagnostic hearing testing to prevent life-long negative consequences. This research is innovative in testing an intervention not previously assessed in hearing healthcare within a state-funded EHDI program, and in integrating implementation research and cost-effectiveness methods with our effectiveness aim. Our results will impact the field by partnering with communities to inform the scale-up of this and other innovative patient supportive interventions to create efficient and effective EHDI programs and maximize public health impact.

项目概要 作为美国最常见的新生儿感觉障碍，婴儿听力损失的发生率 每 1000 名新生儿中有 1.7 人。延误诊断和未能及时干预的后果包括 严重的沟通障碍和负面的社会经济影响。整体终生医疗， 耳聋造成的教育和职业损失估计超过 21 亿美元。及早发现 听力可能会阻碍语言发展和学习障碍。国家标准规定所有婴儿 应在 1 个月大时进行筛查，在 3 个月大时进行诊断，在 6 个月大时开始治疗 年龄（1-3-6 规则）且 3 个月内不遵守诊断的婴儿不应超过 10% 出生。 2015年，59.4%的美国婴儿在异常筛查后3个月内未能得到诊断。 需要制定和实施促进遵守及时治疗的干预措施 诊断和治疗标准。早期婴儿听力检测和干预 (EHDI) 计划 在州一级进行协调，诊断过程非常复杂，对家长来说很难驾驭。 听力损失儿童的家庭报告说，他们在为自己的孩子获得护理方面缺乏信心和支持 孩子。患者导航 (PN) 计划提高了对推荐的癌症诊断测试的依从性 检测到筛查异常后进行护理，从而节省大量医疗保健系统成本。 PN 是经过培训的个人，他们通过教育患者和 提高自我效能。我们最近证明了 PN 可以有效减少婴儿不依从的情况 听力诊断护理；然而，PN 尚未在不同社区进行测试或实施到 EHDI 中 该领域在干预措施的有效性和实施研究方面存在差距 以减少不依从性。拟议的研究是一项社区参与的 1 类混合有效性研究—— 旨在减少婴儿听力诊断不依从性的 PN 干预实施试验 在国家资助的 EHDI 诊所进行的新生儿听力筛查未通过。以我们的社区咨询为指导 董事会和合作伙伴，我们的目标是 1) 测试 PN 的有效性，以减少不遵守接收婴儿的情况 使用阶梯楔形试验设计在出生后 3 个月内进行听力诊断，2) 调查实施情况 结果和影响实施的因素，以及 3) 确定 PN 的成本效益 第三方付款人的视角。这项研究意义重大，因为它的目的是减少不遵守及时的情况 婴儿诊断性听力测试可防止终生的负面后果。这项研究的创新之处在于 在国家资助的 EHDI 计划中测试之前未在听力保健方面评估过的干预措施，以及 将实施研究和成本效益方法与我们的有效性目标相结合。我们的成果 将通过与社区合作来影响该领域，以扩大该患者和其他创新患者的规模 支持性干预措施，以创建高效且有效的 EHDI 计划并最大限度地提高公共卫生影响。