California Tele-Audiology Program removes barriers to care, ensuring infants get follow-up hearing tests.

SACRAMENTO, Calif. — Researchers at UC Davis have shown that the California Tele-Audiology Program (CTP), which provides follow-up diagnostic evaluations for infants who did not pass their initial newborn hearing test, dramatically improves access to audiologists. In a study published in the journal Telemedicine and e-Health, the team found that families with access to CTP had 100 percent participation in follow up evaluations. This is an enormous improvement. Before the program was implemented, more than 22 percent of families in the study region were unable to complete follow up.

“Before CTP, Northern California had a very high loss to follow-up,” said Madan Dharmar, assistant research professor in the Pediatric Telemedicine Program. “The California average is about 4.5 percent, but this area had an almost 22 percent loss to follow up. However, since CTP started, we have not even had one loss to follow-up.”

All infants receive a hearing screening shortly after birth. If the child does not pass the hearing test, the family is strongly encouraged to get a follow-up test within three months. Early intervention can dramatically impact language skills and academic achievement.

“There’s only a short window when intervention can have a large effect on how these kids develop. They have a chance to develop similar to their hearing peers,” said Dharmar. “If you miss this window, it may be more difficult for the child to have a similar outcome.”

Unfortunately, many families in rural communities have trouble meeting this requirement, as they may have to travel long distances to find a specialist. Other issues, such as a shortage of qualified audiologists, compound the problem.

In 2011, UC Davis Children’s Hospital and several other organizations launched CTP to ensure that all Northern California children receive this all-important follow-up care. The program created a secure telemedicine link between UC Davis Children’s Hospital and Mercy Medical Center Redding (MMCR). The link includes video conferencing and a laptop that allows a UC Davis Children’s Hospital audiologist to control the audiology equipment at MMCR.

During the evaluation, the remote audiologist conducts a number of tests to assess whether the child has suffered hearing loss and, if so, the degree of impairment. A telepresenter at MMCR prepares the infant and acts as an assistant for both the parents and the remote audiologist.

During the study period (2011-13), 22 infants were referred to the CTP for audiology follow-up and all were tested. Of these, nine had normal hearing and 13 had some level of hearing loss – 8 had severe impairment.

The study team also surveyed both parents and providers to gauge their comfort with the technology. Each group gave high marks for the quality of the links, as well as the overall consultations. This is the first study to measure parental perceptions of tele-audiology. In addition, CTP’s success has opened the door to possible expansion.

“We want to bring this to other hospitals other than just Redding,” said Dharmar. “We would also like to move beyond diagnostics and develop a remote intervention program. There is technology being developed right now that could allow this in the future.”

Other researchers included Anne Simon, Candace Sadorra and James P. Marcin at UC Davis; Gerald Friedland at UC Berkeley; Jennifer Sherwood and Hallie Morrow at the California Department of Health Care Services; Dawn Deines and David Lucatorta at UC San Francisco; and Deborah Nickell at Mercy Medical Center Redding.

This research was funded by a grant from the Health Resources and Service Administration in partnership with Systems of Care Division of the California Department of Health Care Services, the Departments of Pediatrics and Otolaryngology at UC Davis Children’s Hospital, the Center for Health and Technology at UC Davis Health System, and Dignity Health Mercy Medical Center Redding (MMCR) in Redding, Calif.

UC Davis Children’s Hospital is the Sacramento region’s only nationally ranked, comprehensive hospital for children, serving infants, children, adolescents and young adults with primary, subspecialty and critical care. It includes the Central Valley’s only pediatric emergency department and Level I pediatric trauma center, which offers the highest level of care for critically ill children. The 120-bed children’s hospital includes the state-of-the-art 49-bed neonatal and 24-bed pediatric intensive care and pediatric cardiac intensive care units. With more than 120 physicians in more than 30 subspecialties, UC Davis Children’s Hospital has more than 74,000 clinic and hospital visits and 13,000 emergency department visits each year. For more information, visit http://children.ucdavis.edu.