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.

项目摘要 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为 每1000个出生1.7。延迟诊断和无法及时干预的后果包括 重大的沟通障碍和负面的社会经济影响。整体一生医学， 据估计，由于耳聋而导致的职业成本估计超过21亿美元。早期检测 听力可能会阻止语言发展和学习障碍。国家标准规定所有婴儿 应在1个月大的1个月内进行筛查，在3个月大时诊断，并在6个月内开始治疗 年龄（1-3-6规则）和不超过10％的婴儿应在3个月内不适合诊断 出生。 2015年，59.4％的美国婴儿在异常筛查后3个月内未能获得诊断。 需要开发和实施干预措施，以促进遵守及时 诊断和治疗标准。早期婴儿听力检测和干预（EHDI）计划是 在州一级进行协调，诊断过程很复杂，父母很难导航。 听力损失的儿童家庭报告说，他们缺乏对自己的护理的信心和支持 孩子。患者导航器（PN）计划提高了依从性，以推荐癌症的诊断测试 发现筛查异常后的护理，从而节省了大量的医疗保健系统。 PN是受过训练的人，他们通过教育患者和 提高自我效能。我们最近证明了PN功效以降低婴儿的不遵守 听力诊断护理；但是，PN尚未在不同社区进行测试或实施EHDI 计划，这一领域存在有关干预措施的有效性和实施研究的差距 降低不遵守。拟议的研究是一项社区参与的1型混合有效性 - PN干预措施的实施试验，旨在降低婴儿听力诊断后不遵守 在国家资助的EHDI诊所进行的新生儿听力筛查失败。在我们的社区咨询的指导下 董事会和合作伙伴，我们的目标是1）测试PN降低不遵守的有效性 出生后3个月内使用阶梯窗格试验设计的听力诊断，2）调查实施 影响实施的结果和因素，3）确定PN的成本效益 第三方付款人的观点。这项研究很重要，因为它旨在将不遵守性降低到及时 婴儿诊断听力测试，以防止终身负面影响。这项研究具有创新性 测试以前未在国家资助的EHDI计划中评估过的听力医疗保健的干预措施，并 在将实施研究和成本效益方法与我们的有效目标相结合。我们的结果 将通过与社区合作以告知该领域的规模和其他创新患者，从而影响该领域 支持性干预措施，以创建高效有效的EHDI计划并最大程度地发挥公共卫生影响。