Evaluation of the Virginia Early Hearing Detection and Intervention Program

BACKGROUND:   Newborn hearing loss, also known as congenital hearing loss, is the most commonly occurring condition for which newborns are screened. The goal of the Virginia Early Hearing Detection and Intervention Program (VEHDIP) is to identify congenital hearing loss in children before three months of age and to assure enrollment in appropriate early intervention services before six months of age. In 2010, the VEHDIP newborn hearing screening database was redesigned and integrated with a larger, more comprehensive reporting system, which includes electronic birth certificates and the birth defect registry. An evaluation of the redesigned surveillance system was conducted to assess the overall effectiveness and efficiency of the system and to identify areas for improvement.

METHODS: The VEHDIP surveillance system was evaluated using the Centers for Disease Control and Prevention’s “Updated Guidelines for Evaluating Public Health Surveillance Systems”. The evaluation addressed multiple system attributes with varying data sources, including stakeholder interviews and VEHDIP data from the Virginia Vital Events and Screening Tracking System (VVESTS). Analyses were performed using SAS v9.2 statistical software.

RESULTS: VEHDIP plays a critical role in assuring that hearing loss is identified early and that intervention to improve outcomes begins as soon as possible. Newborn hearing screening is complex, as the case definition has multiple components, including an initial screen followed by at least one diagnostic audiology evaluation. Furthermore, case ascertainment requires passage through multiple levels of reporting. The data quality is high; however sensitivity and positive predictive value are low. Representativeness has been affected by the lack of audiological facilities in some areas of the state. While almost all infants are screened before hospital discharge, diagnosis and enrollment in early intervention services fall short of the national benchmark. Assurance of a timely diagnosis and enrollment in early intervention services is impacted by loss to follow up.

CONCLUSIONS: VEHDIP increases early detection and intervention for children with hearing impairment. Based on this evaluation, VEHDIP seems to be effectively screening infants prior to hospital discharge. However, many cases are not being diagnosed in a timely manner. Linkage to other surveillance systems is recommended to improve data quality and usefulness. Evaluation findings will be used to guide improvements in newborn hearing loss surveillance in Virginia.