Impact of Patient Navigation on Time to Intervention for Deaf and Hard-of-Hearing Children.

Abstract

Early identification of pediatric hearing loss is crucial for development. Only 44.5% of deaf and hard-of-hearing (DHH) children are enrolled in early intervention by the recommended age of 6 months. This study evaluated the impact of a patient navigator on time to intervention for pediatric hearing loss. Pre-post cohort study. Tertiary children's hospital. We compared a prospective cohort of newly-identified DHH children who received the Patient Navigator Intervention to a retrospective preintervention cohort. Study endpoints included time to (1) Enrollment in Part C Early Intervention (education intervention); (2) Medical clearance for amplification; (3) Hearing aid fitting or cochlear implant activation. 76 newly-identified DHH children received the Patient Navigator Intervention and 47 children did not. Children who received the intervention had a significantly shorter time to Early Intervention enrollment (36 vs 77 days, P = .011) and medical clearance for amplification (18 vs 53 days, P = .001). This remained significant after controlling for hearing loss severity and neighborhood disadvantage. There was no difference in time to medical intervention. Race, household language, or health insurance were not associated with delays. The intervention was associated with a higher proportion who received timely medical clearance (55.0% vs 81.8%, P = .003) and enrollment in Early Intervention (57.1% vs 82.9%, P = .013). A patient navigator significantly decreased the time from hearing loss identification to educational intervention and medical clearance. Additionally, the intervention increased the proportion who achieved Early Intervention services in accordance with nationally recognized Early Hearing Detection and Intervention quality milestones.