Improving Follow Up for Failed Newborn Hearing Screening


In the past decade, the U.S. has made impressive progress in screening infants for hearing loss in hospitals, with screening rates increasing from 46.5 percent in 1999 to over 97 percent today. However, this is only the first step in a successful screening program. Unfortunately, follow-up visits to confirm diagnoses and referrals to appropriate early intervention services do not happen at the same level of reliability as the initial screening. As a result, nearly one-half of infants screened for hearing loss at birth are lost to follow-up or lost to documentation, and close to one-third of babies diagnosed with hearing loss are not documented as having entered intervention. Eliminating this systemic flaw ill enable the appropriate development of infants with hearing loss and ensure the full success of the screening program.


The Health Resources and Service Administration’s Maternal and Child Health Bureau (MCHB) engaged us to help state Early Hearing Detection and Intervention (EHDI) programs improve the quality and timeliness of care to newborns with hearing loss by (1) enhancing the performance of states in meeting EHDI program goals of screening, diagnosis and intervention; (2) building the capacity of state EHDI programs to use and apply quality improvement methods to their work; and (3) improving state data collection processes. Through five separate but connected engagements with MCHB collaborative improvement projects across 8 years, we worked with state-based teams from 49 states and three territories to apply quality improvement methods to test and implement new ways to improve the timeliness of screening, audiologic diagnosis, and entry for interventions.


  • Developed and broadly implemented customized tools to support communication between providers and parents, which resulted in improved parent involvement and information sharing across all participating teams.
  • Successfully embedded quality improvement theory into the practice of EHDI offices in 49 states.
  • Created cross-sector collaboration and partnerships between state partners and systems involved in newborn hearing screening and follow-up.


By the Numbers

These are some of the many impressive results from teams in NICHQ's Improving Hearing Screening and Intervention Systems (IHSIS) project.

Percent of diagnostic hearing results sent to PCP in Improving Hearing Screening and Intervention Systems (IHSIS) project

Percent of children seen where the family was able to re-state the next steps in the Improving Hearing Screening and Intervention Systems (IHSIS) project