Wasser Janice, Ari-Even Roth Daphne, Herzberg Orly, Lerner-Geva Liat, Rubin Lisa
Department of Maternal and Child Health, Public Health Services, Ministry of Health, Jerusalem, Israel.
Department of Communication Disorders, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr J Health Policy Res. 2019 Mar 11;8(1):30. doi: 10.1186/s13584-019-0296-6.
The Israeli Newborn Hearing Screening Program (NHSP) began operating nationally in January 2010. The program includes the Otoacoustic Emissions (OAE) test for all newborns and Automated Auditory Brainstem Response (A-ABR) test for failed OAE and infants at risk for auditory neuropathy spectrum disorders. NHSP targets are diagnosis of hearing impairment by age three months and initiation of habilitation by six months.
(1) Review NHSP coverage; (2) Assess NHSP impact on age at diagnosis for hearing impairment and age at initiation of habilitation; (3) Identify contributing factors and barriers to NHSP success.
(1) Analysis of screening coverage and referral rates for the NHSP; (2) Analysis of demographic data, results of coverage, age at diagnosis and initiation of habilitation for hearing impaired infants pre-implementation and post-implementation of NHSP from 10 habilitation centers; (3) Telephone interviews with parents whose infants failed the screening and were referred for further testing.
The NHSP coverage was 98.7% (95.1 to 100%) for approximately 179,000 live births per year for 2014-2016 and average referral rates were under 3%. After three years of program implementation, median age at diagnosis was 3.7 months compared to 9.5 months prior to NHSP. The median age at initiation of habilitation after three years of NHSP was 9.4 months compared to 19.0 prior to NHSP. Parents (84% of 483 sampled) with infants aged 4-6 months participated in the telephone survey. While 84% of parents reported receiving a verbal explanation of the screening results, more than half of the parents reported not receiving written material. Parental report of understanding the test results and a heightened level of concern over the failed screen were associated with timely follow-up.
The findings indicate high screening coverage. The program reduced ages at diagnosis and initiation of habilitation for hearing impaired infants. Further steps needed to streamline the NHSP are improving communication among caregivers to parents to reduce anxiety; increasing efficiency in transferring information between service providers using advanced technology while ensuring continuum of care; reducing wait time for follow-up testing in order to meet program objectives. Establishment of a routine monitoring system is underway.
以色列新生儿听力筛查计划（NHSP）于2010年1月在全国范围内启动。该计划包括对所有新生儿进行耳声发射（OAE）测试，以及对OAE测试未通过的新生儿和有听觉神经病谱系障碍风险的婴儿进行自动听性脑干反应（A-ABR）测试。NHSP的目标是在三个月龄时诊断出听力障碍，并在六个月龄时开始进行康复治疗。
（1）审查NHSP的覆盖范围；（2）评估NHSP对听力障碍诊断年龄和康复治疗开始年龄的影响；（3）确定促成NHSP成功的因素和障碍。
（1）分析NHSP的筛查覆盖范围和转诊率；（2）分析来自10个康复中心的人口统计学数据、覆盖范围结果、NHSP实施前后听力受损婴儿的诊断年龄和康复治疗开始年龄；（3）对筛查未通过并被转诊进行进一步检测的婴儿的父母进行电话访谈。
2014 - 2016年，NHSP对每年约179,000例活产婴儿的覆盖范围为98.7%（95.1%至100%），平均转诊率低于3%。在该计划实施三年后，诊断的中位年龄为3.7个月，而在NHSP实施前为9.5个月。NHSP实施三年后康复治疗开始的中位年龄为9.4个月，而在NHSP实施前为19.0个月。对4 - 6个月龄婴儿的父母（483名抽样父母中的84%）进行了电话调查。虽然84%的父母报告收到了关于筛查结果的口头解释，但超过一半的父母报告未收到书面材料。父母对测试结果的理解报告以及对筛查未通过的更高关注度与及时随访相关。
研究结果表明筛查覆盖范围很高。该计划降低了听力受损婴儿的诊断年龄和康复治疗开始年龄。简化NHSP所需的进一步措施包括改善护理人员与父母之间的沟通以减少焦虑；利用先进技术提高服务提供者之间信息传递的效率，同时确保连续护理；减少随访测试的等待时间以实现计划目标。目前正在建立一个常规监测系统。
