Reducing Childhood Hearing Loss in Rural Alaska Through a Preschool Screening and Referral Process Using Mobile Health and Telemedicine
Condition: Hearing Loss
MeSH terms: Hearing Loss; Deafness
Study type: Interventional

Summary: 
      The population in rural Alaska, which is predominately Alaska Native, experiences a
      disproportionately high burden of hearing loss compared to the general US population. The
      impact of untreated hearing loss in early childhood is tremendous and has grave implications
      for school achievement. Preschool children with hearing loss experience speech and language
      delays and are less likely to be ready for kindergarten than their normal-hearing peers.
      Early identification and treatment can reverse these ill effects. Importantly, the majority
      of hearing loss in this age group in rural Alaska is infection-mediated, arising from acute
      and chronic otitis media that is treatable.

      In response, preschool hearing screening is federally mandated at all Head Start centers
      across the country. In accordance with this mandate, hearing screening is already performed
      by the three organizations that offer early childhood education in the Norton Sound region:
      Kawerak Inc, RurAL CAP, and Bering Strait School District.

      While the concept of screening in this age group is well established nationally, what is less
      well understood is the optimal screening protocol for preschool children. There is little
      evidence evaluating sensitivity and specificity of different screening protocols in this age
      group. Further, loss to follow up in the referral stage is a problem in preschool hearing
      screening just as it is in school hearing screening.

      Alaska has already developed innovative strategies to address hearing loss. A network of
      village health clinics staffed by community health aides provide local care, and telemedicine
      has been adopted in over 250 village clinics statewide. Despite being widely available,
      telemedicine has not yet been used to speed up the referral process for preventive services
      such as hearing screening.

      Norton Sound Health Corporation has partnered with Duke and Johns Hopkins Universities to
      evaluate hearing screening and referral processes in early childhood education in the Norton
      Sound region of northwest Alaska. Preschool children will receive screening from the
      preschool and a new mHealth screening protocol. These will be compared against a benchmark
      audiometric assessment to determine sensitivity and specificity. Communities will then be
      randomized to continue the current primary care referral process or to adopt telemedicine
      referral. The primary outcome will be time to ICD-10 ear/hearing diagnosis. Secondary
      outcomes will include sensitivity and specificity of screening protocols and prevalence of
      hearing loss. The goal of this study is to evaluate the optimal screening and referral
      strategy for preschool children in rural Alaska.
    


Intervention name(s): Current Primary Care Referral Process; Telemedicine Referral Process
Intervention type(s): Other; Other
Intervention description(s): Children who refer hearing screening will receive the same referral method each preschool had been using previously. This process involves a letter home to the parents, either sent with the child or by mail, requesting that the parent/caregiver bring the child to village health clinic for an evaluation.; In communities randomized to the expedited telemedicine intervention, parents of children who refer hearing screening will receive a phone call from the school or the clinic on the day of screening notifying them of the day and time of their child's telemedicine consultation appointment. Appointments will be made with community health aides (CHAs) who have dedicated time blocked off to perform telemedicine consults. Participating children who refer screening will be transported to clinic for their appointment with adult chaperones. Parent participation will be required unless parents direct otherwise. Nonparticipating children in communities assigned to the expedited telemedicine intervention arm will receive standard referral following the current school primary care referral process.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: hearing loss; deafness; hearing disorders; ear diseases; otorhinolaryngologic diseases; child, preschool