title: Reducing Loss to Follow-Up with Tele-audiology Diagnostic Evaluations.
abstract: BACKGROUND
  Infants who do not pass their newborn hearing screen require diagnostic follow-up visits but often face access barriers such as travel distance and shortage of pediatric audiologists. Telemedicine (tele-audiology) is a potential solution to provide diagnostic hearing evaluations for families of infants facing access barriers. We determined the feasibility and impact of a tele-audiology program that provided comprehensive diagnostic evaluations to a region with a high lost to follow-up rate among newborns who did not pass their newborn hearing screen.
  
  
  METHODS
  We evaluated the tele-audiology program using parent and provider surveys to determine the perception of quality and satisfaction of care. We also compared the lost to follow-up rate of the tele-audiology program with the loss to follow-up in the region before the implementation of the program.
  
  
  RESULTS
  Twenty-two infants who did not pass their newborn hearing screen were referred to the tele-audiology program for diagnostic evaluation. Among these infants, 59.1% were diagnosed with some form of hearing loss. The mean quality score rated by both parents and providers on the telemedicine interaction was over 6.5 on a 7-point Likert scale. All parents rated the importance of tele-audiology as 7 (extremely important) for their family, whereas the provider rated the mean importance as 6.4 (95% confidence interval, 5.9, 6.9) on a 7-point Likert scale. Almost all parents actively participated or were engaged during history taking and counseling and were comfortable in discussing their child's hearing status remotely over telemedicine. All infants completed their diagnostic evaluation with no loss to follow-up compared with 22% loss to follow-up in the region before the implementation of the program.
  
  
  CONCLUSIONS
  Tele-audiology is a feasible solution that reduces the loss to follow-up among infants who do not pass their newborn hearing screen and have access barriers to qualified audiologists for diagnostic evaluations.
authors.affiliation: 1 Department of Pediatrics, University of California Davis , Sacramento, California.|2 Center for Health and Technology, University of California Davis , Sacramento, California.
authors.forename: Madan
authors.initials: M
authors.lastname: Dharmar
authors.affiliation: 3 Department of Otolaryngology, University of California Davis , Sacramento, California.
authors.forename: Anne
authors.initials: A
authors.lastname: Simon
authors.affiliation: 2 Center for Health and Technology, University of California Davis , Sacramento, California.
authors.forename: Candace
authors.initials: C
authors.lastname: Sadorra
authors.affiliation: 4 International Computer Science Institute, University of California Berkeley , Berkeley, California.
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
authors.affiliation: 5 Systems of Care Division , California Department of Health Care Services, Sacramento, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sherwood
authors.affiliation: 5 Systems of Care Division , California Department of Health Care Services, Sacramento, California.
authors.forename: Hallie
authors.initials: H
authors.lastname: Morrow
authors.affiliation: 6 Neurodiagnostics, Benioff Children's Hospital, University of California San Francisco , San Francisco, California.
authors.forename: Dawn
authors.initials: D
authors.lastname: Deines
authors.affiliation: 7 Dignity Mercy Medical Center , Redding, California.
authors.forename: Deborah
authors.initials: D
authors.lastname: Nickell
authors.affiliation: 6 Neurodiagnostics, Benioff Children's Hospital, University of California San Francisco , San Francisco, California.
authors.forename: David
authors.initials: D
authors.lastname: Lucatorta
authors.affiliation: 1 Department of Pediatrics, University of California Davis , Sacramento, California.|2 Center for Health and Technology, University of California Davis , Sacramento, California.
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
keywords: pediatrics; technology; telecommunications; telemedicine