Case Studies

Strengthening Hearing Detection + Intervention

HRSA engaged NICHQ to improve the quality and timeliness of care to newborns with hearing loss in state Early Hearing Detection and Intervention (EHDI) programs by: (1) enhancing performance to meet EHDI program goals for screening, diagnosis and intervention; (2) building the capacity of state EHDI programs to use and apply QI methods in their work; and (3) improving state data collection processes. 

While the U.S. has made impressive progress in screening infants for hearing loss in hospitals, with rates increasing from 46.5 percent in 1999 to over 97 percent today, this only represents the first step in a comprehensive screening program. Follow-up visits to confirm diagnoses and referrals to appropriate early intervention services do not happen at the same level of reliability due to systemic breakdowns. As a result, nearly one-half of newborns screened for hearing loss at birth are lost to follow-up or documentation, and close to one-third of babies diagnosed with hearing loss are not documented as having entered intervention.

Our Approach

Through five separate, but connected, engagements with HRSA collaborative improvement projects over 8 years, NICHQ introduced and trained teams from 49 states and three territories on how to use quality improvement methods to drive change in EHDI programs. NICHQ brought together a team of improvement advisors and content experts from across the country to refine the key drivers for change. This led to the development of a comprehensive driver diagram and a custom change package (strategies and interventions) to guide participants’ efforts to test, evaluate and implement new methods for improving the timely delivery of screenings, audiologic diagnoses and interventions. 

The Results

For EHDI programs in 49 states and three territories:

  • Successfully embedded quality improvement theory into the practice of all offices
  • Developed and broadly implemented customized tools to support communication between providers and parents, resulting in increased parent involvement and information sharing across all participating teams
  • Created cross-sector collaboration and partnerships between state partners and systems involved in newborn hearing screening and follow-up
  • Developed “Improving Follow-Up After Newborn Hearing Screening: An Action Kit for Audiologists” to support this work. Learn more >
Infant Hearing Test


With systemic and sustainable change for more efficient and reliable diagnosis and referral, infants who are deaf or hard of hearing are able to get the vital intervention services needed as early as possible, significantly improving outcomes for these children and their families.

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