Parent Perspectives on Multidisciplinary Care

Oliver F. Adunka, MD, FACS, Prashant Malhotra, MD, Ursula Findlen, PhD

Disclosures •  Consultant for

‒  MED-EL Corporation ‒  Advanced Bionics Corporation ‒  Applied Genetics Technologies Corporation

•  Research support ‒  MED-EL Corporation ‒  Cochlear Corporation ‒  Advanced Bionics Corporation

•  Ownership ‒  Advanced Cochlear Diagnostics

Healthcare Delivery Models1, 2

Multidisciplinary: Discipline-specific assessment and treatment completed in silos with the team coming together to formulate a cohesive treatment plan

Interdisciplinary: Team working together to integrate expertise from individual disciplines to formulate a care plan through shared responsibility and a highly interactive process

Transdisciplinary: Team members working together beyond the boundaries of their own disciplines to work toward formulating a novel solution (not common in healthcare)

1.  Choi, B.C.K., & Pak, A.W.P. (2006). Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education, and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med, 29, 351-64.

2.  Patel, D.R., and Pratt, H.D. (2008). Team Processes and Team Care for Children with Developmental Disabilities. Pediatr Clin N Am, 55, 1375-90.

Hearing Team Approach

•  A multidisciplinary team model has been advocated for, and endorsed by, stakeholders in pediatric hearing healthcare1, 2, 3.

•  Family-centered healthcare demands that families provide input regarding the care of their children2; however, very little is known about how families perceive their experience in multidisciplinary team models for hearing healthcare.

1.  Joint Commission on Infant Hearing. (2007). Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics, 120, 898-921.

2.  Yoshinaga-Itano, C. (2014). Principles and Guidelines for Early Intervention After Confirmation That a Child Is Deaf or Hard of Hearing. J. Deaf Studies and Deaf Ed. 19, 143-75.

3.  Sirimanna, K. S. (2001). Management of the hearing impaired infant. Semin Neonatol, 6, 511-19.

Hearing Loss Team

Medical/Surgical

Child & Family

Audiology/SLP

Education

Genetic

Auditory-based Intervention

Otology

Radiology Craniofacial Center Neurology Pediatrics

Objectives

1.  Does a multidisciplinary team clinic appointment meet the needs of families of children …with hearing loss?

2.  Are families processing all the information …provided during a multidisciplinary team appointment?

Methods

•  Survey formulation ‒ Diagnosis ‒ Treatment plan ‒ Resources ‒ Additional testing ‒ Overall experience

•  Survey dissemination ‒ Electronically ‒ Hard copy

Diagnosis

Treatment Plan

Resources Additional Testing

Overall Experience

Sample Survey Questions

Survey Response

Survey Dissemination Date(s) # Distributed # Respondents Response Rate

In-Person Hearing Clinic November to December 2016 89 19 21.0%

REDCap Survey December 2016 350 38 11.0%

Mailing January to February 2017 500 53 10.8%

Totals 939 110 11.7%

Strengths •  Enough time with providers •  Gained good information

regarding diagnosis and treatment of HL

•  Request to have services completed in one appointment

•  Services had improved over the past 5-10 years

Providers Seen

0

10

20

30

40

50

60

70

80

90

100

ENTDoctor NursePrac99oner Audiologist SpeechPathologist SocialWorker

Percen

tSeen

TotalSurvey

Actual*

In-Clinic**

*Actual: Random Sample of 138 patients seen between January and December 2016

** In-Clinic: 19 surveys returned at the time of Hearing Clinic Appointment

Needs

•  Overwhelmed by amount of information shared •  Too many providers with a revolving door …would prefer meeting with the entire team once

•  Too much information too early in the process •  Lack of school resource information •  No need to meet with all providers every appointment

Additional Changes - 2017

•  Otolaryngology completes a medical assessment •  Social Work still available •  AuD & SLP released

…to provide more assessment appointments •  Care coordination

•  Bi-monthly Multidisciplinary Team Meeting • Communication via clinical database

Database - Care Coordination

Future Directions

•  Re-evaluate family experience periodically •  Data driven refinement of care delivery •  Continue to improve the clinical database

• Care coordination based on parent & provider feedback • Research needs based on study enrollment

Acknowledgements The Hearing Program •  Oliver F. Adunka, MD

•  Prashant S. Malhotra, MD

•  Lura Keating, RN

•  Alexandria Banta, MSW

Audiology Program Manager

•  Gina M. Hounam, PhD

Speech Pathology Program Manager •  Lindsey Pauline, MA, CCC-SLP

Hearing Impaired Speech Team •  Shana Lucius, MA, CCC-SLP

•  Nichole Kus, MA, CCC-SLP

•  Corrine Anderson, MA, CCC- SLP

Audiology Team •  Rebecca Belt, AuD-

Clinical Lead

•  Sandra Alston, AuD

•  Virginia Bolster, AuD

•  Nikia Bridges, AuD

•  Lindsey Cameron, AuD

•  Lauren Durinka, AuD

•  Holly Gerth, AuD

•  Jamie Godsey, AuD

•  Mandi Hinton, AuD

•  Alecia Jayne, AuD

•  Melissa Kappes, MA

•  Rebecca Lewis, AuD

•  Christine Schafer, AuD

•  Nicole Schuller, AuD

•  Michelle Shannon, AuD

•  Cindi Warner, AuD

•  Krista Winner, AuD

Thank you!

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