Pennsylvania’s EPIC-EHDI

Physician Outreach Initiative

Robert C. Cicco, M.D.- President, Pennsylvania Chapter,

American Academy of Pediatrics; Neonatologist,

West Penn Hospital, Pittsburgh, PA

Diane L. Sabo, Ph.D. - Clinical Director of Audiology,

Children’s Hospital of Pittsburgh, Pittsburgh, PA

Robert F. Staver - Public Health Program Manager,

Pennsylvania Department of Health, Harrisburg, PA

Why physician education?

Essential for success of the program

Families refer to their Primary Care Physician (PCP) for advice

Key component to follow up is PCP

Need for EDHI Education

Knowledge of the program and program goals

Knowledge of the guidelines

Roles of the professionals

Goal: Find best way to get physicians to recognize the importance of EHDI Barriers: Geographical uniqueness of PA – state has

large urban centers in east and west with large rural mid-section and north central area.

Large number of small hospitals with birthing centers.

“Old School” disbelievers still exist.

What is EPIC?

Educating

Physicians

In The

Community

Advantages Of An EPIC Model

Presenters model a multidisciplinary and team- oriented approach.

Learning takes place in a local hospital or office setting so that problems unique to that hospital (or practice) can be addressed.

Presenters are most often from the local community and are familiar with the people they’re teaching.

Goal of presentations is to affect positive change and not just present information.

EPIC Programs In PA

Existing EPIC-IEP—Immunizations EPIC-SCAN—Suspected Child Abuse and Neglect EPIC-IC—Medical Home Clean Air—Tobacco Cessation

New EPIC-EHDI—Early Hearing Detection and Intervention

Proposed Obesity Emergency Preparedness Asthma

Pennsylvania’s 3-year EPIC-EHDI project was . . . Conceived as a multi-faceted outreach strategy to inform

pediatricians and PCPs about the importance of EHDI consistent with the Medical Home model.

An outgrowth of an existing PA AAP Medical Home grant.

Proposed as a key feature in PA DOH’s grant application to HRSA/MCHB for UNHSI funding as the primary means of program outreach to physicians.

Formulated in cooperation with PA AAP using multi-disciplinary input from PA DOH’s Infant Hearing Screening Advisory Committee.

Three-year Contract between PA-AAP and PA DOHTotal amount ~ $452,000 EPIC Team Training (1½-day team training seminar

at beginning of project -- $15,000 Teleconferences (one per year) -- $18,000 Grand Round Presentations (26 per year, includes

travel, lodging & honorariums) -- $93,000 Technical Assistance (up to 15 per year) -- $12,000 CDs , Video & Audiotapes, web dev. -- $27,000 Education & Outreach Materials -- $79,000 Salaries & Administration -- $208,000

Steps in Organizing the Program

Establish Multidisciplinary Advisory Committee

Develop Content Goals and Objectives

Determine Optimal Learning Modalities

Identify EPIC Team Members

Plan Training Session for EPIC Team Members

Steps in Organizing the Program cont.

Identify Target Hospitals/Practices

Market Program to Target Audience

Conduct Educational Programs and Incorporate Improvements and Adjustments Based on Audience Feedback

Evaluate Effectiveness of Educational Programs

Formulating the Content . . .

Full-day work session with Infant Hearing Screening Advisory Committee to plan content.

Attention paid to all perspectives: parents, PCPs, audiologists, hospital staff and public health administrators.

Inventory taken of key themes and messages.

Trial run and critique of prototype presentation during team training workshop.

Development of teleconference script dialogue followed by rehearsal and team critique.

Pennsylvania’s EPIC-EHDI Initiative is a multi-faceted educational approach, utilizing . .

Hospital-Based Grand Rounds Presentations Mentoring and Technical Assistance Audio Teleconference Training Video Web Based Learning Modules Resource Parent Packets available in offices

This concept allows educational goals to be achieved in a number of learning formats.

Hospital-Based Grand Rounds

Presentations made by 4-person EPIC teams.

Goal to provide 26 presentations each year for three years, which would cover over half of PA hospitals over the course of 3 years.

Attendees receive CMEs for participation.

Presentations geared towards physicians but attendees often also include hospital staff.

Mentoring and Technical Assistance

EPIC team members available in their local community.

Address problems such as: Hospital referral rates too high or

too low. Hospitals not sending timely

reports to state DOH. PCPs not making timely referrals

for diagnostic evaluations or to EI.

Technical assistance may occur either in person orby phone.Can be provided in a potentially less threatening manner if done by local colleague.

Audio Teleconference

Teleconference produced as part of PA-AAP’s monthly ongoing “Let’s Talk” educational series.

Presented as a scripted panel discussion in contrast to the more didactic Grand Rounds presentations.

Panel participants with same disciplines as EPIC team members (physician, audiologist, parent and DOH staff member).

Audio CD distributed to every PCP practice in Pennsylvania.

Training Video

Produced from a model Grand Rounds presentation and includes all audiovisuals used in this presentation.

Distributed to all PCP practices in PA to allow practices to view presentation even if they have not attended the Grand Rounds.

Web Based Modules

Allows use of multimedia audio and visual files.

Through these modules, learner can go into more depth in areas such as: Components of a diagnostic evaluation Accessing the EI system Communication options Understanding the coordinating role of

DOH Learners can work through modules

at their own pace.

Parent Educational Packets

Allow families to receive additional information concerning the impact of early diagnosis.

Emphasize the need to obtain timely diagnostic evaluations and to follow speech and language milestones for all children.

Each team consists of a physician, audiologist, parent advocate, and DOH staff member.

Teams received multidisciplinary training during 1½-day workshop in October 2003. Stragglers were trained by teleconference in January 2004.

Team members live in the same regions as the hospitals where Grand Round presentations take place.

DOH actively coordinates with PA-AAP to prioritize training sites based on birthing volume, screening and referral percentages, and infrequent or inconsistent submission of referrals and screening data.

Regional EPIC-style teams are the project’s core strength

EPIC Team Member Roles

Physician—conveys importance of EHDI evaluation from a medical perspective, including importance of hearing in child’s development and modeling medical home principles.Audiologist—brings auditory function, diagnosis, and assistive technology perspective; need to report diagnostic results to state DOH; key resource for technical assistance. Parent—gives firsthand description of difficulties in navigating the system, coping with ECHL & EI; presents the personal story.DOH Representative—describes EHDI from a public health program perspective, incl. reporting and follow-up tracking, educational outreach, program guidelines and ongoing program development.

Targeting Hospitals

Targeted hospitals are based on:

Recommendations from the PA Department of Health

Birthing volume and referral rates Hospitals interested in the program

When targeting hospitals, keep focus off of Newborn Hearing Screening and more on diagnosis, follow-up and the importance of intervention services.

Getting the Word Out

Calls to Hospitals

Brochure describing all aspects of the program – sent out to all PA PCPs

Other areas of interest – such as SHIP (State Health Improvement Plan) partners and Early Intervention Services

Setting Up Presentations

It is important to work closely with the hospital contact person.

Obtain a list of possible dates from hospital. Determine the date that is best for hospital

and the local presentation team.

Necessary Paperwork

Send presenters a confirmation letter along with disclosure form and anything else that needs to be completed.

Send hospital contact person a confirmation letter, evaluation forms, attendance sheet, necessary CME/CEU forms, and participant packets.

Send local PCPs a letter inviting them to the presentation.

Participant Packets

Currently, our participant packets include the following:

Handout of the slide presentation

List of related websites Copy of PA Department of Health program

guidelines Copy of the Guidelines for Pediatric Medical

Home Providers Related info. such as the PA phone number

for Early Intervention Services

Steps in Organizing the Program

Establish Multidisciplinary Advisory Committee

Develop Content Goals and Objectives

Determine Optimal Learning Modalities

Identify EPIC Team Members

Plan Training Session for EPIC Team Members

Identify Target Hospitals/Practices

Market Program to Target Audience

Conduct Educational Programs and Incorporate Improvements and Adjustments Based on Audience Feedback

Evaluate Effectiveness of Educational Programs