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Abstract
Objective: The present study investigated a telehealth-enabled auditory-brainstem-response (TH-ABR) programme provided by the British Columbia Early Hearing Program (BCEHP) to families in a remote northern area who face barriers such as travel distance and access to audiologists trained in ABR testing. Objectives were to: (i) outline the design/implementation of a TH-ABR programme, (ii) summarise equipment/procedures, and (iii) report on results for the TH-ABR programme (cost/time effectiveness, testing accuracy/efficiency, and caregiver satisfaction).
Design: TH-ABR implementation was described and TH-ABR results were compared to behavioural follow-up findings to evaluate TH-ABR test accuracy. Caregivers were invited to complete TH-ABR satisfaction surveys following their appointment(s).
Study sample: One hundred and two infants (mean age: 2.3 months) were assessed via TH-ABR at four points-of-care; 41/66 caregivers completed surveys.
Results: The TH-ABR programme was suitable, sustainable and scalable. After 29 TH-ABR events, the service was cost neutral to BCEHP ($91,250 averted after 102 TH-ABRs). Fifty infants were identified with hearing loss and TH-ABR accuracy and efficiency were comparable to face-to-face assessments. Parent survey results indicated a high level of satisfaction with the TH-ABR experience.
Conclusions: TH-ABR is efficient, accurate, valued by parents, optimises availability to audiology resources, builds local service capacity, and reduces costs for northern BC communities.
Acknowledgments
The BCEHP is thankful for the collaborative participation of the staff and families in the Northern Health Authority in collecting this data and supporting the TH-ABR service. Funding for this project was provided by the BCEHP.
Disclosure statement
We wish to draw attention to potential conflicts of interest. J. Hatton and A. Beers are Program Support Audiologists employed by the BC Early Hearing Program (BCEHP) funded by the Provincial Health Services Authority; J. Rowlandson was hired as a consultant to the BCEHP; and S. Small received honoraria for her research programme as a consultant for the BCEHP.
Notes
Notes
1 In Canada, EHDI programs in both the province of Alberta (Packford et al. Citation2012) and Ontario (Campbell and Hyde 2010) have implemented telehealth-enabled ABR services.
2 When implementing TH-ABR programming in Alberta and Ontario, the service model did not require that testing be completed in an electrically-isolated sound booth. Unfortunately, electrical interference was reported to be an ongoing issue for these TH-ABR programs.
3 For example, the test bed demonstrated that the processor chipsets in the new ABR laptops introduced unacceptable levels of noise and required an upgrade of the hearing assessment hardware at Northern Health Authority points-of-care.
4 The remote desktop software is standard to all Windows operating systems at no cost and was used as it provides an easy-to-use, standards-based approach to streaming data between ‘trusted’ endpoints (the client in the community and the Audiologist at BCCH).
5 One child was very congested at the time of the ABR and only slept long enough to confirm AC-ABR elevations for both ears in the presence of reduced tympanic membrane mobility (i.e., no BC-ABR was completed). Due to health concerns and chronic congestion for the first 6 months of life the family elected to confirm hearing status via behavioural audiometry when the child was 9-months old. The other child had present otoacoustic emissions (OAEs) for both ears but only slept long enough for normal hearing to be verified for one ear by ABR. Follow-up behavioural testing for both children was consistent with normal hearing bilaterally.
6 BCEHP “normal” values in dB nHL are as follows: AC: 500 Hz ≤35, 1000 Hz ≤35, 2000 Hz ≤30, & 4000 Hz ≤25; BC: 500 Hz ≤20 & 2000 Hz ≤30. Normal program target levels equate to thresholds ≤25 dB eHL at each frequency (i.e., “nHL” to “eHL” (estimated behavioural threshold) corrections used by BCEHP are: (i) AC: -10, -10, -5 and 0 dB for 500, 1000, 2000 and 4000 Hz, respectively, and (ii) BC: +5 and -5 dB for 500 and 2000 Hz, respectively).
7 This approach was chosen because Canada is a single payer system making cost segmentation difficult at a system and even a program level.
8 Minimal stimulus levels equate to perceptual thresholds of about 25dB HL, reflecting BCEHP targeted hearing loss of 30 dB HL or more.
9 One survey was excluded because only the first page was filled out.
10 The BCEHP does not currently have BC-ABR norms at 4000 Hz and therefore the nature of the elevation at this frequency could not be determined based on the ABR results for these infants.