Table 1.
Quality indicators and related benchmarks assessed in our study
| ID | Indicator | Benchmark | Source | Numerator | Denominator | Dimension |
|---|---|---|---|---|---|---|
| 1 | Recruitment | ≥95 % | AAPa, 1999 and JCIH, 2007 | Number of neonates that have a hearing screening test by 1 month of age | Number of neonates | Universality |
| Percentage of newborns who complete screening by 1 month of age | ||||||
| 2 | Adherence | ≥70 % | AAP, 1999, JCIH, 2000 | Number of neonates positive at the first screening test minus neonates who do not complete further testing (lost to follow-up) | Number of neonates positive at the first screening test | Universality |
| Follow-up rate | ||||||
| 3 | Timely definitive audiological evaluation | ≥90 % | JCIH, 2007 | Number of neonates undergoing definitive audiological evaluation by 3 months of age | Number of neonates undergoing a definitive audiological evaluation due to failed screening tests | Timely detection |
| Percentage of newborns who complete audiological evaluation by 3 months of age | ||||||
| 4a | High-risk measured prevalence | 2 % - 5 % (available prevalence rates [5]) | Data from Scientific literature | Number of screened neonates with audiological risk factors identified with hearing loss after definitive audiological evaluation | Number of screened neonates with audiological risk factors (at net of the lost to follow-up) | Timely detection |
| Observed prevalence in high-risk population | ||||||
| 4b | Low-risk measured prevalence | Not available (N.A.) | N.A. | Number of screened neonates without any audiological risk factor identified with hearing loss after definitive audiological evaluation | Number of screened neonates without any audiological risk factors (at net of all the lost to follow-up) | Timely detection |
| Observed prevalence in low-risk population | ||||||
| 4c | Overall measured prevalence | 0.1 % - 0.3 % (available prevalence rates [1–4]) | Data from scientific literature | Number of screened neonates (with and without audiological risk factors) identified with hearing loss after definitive audiological evaluation | Number of screened neonates with or without audiological risk factors (at net of the lost to follow-up) | Timely detection |
| Observed prevalence for whole population | ||||||
| 5 | Referral rate at discharge | a) 5-20 % (for only otoemissions) | Adapted from AAP, 1999 | Number of screened neonates with a positive test at the last screening test prior to hospital discharge | Number of screened neonates | Overreferral |
| Referral rate before leaving the hospital | ||||||
| b) 4 % (when ABR is also used) | ||||||
| 6 | Referral rate for definitive audiological testing after screening | <4 % | AAP, 1999 and JCIH, 2007 | Number of children sent to a definitive audiological evaluation | Number of screened neonates (at net of all those lost to follow-up) | Overreferral |
| Percentage of all newborn infants who fail initial screening and fail any subsequent rescreening before definitive audiological evaluation; the recommended benchmark is less than 4 %. | ||||||
| 7 | False-positive rate | ≤3 % | Adapted from AAP, 1999 | Number of neonates with positive test at last screening test who have a negative definitive audiological evaluation (false positives) | Number of screened neonates without disease (false positive plus true negativeb) at net of all those lost to follow-up. | Resource consumption |
| False-positive rate related to the entire screening process |
aAmerican Academy of Pediatrics
bWhen the true negatives are not available we have considered that all the negatives (i.e., all the screened minus the true positives and minus the lost to follow-up) are true negatives