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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 2: Screening in Primary Care

685 - A Model for Autism Screening and Diagnosis of Pre-School Aged Children in a Pediatric Primary Care Clinic

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 685
Publication Number: 685.152

Christina Baah, University of Massachusetts Medical School, Marlborough, MA, United States; Roula Choueiri, Boston Children's Hospital, Boston, MA, United States; Leah R. Evans Wong, University of Massachusetts Medical School, Worcester, MA, United States; Anna M.. Bottar, UMass Memorial Children's Medical Center, Webster, MA, United States; Valerie Tokatli, Boston Children's Hospital, Boston, MA, United States; Jillian Belgrad, University of Massachusetts Medical School, Worcester, MA, United States; Naaz Daneshvar, University of Massachusetts Medical School, Worcester, MA, United States

Presenting Author(s)

Christina Baah, MD (she/her/hers)

Associate Professor of Pediatrics
University of Massachusetts Medical School
Marlborough, Massachusetts, United States

Background: Autism Spectrum Disorder (ASD) can be clinically observed starting at six months of age. However, the average age at diagnosis is four years old leading to delayed entry into evidence-based therapies. Socioeconomically disadvantaged groups experience further delays in diagnosis. A shortage of autism diagnosticians further contributes to diagnostic delays with wait times up to 12 months for an autism evaluation.

Objective: Develop a model for identifying children less than 5 years old who are at high risk for autism with the Rapid Interactive Test for Autism in Toddlers (RITA-T) and develop a diagnostic model in our primary care clinic.

Design/Methods: We used the Plan-Do-Study-Act method. We trained three primary care pediatricians to use the RITA-T to identify preschoolers who were designated as high risk for ASD because of a score of ≥16. We then evaluated these children for ASD using the Child Autism Rating Scale (CARS2-ST) and DSM-V ASD criteria. Those with a score < 16 were referred to ASD subspecialist diagnosticians. Pediatricians met with a neurodevelopmental disabilities pediatrician with autism expertise monthly from January to December 2022 to receive training and to discuss cases, the interpretation of observations, documentation, billing, workflow, and therapy recommendations. We used descriptive statistics to assess wait times between referral and ASD evaluation and feedback from the pediatricians to inform changes to the protocol.

Results: We evaluated 33 patients for autism in primary care. The average age of the patients was 32 months. There were 27 boys and six girls. Thirteen identified as white and 20 identified as non-white. Fourteen identified as Hispanic and 18 identified as non-Hispanic. The average RITA-T score was 19 with a range of 16 to 28. The average time between referral and autism evaluation was eight weeks, with a range of 2 to 24 weeks. Challenges identified included: staff confusion about the referral protocol and scheduling, inadequate time in schedules to meet wait time goals, lack of administrative staff support, incorrect billing and coding, absence of a family navigator for families after diagnosis.

Conclusion(s): ASD diagnostic evaluations within a pediatric primary care setting are feasible after careful triaging patients and training. Evaluations in primary care increases access to evidenced-based therapies at an earlier age.