272 - Improving Identification of Autism Spectrum Disorder in a NICU Follow-up Program using Quality Improvement Methodology

Poster Number: 272
Publication Number: 272.453

Emily Scott, IU School of Medicine, Indianapolis, IN, United States; Elesia Hines, Indiana University School of Medicine, Indianapolis, IN, United States; Christine Raches, Riley Child Development Center- LEND Program, Indianapolis, IN, United States; Abbey C. Hines, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Despite evidence that autism can be reliably diagnosed between 1-2 years of age, the average age of autism diagnosis in the US is over 4 years. The AAP recommends that autism screening occur at the 18-month well child visit; however, studies estimate that less than half of children with autism were screened before age 3. Children born prematurely or requiring neonatal intensive care are more likely to be diagnosed with autism, and early diagnosis and intervention improves developmental outcomes for these children. We implemented an autism screening protocol for children enrolled in a NICU Follow-Up Program serving patients discharged from level 3 and 4 NICUs.  

Objective: To screen 60% of children enrolled in the NICU Follow-Up Program at their 18-month visit using the M-CHAT-R/F within 9 months of project initiation and to refer at least 90% of children who screened positive for further evaluation. 

Design/Methods: An interdisciplinary team created SMART aims and a key driver diagram (Figure 1). A standardized process was developed to screen children with an M-CHAT-R/F during the 18-month NICU follow-up visit (Figure 2). The QI team meets monthly to review metrics and plan PDSA cycles. Data is collected via chart review and displayed in run charts.  Changes are spread throughout the program through staff meetings and one-on-one coaching. 

Results: Nine months into this QI initiative, 67 children have been screened with the M-CHAT-R/F.  Autism screening at eligible visits increased from baseline, with screening the past 3 months above the aim and median (Figure 3). Need for further evaluation was identified in 25% of patients.  Seventy percent of patients with positive screens were referred for further autism evaluation, with these appointments occurring, on average, within 7 weeks.  Future PDSA cycles for this project will focus on improving the referral rate of patients with a positive M-CHAT-R/F.   

Conclusion(s): Caregivers bring their toddlers to NICU follow-up programs for a comprehensive assessment of their child’s development. Universal autism screening can be successfully implemented in a comprehensive NICU follow-up program using a structured QI framework and engagement of an interdisciplinary team. As NICU graduates are at higher risk for autism spectrum disorders, NICU follow-up programs should consider implementing autism screening to decrease the age of diagnosis in affected children, improving their clinical outcomes.