Developmental and Autism Screening A Survey Across Six States
Developmental and Autism Screening A Survey Across Six States
复制标题
DOI：
10.1097/iyc.0b013e31825a5a42
复制
发表时间：
2012-07-01
影响因子：
1.1
通讯作者：
Weitzman, Carol
中科院分区：
文献类型：
--
作者：
Arunyanart, Wirongrong;Fenick, Ada;Weitzman, Carol
美国儿科学会（AAP）建议筛查儿童发育迟缓和自闭症。迄今为止，对当前筛查实践的研究范围有限，主要集中在小的地方样本上。本研究旨在确定对AAP筛查建议的依从性：（1）在9，18和24或30个月时进行发育筛查;（2）在监测访视时提出关注时进行筛查;（3）在18和24个月时进行自闭症筛查，并检查与依从性相关的儿科医生和实践特征。来自6个州的儿科医生完成了一份38项基于网络的问卷（N = 406），内容涉及对建议的依从性、筛查实施情况、自指南发布以来筛查实践的变化以及儿科医生和实践人口统计学。总体而言，17.8%的儿科医生符合所有3项筛查建议。共有41.6%的儿科医生在9个月访视时进行了发育筛查，18个月访视时为58%，24或30个月访视时为52%。共有59.8%的医生在18个月访视时筛查自闭症，50.2%在24个月访视时筛查自闭症。与5年前相比，44.8%的儿科医生目前更频繁地筛查发育，72.2%的儿科医生更频繁地筛查自闭症。在儿科医生的实践中，10%-50%的非白人患者/种族的儿科医生比超过50%的患者的儿科医生更不可能筛查发育迟缓（比值比[OR] = 0.30; 95%置信区间[CI] = 0.13，0.69; p = 0.004）。同样，与超过30%的患者相比，10%-30%的医疗补助保险患者的儿科医生不太可能筛查发育迟缓（OR = 0.45; 95%CI = 0.25，0.80; p = .0007）。相比之下，有10%-30%医疗补助保险患者的儿科医生比有30%以上患者的儿科医生更有可能筛查自闭症患者（OR = 2.46; 95% CI = 1.38，4.40; p = .0002）。越来越多的儿科医生正在筛查儿童发育迟缓和自闭症。经济上处于不利地位的儿童明显更有可能接受发育迟缓的筛查，但不太可能接受自闭症的筛查。
The American Academy of Pediatrics (AAP) recommends screening children for developmental delay and autism. Studies of current screening practice to date have been limited in scope and primarily focused on small, local samples. This study is designed to determine compliance with AAP screening recommendations: (1) developmental screening at 9, 18, and 24 or 30 months; (2) screening when concerns are raised at a surveillance visit; and (3) autism screening at 18 and 24 months and to examine pediatrician and practice characteristics associated with compliance. Pediatricians from 6 states completed a 38-item web-based questionnaire (N = 406) regarding compliance with recommendations, screening implementation, changes in screening practice since the publication of guidelines, and pediatrician and practice demographics. Overall, 17.8% of pediatricians were compliant with all 3 screening recommendations. A total of 41.6% of pediatricians screened for development at the 9-month visit, 58% at the 18-month visit, and 52% at the 24- or 30-month visit. A total of 59.8% of physicians screened for autism at the 18-month visit and 50.2% at 24-month visit. As compared with 5 years ago, 44.8% of pediatricians currently screen for development more often and 72.2% screen for autism more often. Pediatricians with 10%-50% of patients of non-White race/ethnicity in their practice were significantly less likely to screen for developmental delay than pediatricians with more than 50% of patients (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.13, 0.69; p = .004). Similarly, pediatricians with 10%-30% of Medicaid-insured patients were less likely to screen for developmental delay than pediatricians with more than 30% of patients (OR = 0.45; 95% CI = 0.25, 0.80; p = .0007). In contrast, pediatricians with 10%-30% of Medicaid-insured patients were significantly more likely to screen patients for autism than pediatricians with more than 30% of patients (OR = 2.46; 95% CI = 1.38, 4.40; p = .0002). Increasing numbers of pediatricians are screening children for developmental delays and autism. Economically disadvantaged children are significantly more likely to be screened for developmental delay but less likely to be screened for autism than do less disadvantaged children.