Improving Accuracy and Accessibility of Early Autism Screening

描述（由申请人提供）：自闭症很普遍（50名儿童中有1名），并且有损害性，但早期干预已被证明可以改善结果，提示建议在两年和18个月的健康检查中进行筛查。早期发现自闭症至关重要，但准确的筛查工具一直难以捉摸。在第二阶段，通过调整经过验证和推荐的随访访谈M-CHAT F/Ui（F/U），创建了一种提高M-CHAT（最广泛使用的自闭症筛查）准确性的实用方法，以便在访问期间有效使用。在积极筛查的情况下，初级保健提供者（PCP）可以使用CHADIS，一个基于网络的问卷交付，决策支持和访视后参与系统，进行F/U，而不是需要与另一个专业人员进行访问。II期数据显示，PCP的F/U结果与自闭症中心相当。通过CHADIS获得的M-CHAT + F/U的II期数据重复了F/U作者的发现，显示> 20个月的儿童的阳性预测值（PPV）为0.96（因此对24个月大的儿童有效），<20个月的PPV为0.54。令人鼓舞的是，在马里兰州的400名医生中，使用CHADIS系统进行了超过22,000次自闭症筛查，使用决策树进行的II期探索性分析（包括来自常规使用的标准语言筛查（ASQ沟通量表）的补充数据和来自语言测量（MCDI）的项目加上标准自闭症筛查（M-CHAT + F/U））达到了0.95的PPV。<20 month group. This screen completion could be done efficiently online by parents. Phase IIB plans a replication of this screening procedure which promises to be accurate for 18 month olds and comparison to alternatives using the community network of >一个更准确的筛选测试是没有价值的，如果它不是普遍使用。在第二阶段，开发了一种方法，使用家长更喜欢的"会说话"的平板电脑亭来减少筛查机会的差异，但进一步的工作流程问题将在第二B阶段得到解决。为了提高屏幕完成，我们将在CHADIS中设置自动提醒/完成确认文本/电子邮件系统，并提供优惠券作为父母的奖励。在第二阶段，CHADIS经过调整，以捕捉患者的输入和医生的决策和认证的维护（MOC）认证是由美国儿科委员会授予该计划，并获得了140名儿科医生。这个每月的医生质量改进计划将扩展到整个办公室团队的日常持续质量改进过程，以进一步确保患者参与筛查，同时为办公室提供其他有价值的临床和财务分析。IIB阶段的目标是开发和测试一种创新的“筛选系统”，而不仅仅是一种新的测试。

DESCRIPTION (provided by applicant): Autism is prevalent (1 in 50 children) and impairing but early intervention has been shown to improve outcomes prompting recommendations for screening at both two year and 18 month health check-ups. Detection of autism early is crucial but accurate screening tools have been elusive. In Phase II, a practical method of improving accuracy of M-CHAT, the most widely used autism screen, was created by adapting the validated and recommended follow up interview, M-CHAT F/Ui (F/U), for efficient use during the visit. In the case of a positive screen, the primary care provider (PCP) can use CHADIS, a web-based questionnaire delivery, decision support and post-visit engagement system, to conduct F/U rather than requiring a visit with another professional. Phase II data showed F/U results by a PCP were equivalent to the autism center. Phase-II data on the M-CHAT plus F/U via CHADIS replicated findings of the F/U authors in showing both excellent positive predictive value (PPV) 0.96 for children >20 months (thus effective for 24 month olds) and also low PPV 0.54 for <20 months. Promisingly, Phase II exploratory analyses using a decision tree including supplementary data from a routinely used standard language screen (ASQ communication scale) and an item from a language measure (MCDI) plus the standard autism screen (M-CHAT plus F/U) reached PPV of 0.95 in the <20 month group. This screen completion could be done efficiently online by parents. Phase IIB plans a replication of this screening procedure which promises to be accurate for 18 month olds and comparison to alternatives using the community network of >400 Maryland doctors where >22,000 autism screens have been done using the CHADIS system. A more accurate screening test is of less value if it is not universally used. In Phase II, an approach was developed that reduces disparities in access to screening using a "talking" tablet kiosk that was preferred by parents to alternatives, but further workflow issues will be addressed in Phase IIB. To improve screen completion, we will program an automated reminder/completion confirmation text/email system in CHADIS with coupons as incentives for parents. In Phase II, CHADIS was adapted to capture both patient input and doctor decision-making and Maintenance of Certification (MOC) accreditation was awarded by the American Board of Pediatrics for this program and earned by 140 pediatricians. This monthly doctor quality improvement program will be extended to a daily continuous quality improvement process for the whole office team to further assure patient participation in screening while providing other clinical and financial analytics of value to the office. The Phase-IIB goal is to develop and test an innovative "screening system" not just a new test.