Secondary data analysis of universal autism screening in a large primary care network: The impact of early autism screening on age of diagnosis, referral, and entry into intervention (R03)

大型初级保健网络中普遍自闭症筛查的二次数据分析：早期自闭症筛查对诊断年龄、转诊和进入干预的影响 (R03)

• 批准号: 9762199
• 负责人: JUDITH Susanne MILLER
• 金额: $ 8.6万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762199
• 关键词: Academy; Advisory Committees; Age; Age-Years; American; Awareness; Caring; Child; Childhood; Clinical; Communities; Consensus; Country; Data; Data Analyses; Data Set; Decision Trees; Development; Diagnosis; Diagnostic; Early Diagnosis; Early Intervention; Early identification; Early treatment; Electronic Health Record; Family; Funding; Future; Guidelines; Healthcare Systems; Industry Standard; Intervention; Interview; Judgment; Lead; Logistic Regressions; Medical; Outcome; Parents; Pediatric Hospitals; Pediatrics; Philadelphia; Predictive Value; Preventive service; Primary Health Care; Procedures; Process; Provider; Publishing; Randomized; Recording of previous events; Risk Factors; Sampling; Screening Result; Socioeconomic Status; Specificity; Techniques; Testing; Time; Toddler; United States; Visit; aged; autism spectrum disorder; autistic children; base; classification trees; control trial; decision tree learning; demographics; evidence base; experience; follow-up; group intervention; improved; medical specialties; meetings; patient population; pediatrician; premature; prevent; prospective; random forest; regression trees; rural setting; screening; screening program; secondary analysis; standard of care; urban setting

PROJECT SUMMARY/ABSTRACT The United States Preventive Services Task Force (USPSTF) recently highlighted the lack of studies examining universal autism screening in primary care and whether it leads to earlier diagnosis and treatment. This gap prevented them from being able to recommend universal autism screening until there is more evidence. CHOP has successfully implemented universal autism screening in primary care – 83% screening compliance in 2016, and has both screening and follow-up primary care available in the electronic health record. This proposal is for a secondary analysis of this data to directly answer the question of whether universal screening results in earlier identification and earlier treatment entry for children with autism. Preliminary analyses on 13,503 children found the sensitivity of the M-CHAT was surprisingly low -- 40% (specificity 94%, positive predictive value 16%, and negative predictive value of 98%). These results show that, with only one screen, more children with autism screened negative (n=198) than screened positive (n=128). This project will include a sample double this size (as more children age into the 4-6 year age range), and include the wealth of data within the EHR to accomplish two aims. Aim 1 will determine the age of diagnosis and entry into early intervention for children in a universal autism screening program. Many factors contribute to the age of diagnosis and intervention, but this dataset can answer three important questions: First, to determine the age of diagnosis and entry to intervention for children with autism who screened positive as toddlers at the first v. second screen (“true positives”). Second, to determine the age of diagnosis and early intervention for children who screened negative but went on to be diagnosed with autism (“false negatives”), since negative screening results can still lead to heightened awareness of milestones. Third, to explore the age of diagnosis and intervention for screened v. unscreened children, since a subset of children were not screened (approximately 17% of well-child visits, as well as some number of children who received sick care but did not present for well-child visits). Aim 2 will identify factors that would improve screening accuracy, and then create and validate a clinical decision tree. Pediatricians use clinical judgment to interpret screening results—this project can provide much needed evidence. Variables such as autism risk factors (e.g., family history); child demographic, medical, and developmental factors; family variables including socio-economic status and parent concerns; and practice-level variables including patient population demographics, provider years of experience, provider compliance with screening, and provider rates of referrals, could inform clinical judgment. Upon successful completion, this project will contribute the exact type of evidence from universal screening in primary care requested by the USPSTF, as well as provide guidance for pediatricians on how to fine tune their interpretation of screening results. This can significantly impact the age of diagnosis and intervention, by revealing for whom screening is and is not working well.

项目总结/文摘

项目成果

Provider Responses to Positive Developmental Screening: Disparities in Referral Practices?

提供商对积极发育筛查的反应：转诊实践中的差异？

• DOI: 10.1097/dbp.0000000000000855
• 发表时间: 2021
• 期刊: Journal of developmental and behavioral pediatrics : JDBP
• 作者: Wallis,KateE;DavisRivera,LaurenB;Guthrie,Whitney;Bennett,AmandaE;Mandell,DavidS;Miller,JudithS
• 通讯作者: Miller,JudithS