Can a novel telemedicine tool reduce disparities related to the identification of preschool children with autism?

新型远程医疗工具能否减少学龄前自闭症儿童识别方面的差异？

• 批准号: 10354317
• 负责人: Zachary E Warren
• 金额: $ 21.63万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-17 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10354317
• 关键词: Address; African American; Age; Age-Months; Agreement; Assessment tool; Attention; Behavior; Behavior Disorders; Behavioral; Blinded; COVID-19; COVID-19 pandemic; Caring; Child; Classification; Clinical; Computer Analysis; Data; Data Set; Decision Making; Development; Diagnosis; Diagnostic; Early Diagnosis; Early Intervention; Engineering; Evaluation; Evidence based intervention; Face; Family; Geography; Gold; Health Services Accessibility; Hispanic; Home; Improve Access; Investigation; Linguistics; Machine Learning; Measures; Methodology; Methods; Mining; Modeling; Nursery Schools; Parents; Performance; Persons; Phenotype; Play; Population; Preschool Child; Procedures; Process; Production; Property; Provider; Psychometrics; Registries; Reporting; Risk; Risk Assessment; Sampling; Scientist; Services; Socioeconomic Status; Specialist; Structural Racism; Structure; Symptoms; System; Target Populations; Techniques; Telemedicine; Testing; Time; Toddler; Translating; Underserved Population; Wait Time; Waiting Lists; Work; aged; aging population; autism spectrum disorder; autistic children; barrier to care; base; community clinic; design; diagnostic tool; disorder risk; disparity reduction; formative assessment; geographic barrier; health disparity; improved; innovation; novel; satisfaction; sound; telehealth; tertiary care; tool; tool development; underserved community; usability

PROJECT SUMMARY Families seeking evaluation for autism spectrum disorder (ASD) often face barriers such as low availability of specialists, lengthy waitlists, and long distances to tertiary care diagnostic centers. This is especially true for children from traditionally underserved groups and communities. Without innovative approaches for enhanced identification of ASD, families and clinicians will continue to struggle with accessing and providing care. Telemedicine offers tremendous potential for addressing this need, but there are few psychometrically sound, validated tools that can be administered remotely, via telehealth platforms, in order to guide service and action. Our team developed and conducted a preliminary evaluation of a novel parent-administered, clinician-guided tele-diagnostic tool, the TAP (TELE-ASD-PEDS), designed specifically for direct-to-home and community clinic use with toddlers. Remote administration of the TAP yielded a very high level of agreement with blinded comprehensive evaluation regarding ASD risk classification. Subsequently, the unanticipated broad dissemination of the TAP during COVID-19 demonstrated its value for traditionally underserved groups, spanning broad geographies. Although promising, this work was limited by its specific focus on toddlers with ASD concerns. A telemedicine tool designed for the unique context and population of preschool-aged children referred for diagnostic assessment could have tremendous value in terms of both accurate identification as well as family engagement with service. In the current work, we propose a computationally informed co-production in which we involve our targeted population as active partners in designing a new telemedicine tool, the TAP– Preschool, for ASD risk assessment in preschoolers. This approach will follow our innovative methodology for fusing advanced computational analyses with stakeholder expertise (1) by mining our large clinical registry to identify key ASD behavior targets and (2) rigorously translating these key behaviors to generate telehealth assessment techniques. With input from our computational experts, clinical scientists, and end-users, we will then evaluate the performance, usability, and utility of the TAP–Preschool. We will gather critical data not only regarding its structure and accuracy, but also its potential deployment across systems responsible for engaging children and families from underserved groups in meaningful service. This work has potential to transform the ASD evaluation process and dramatically improve care access for traditionally underserved groups.

项目摘要 寻求评估自闭症谱系障碍（ASD）的家庭通常会面临诸如低可用性之类的障碍 专家，冗长的候补名单以及第三级护理诊断中心的距离。尤其如此 传统上服务不足的群体和社区的孩子。没有创新的方法来增强 识别ASD，家庭和临床医生将继续努力获得和提供护理。 远程医疗为满足这一需求提供了巨大的潜力，但是在心理上的声音很少， 经过验证的工具可以通过远程医疗平台远程管理，以指导服务和行动。 我们的团队对新型的父母管理，临床引导进行了初步评估 Tele-degnostic工具，Tap（Tele-ASD-PEDS），专为直接到家和社区诊所设计 与幼儿一起使用。水龙头的远程管理与盲人达成了很高的一致性 有关ASD风险分类的全面评估。随后，意外的广泛 Covid-19期间的Tap的传播证明了其对传统服务不足的群体的价值， 广泛的地理位置。尽管很有希望，但这项工作受到ASD的幼儿的特定关注的限制 关注。远程医疗工具，专为学龄前儿童独特的环境和人口而设计 诊断评估的转介也可以在准确的识别方面具有巨大的价值 作为家庭参与服务。在当前的工作中，我们提出了一个计算知情的共同制作 在其中，我们将目标人群作为主动合作伙伴，以设计新的远程医疗工具Tap- 学龄前，用于学龄前儿童的ASD风险评估。这种方法将遵循我们的创新方法 通过将我们的大型临床注册表挖掘到 确定关键的ASD行为目标，（2）严格翻译这些关键行为以生成远程医疗 评估技术。通过我们的计算专家，临床科学家和最终用户的投入，我们将 然后评估TAP -PRESCHOOL的性能，可用性和实用性。我们将不仅收集关键数据 关注其结构和准确性，以及其在负责参与的系统中的潜在部署 来自服务不足的团体的儿童和家庭有意义的服务。这项工作有可能改变 ASD评估过程并大大改善了传统服务不足的群体的护理访问。