Improving Accuracy and Accessibility of Early Autism Screening

描述（由申请人提供）：自闭症很普遍（每50个孩子中就有1个），并且会损害健康，但早期干预已被证明可以改善结果，因此建议在两岁和18个月的健康检查中进行筛查。早期发现自闭症是至关重要的，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)，在访问期间有效地使用，创建了一种实用的方法来提高使用最广泛的自闭症筛查M-CHAT的准确性。在筛查呈阳性的情况下，初级保健提供者（PCP）可以使用CHADIS（一种基于网络的问卷发放、决策支持和访问后参与系统）进行F/U，而不需要与其他专业人员进行访问。第二阶段的数据显示，PCP的F/U结果与自闭症中心相当。通过CHADIS进行的M-CHAT加F/U的ii期数据重复了F/U作者的研究结果，显示出对于0 - 20个月的儿童，极好的阳性预测值（PPV）为0.96（因此对24个月的婴儿有效），而对于<20个月的儿童，PPV也很低，为0.54。有希望的是，使用决策树的第二阶段探索性分析，包括常规使用的标准语言屏幕（ASQ交流量表）和语言测量（MCDI）加上标准自闭症屏幕（M-CHAT加上F/U）的补充数据，在<20个月的组中达到了0.95的PPV。这种屏幕补全可以由家长在网上有效地完成。IIB阶段计划复制这一筛查程序，该程序承诺对18个月大的婴儿是准确的，并与由400名马里兰州医生组成的社区网络进行比较，该社区网络使用CHADIS系统进行了22000次自闭症筛查。如果没有普遍使用，更准确的筛选测试的价值就会降低。在第二阶段，研究人员开发了一种方法，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距，但在第二阶段将解决进一步的工作流程问题。为了提高屏幕完成度，我们将在CHADIS中编写一个自动提醒/完成确认文本/电子邮件系统，并提供优惠券作为家长的奖励。在第二阶段，CHADIS被用于同时记录患者的意见和医生的决策，140名儿科医生获得了美国儿科委员会颁发的维护认证（MOC）认证。这项每月一次的医生质量改进计划将扩展到整个办公室团队的每日持续质量改进过程，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.