Improving Accuracy and Accessibility of Early Autism Screening

描述(由申请人提供)：自闭症很普遍(50个儿童中就有一个)，并有损害，但早期干预已被证明改善了结果，促使建议在两年和18个月的健康检查中进行筛查。自闭症的早期发现是至关重要的，但准确的筛查工具一直难以找到。在第二阶段，创建了一种实用的方法来提高M-Chat的准确性，M-Chat是最广泛使用的自闭症筛查，通过采用经过验证和推荐的后续访谈M-Chat F/Ui(F/U)，以便在访问期间有效地使用。在筛查阳性的情况下，初级保健提供者(PCP)可以使用CHADIS，这是一种基于网络的问卷交付、决策支持和访问后参与系统，以进行F/U，而不需要与另一名专业人员进行访问。II期数据显示，PCP的F/U结果相当于自闭症中心。通过CHADIS对M-Chat Plus F/U的第二阶段数据复制了F/U作者的发现，显示了对20个月儿童的极好阳性预测价值(PPV)0.96(因此对24个月大的婴儿有效)，以及对20个月的低PPV 0.54。有希望的是，使用决策树进行的第二阶段探索性分析，包括来自常规使用的标准语言筛查(ASQ交流量表)的补充数据和来自语言测量(MCDI)加上标准自闭症筛查(M-Chat+F/U)的项目，在20个月组中PPV达到0.95。家长可以在网上高效地完成屏幕补全。第二阶段计划复制这一筛查程序，有望对18个月大的婴儿进行准确的筛查，并与使用社区网络的马里兰州400名医生的替代方案进行比较。在马里兰州，已使用CHADIS系统进行了2.2万例自闭症筛查。如果不是普遍使用，更准确的筛查测试就没有那么大的价值。在第二阶段，制定了一种办法，利用父母更喜欢的“会说话”的平板电脑亭减少获得筛查的差距，但进一步的工作流程问题将在第二阶段B中解决。为了改善屏幕的完成度，我们将在CHADIS中设计一个自动提醒/完成确认文本/电子邮件系统，并将优惠券作为对家长的激励。在第二阶段，CHADIS被调整以获取患者的意见和医生的决策，美国儿科委员会为此项目授予了维持认证(MOC)认证，140名儿科医生获得了认证。这一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。第二阶段的目标是开发和测试一种创新的“筛查系统”，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.