Improving Accuracy and Accessibility of Early Autism Screening

描述（由申请人提供）：本提案的目的是完成一种新工具的计算机化适应的开发和评估，以更准确地识别具有自闭症谱系障碍（ASD）迹象的幼儿，并使该工具可用于不同人群。在早期干预的有效性证据之后，ASD的早期筛查最近已成为儿科实践的标准。最广泛推荐的屏幕是幼儿自闭症改良清单（MCHAT; Robins，et.例如，1999年）。虽然MCHAT具有良好的心理测量特征，但在初级保健中使用的主要障碍是其高转诊率。而结构化面试（MCHAT后续; Kleinman等。例如，2007年）的发展，减少过度转诊，这是不切实际的，在其原来的形式，简短的良好的儿童访问。该项目的平台是一个基于网络的决策支持系统，CHADIS，提供访视前问卷，如MCHAT在线完成，评分，并将结果呈现给临床医生。CHADIS还在一本电子教科书中提供决策支持，该教科书与父母讲义中的筛查结果和资源相关联。已在CHADIS（CHADIS MCHAT F/U）中创建了由临床医生访谈完成的MCHAT随访的计算机化版本。CHADIS MCHAT F/U是实用的，因为它提示医生只问父母几个问题，以跟进导致阳性MCHAT分数的答案，在每次临床医生输入后，测试自动重新评分，直到获得阳性或阴性结果。预计计算机化的MCHAT和CHADIS MCHAT F/U将减少一半以上的过度转诊率，节省成本和父母的痛苦。CHADIS正在全国范围内和马里兰州用于自闭症筛查项目中相当大的实践网络。然而，在有大量低收入家庭的环境中使用受到限制，因为他们无法或不记得在访问前在线填写问卷。该项目的第一阶段将涉及开发用于管理MCHAT的等候室替代方案，包括交互式语音应答（IVR）电话系统、触摸屏信息亭和笔记本电脑，这些系统将允许结果与CHADIS MCHAT F/U相关联。还将建立一个提醒系统。然后将在3个人群的父母和医生焦点小组中评估这些方法。第二阶段将涉及：评估3个人群中160名家长对候诊室方法的满意度，并检验CHADIS MCHAT F/U方法的阳性预测效度。将通过使用MCHAT筛选马里兰州网络中的4500名儿童，并完成CHADIS MCHAT F/U，并对预期的300名阳性儿童完成ASD评价，以确定有效性。最后，将估计这些方法的相对成本和节省。据推测，新系统将显示出支持广泛的第三阶段传播的优势、节省和可接受性。公共卫生相关性：该提案的目的是完成对一种新工具的计算机化改编的开发和评估，以更准确地识别具有自闭症谱系障碍（ASD）迹象的幼儿，目前每150名儿童中就有1名受到影响，并使该工具可供不同人群使用。ASD的早期筛查是儿科实践的新标准，但最广泛推荐的筛查MCHAT具有很大的过度转诊率，低收入家庭不太能够或不记得在就诊前完成它。该项目将创建在候诊室通过电话（IVR）、触摸屏信息亭和笔记本电脑以及电话提醒系统使用MCHAT的方法;对其进行可接受性试验;然后在3个人群中测量这些方法的偏好、满意度和成本。一个计算机化版本的MCHAT和后续提示面试，旨在减少过度转诊已创建在现有的基于网络的决策支持系统（CHADIS），并将通过评估300名儿童ASD谁有积极的MCHAT屏幕验证，无论他们的MCHAT后续结果。预计计算机化的MCHAT和CHADIS MCHAT F/U将提高ASD的有效筛查率，这对早期识别和干预很重要，但将过度转诊率降低一半以上，节省成本和父母的痛苦。

DESCRIPTION (provided by applicant): The aims of this proposal are to complete development and evaluation of a computerized adaptation of a new tool to more accurately identify toddlers with signs of Autism Spectrum Disorders (ASD) and to make this tool accessible to varied populations. Early screening for ASD has recently become standard for pediatric practice following evidence of the efficacy of early intervention. The most widely recommended screen is the Modified Checklist for Autism in Toddlers (MCHAT; Robins, et. al., 1999). While the MCHAT has good psychometric characteristics, a major obstacle to its use in primary care is its large over-referral rate. While a structured interview (MCHAT Follow Up; Kleinman, et. al., 2007) was developed that reduces over-referral, it is impractical in its original form for brief well child visits. The platform for this project is a web-based decision support system, CHADIS that delivers pre-visit questionnaires such as the MCHAT for completion online, scores them and presents results to the clinician. CHADIS also provides decision support in an electronic textbook linked to screening results and resources in handouts for parents. A computerized version of the MCHAT Follow Up completed by clinician interview has been created in CHADIS (CHADIS MCHAT F/U). CHADIS MCHAT F/U is practical because it prompts doctors to ask the parents only a few questions to follow up on the answers causing the positive MCHAT score, with the test automatically rescored after each clinician input until a positive or negative result is obtained. It is anticipated that the computerized MCHAT and CHADIS MCHAT F/U will cut the over-referral rate by more than half, saving costs and parent agony. CHADIS is being used nationally and in Maryland for a sizable network of practices in an autism screening program. However, use in settings with large numbers of low income families has been limited because they are unable or do not remember to complete questionnaires online prior to visits. Phase I of this project will involve development of waiting room alternatives for administering the MCHAT including Interactive Voice Response (IVR) phone system, touch screen kiosk, and laptop computer that will allow results to be linked to CHADIS MCHAT F/U. A reminder system will also be created. These methods will then be assessed in parent and physician focus groups in 3 populations. Phase II will involve: assessing satisfaction with the waiting room methods in 160 parents in the 3 populations, and testing positive predictive validity of the CHADIS MCHAT F/U method. Validity will be determined by screening 4500 children in the Maryland network using the MCHAT, and completing the CHADIS MCHAT F/U and complete evaluations for ASD on the expected 300 positive children. Finally, relative costs and savings of these methods will be estimated. It is hypothesized that the new system will show advantages, savings, and acceptability that support widespread Phase III dissemination. PUBLIC HEALTH RELEVANCE: The aims of this proposal are to complete development and evaluation of a computerized adaptation of a new tool to more accurately identify toddlers with signs of Autism Spectrum Disorders (ASD), now affecting 1 in 150 children, and to make this tool accessible to varied populations. Early screening for ASD is a new standard for pediatric practice but the most widely recommended screen, MCHAT, has a large over- referral rate and low income families are less able to or do not remember to complete it prior to their visits. This project will create methods for using the MCHAT in the waiting room by phone (IVR), touch screen kiosk and laptop and a phone reminder system; pilot them for acceptability; then measure preference, satisfaction and costs of these methods in 3 populations. A computerized version of MCHAT and of a Follow Up prompted interview designed to reduce over-referral has been created in an existing web-based decision support system (CHADIS) and will be validated by evaluating 300 children for ASD who have positive MCHAT screens regardless of their MCHAT Follow Up results. It is anticipated that the computerized MCHAT and CHADIS MCHAT F/U will improve rates of valid screening for ASD, important to early identification and intervention, but cut the over-referral rate by more than half, saving costs and parent agony.