Computer Assisted Autism Care (CAAC)

描述（由申请人提供）：自闭症和自闭症谱系障碍（ASD）在美国并不罕见。早期诊断，沿着早期、适当和一致的干预是改善ASD儿童长期结局的关键。全科医生，特别是儿科医生，现在看到更多的儿童比以往任何时候都与ASD在他们的做法。因此，全科医生必须增加他们的知识和舒适度在照顾这些孩子。然而，研究表明，与专家相比，初级保健医生更有可能表现出对ASD的过时信念和观点。此外，研究发现，虽然几个医学协会建议对ASD进行常规筛查，但只有8%的儿科医生定期筛查ASD。现代计算机决策支持策略为全科医生提供了最好的希望，使他们能够尽早处理诊断ASD的挑战性任务，并确保及时实施循证治疗计划。我们已经开发了一种新的决策支持系统，用于在儿科实践中实施临床指南。CHICA（通过计算机自动化改善儿童健康）结合了三个要素：（1）以Arden格式编码的儿科指南;（2）动态、可扫描的纸质用户界面;以及（3）与现有电子病历系统兼容的HL7接口。其结果是一个系统，既提供了“及时”的患者相关的指导方针，医生在临床遇到，并准确地捕捉结构化的数据，从所有谁与it.We互动建议扩展CHICA，包括ASD筛查，诊断和治疗参数。本申请的具体研究目的是：（1）扩展和修改现有的基于计算机的决策支持系统（CHICA），以帮助儿科医生识别和管理ASD;（2）评估CHICA系统ASD筛查和监测模块在四个儿科实践中对ASD早期识别的效果;（3）收集早期数据，了解CHICA系统对诊断为ASD的儿童提供的服务的影响，以及这些服务如何影响患者的预后。这项研究将包括一项随机试验，在该试验中，将在干预实践中实施CHICA系统之前和之后对ASD的筛查、诊断和管理与对照实践进行比较。为了衡量CHICA系统对ASD筛查和诊断的影响（目的2），我们将从医疗记录、CHICA数据审查和提供者调查中收集数据。我们 该目标的主要结果测量是在18或24个月随访时使用ASD特异性筛查工具进行筛查的儿童的百分比。为了评价CHICA系统对ASD治疗和管理的影响（目的3），我们将收集18个月至5岁正式诊断为ASD的儿童在基线、6个月和12个月时的过程、结局和满意度指标。目标3的主要关注结果是被诊断患有ASD的儿童接受的指南推荐活动/参与的数量。

DESCRIPTION (provided by applicant): Autism and autism spectrum disorders (ASD) are not uncommon in the United States. Early diagnosis, along with early, appropriate and consistent intervention is key for improved long term-outcomes in children with ASD. General practitioners, especially pediatricians, are now seeing more children than ever with ASD in their practices. Therefore, general practitioners must increase their knowledge and comfort level in caring for these children. However, research has demonstrated that primary care physicians are more likely to demonstrate outdated beliefs and views about ASDs compared to specialists. Additionally, research has found that while routine screening for ASD is recommended by several medical associations, only 8% of Pediatricians routinely screen for ASDs. Modern computer decision support strategies offer the best hope of equipping general practitioners to deal with the challenging task of diagnosing ASD as early as possible and ensuring the timely implementation of evidence-based treatment plans. We have developed a novel decision support system for implementing clinical guidelines in pediatric practices. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with it. We propose to expand CHICA to include ASD screening, diagnosis, and treatment parameters. The specific research aims of this application are to: (1) expand and modify an existing computer-based decision support system (CHICA) to assist pediatricians with identification and management of ASDs; (2) evaluate the effect of the CHICA system ASD screening and surveillance module on the early identification of ASD in four pediatric practices; (3) collect early data on the effect of the CHICA system on services provided to children diagnosed with ASD and how these affect patient outcomes. This study will include a randomized trial in which screening, diagnosis, and management of ASD before and after implementation of the CHICA system in intervention practices will be compared to control practices. To measure the effect of the CHICA system on ASD screening and diagnosis (aim 2), we will collect data from medical records, reviews of CHICA data, and surveys of providers. Our primary outcome measure of interest for this aim is the percent of children who are screened using an ASD specific screening tool at the 18 or 24-month visit. To evaluate the effect of the CHICA system on ASD treatment and management (aim 3), we will collect process, outcome, and satisfaction measures at baseline, 6 months and 12 months from children between the ages of 18 months and 5 years with a formal diagnosis of ASD. The primary outcome of interest for aim 3 is the number of guideline recommended activities/involvements that a child diagnosed with ASD receives.