Improving Accuracy and Accessibility of Early Autism Screening

DESCRIPTION provided by applicant Autism is prevalent in children and impairing but early intervention has been shown to improve outcomes prompting recommendations for screening at both two year and 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 for children andgt months thus effective for month olds and also low PPV for andlt 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 in the andlt 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 month olds and comparison to alternatives using the community network of andgt Maryland doctors where andgt 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 andquot talkingandquot 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 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 andquot screening systemandquot not just a new test PUBLIC HEALTH RELEVANCE Autism is prevalent in children and impairing but early intervention has been shown to improve outcomes prompting recommendations for screening at both two year and month health check ups In Phase I a standard screening procedure was adapted so that doctors could efficiently identify autistic children at two years of age but the screen did not prove accurate at months Phase II data showed that a novel method combining supplemental information and a new computerized scoring pathway promised accurate detection at the critical month age This Phase B proposal is aimed at replicating this unique approach to early autism identification in a community sample comparing it with alternatives plus developing innovative strategies to assure that all children are screened by automating reminders and completion confirmation and by supporting continuous quality improvement in office implementation using automated reporting analytics