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Published on: April 22, 2015
Autism spectrum disorder screening in primary care
Georgette F Gura1, Mary T Champagne, Jane E Blood-Siegfried
1Duke University School of Nursing, Durham, NC, USA. gfg@duke.edu
Insights
Implementing universal autism spectrum disorder (ASD) screening in primary care is feasible and cost-effective. This quality improvement study shows high screening fidelity and a positive revenue offset, demonstrating successful adoption of the Modified Checklist for Autism in Toddlers™.
Area of Science:
- Pediatrics
- Developmental Psychology
- Healthcare Quality Improvement
Background:
- Autism spectrum disorder (ASD) affects 1 in 110 children in the U.S.
- Early identification and intervention are crucial for improving outcomes in children with ASD.
- Routine ASD screening at 18 and 24 months is recommended but not widely adopted.
Purpose of the Study:
- To assess the feasibility of implementing universal ASD screening in a private primary care practice.
- To evaluate the effectiveness of the Modified Checklist for Autism in Toddlers™ (M-CHAT™) for universal screening.
- To overcome barriers to widespread ASD screening adoption.
Main Methods:
- Utilized the Diffusion of Innovations evidence-based conceptual model for practice change.
- Implemented universal ASD screening using the Modified Checklist for Autism in Toddlers™.
- Conducted a retrospective chart review of 99 subjects to assess screening fidelity and costs.
Main Results:
- Achieved an overall screening fidelity of 91% over a 7-month period.
- The average monthly cost of screening was $22.78.
- Average monthly revenue generated from screening was $38.76, offsetting costs.
Conclusions:
- Universal ASD screening can be successfully implemented in primary care settings.
- A low-cost approach to universal screening is achievable through organizational strategies.
- The Modified Checklist for Autism in Toddlers™ is an effective tool for primary care ASD screening.
Objectives:
One in 110 children in the United States has autism spectrum disorder (ASD). Early identification and early intervention have been shown to improve outcomes for children with ASD. Although recommended, routine ASD screening at 18 and 24 months of age has not been widely adopted in practice. This quality improvement study examined whether a private primary care practice could overcome screening barriers and implement the recommended universal ASD screening practice using the Modified Checklist for Autism in Toddlers™.
Method:
Guided by the Diffusion of Innovations evidence-based conceptual model, a practice change using the Modified Checklist for Autism in Toddlers™ was developed. A retrospective chart review of 99 subjects was done to evaluate screening fidelity and cost.
Results:
An overall screening fidelity of 91% was achieved over a 7-month period. The cost of screening to the practice averaged $22.78 per month. This was offset by an average of $38.76 of revenue per month.
Conclusion:
These findings suggest that low-cost universal screening can be implemented in primary care when addressed from an organizational perspective.
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