Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access?

Area of Science:

• Pediatrics
• Developmental Pediatrics
• Quality Improvement Science

Background:

• Access to developmental-behavioral pediatric (DBP) evaluations for young children is often limited by long wait times.
• Quality improvement (QI) initiatives are essential for optimizing healthcare delivery in pediatric settings.

Purpose of the Study:

• To decrease wait times and enhance access to DBP evaluations for children aged 4 and younger.
• To implement a QI initiative within an urban safety-net hospital setting.

Main Methods:

• A primary care pediatrician underwent specialized DBP minifellowship training to become a developmentally-trained primary care clinician (DT-PCC).
• DT-PCCs conducted initial developmental evaluations using standardized tools (Childhood Autism Rating Scale, Brief Observation of Symptoms of Autism).
• The study involved two QI cycles to streamline the referral and evaluation process, comparing it to a baseline 3-visit model.

Main Results:

• The average time to initial developmental assessment decreased from 135.3 days to 67.9 days after streamlining referrals to DT-PCCs.
• For patients requiring further specialist evaluation, the average wait time reduced from 290.1 days to 120.4 days.
• Seventy patients with a mean age of 29.5 months were evaluated.

Conclusions:

• The integration of DT-PCCs successfully improved early access to developmental evaluations for young children.
• Further research is recommended to explore the broader impact of DT-PCCs on accessing care and treatment for developmental delays.