Identifying Autism Spectrum Disorder in a High-risk Follow-up Program through Quality Improvement Methodology

Area of Science:

• Pediatrics
• Developmental Psychology
• Quality Improvement

Background:

• Children born prematurely face a higher risk of autism spectrum disorder (ASD).
• Early ASD diagnosis, typically between 18-24 months, is often delayed by access barriers and medical complexity.
• High-risk infant follow-up (HRIF) programs are crucial for monitoring these vulnerable children.

Purpose of the Study:

• To implement and evaluate an autism spectrum disorder (ASD) screening protocol within a high-risk infant follow-up (HRIF) program.
• To improve the rate of ASD screening and timely referral for diagnostic evaluation in at-risk infants.
• To assess the effectiveness of Quality Improvement (QI) methodology in integrating ASD screening into a multidisciplinary HRIF setting.

Main Methods:

• A standardized workflow was developed to administer the M-CHAT-R/F screening tool to HRIF patients aged 16-22 months.
• Telehealth-based ASD assessments (TELE-ASD-PEDS) were utilized for children screening positive.
• Monthly team meetings facilitated change cycles and process reviews using QI methodology.

Main Results:

• ASD screening rates exceeded the 60% target within 7 months of implementation.
• 72% of screen-positive patients were referred for evaluation, with 27% receiving an ASD diagnosis.
• The average age of ASD diagnosis was 22.5 months, indicating relatively early identification.

Conclusions:

• An ASD screening and referral protocol, utilizing QI, was successfully integrated into an HRIF program.
• The protocol proved effective in identifying at-risk infants and facilitating expedited telehealth evaluations.
• The program's success led to its expansion and the integration of telehealth services to meet access needs, demonstrating QI's value.