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Standardizing and Improving Primary Care-Based Electronic Developmental Screening for Young Children in Federally
Gladys Felix1,2, Alexis Deavenport-Saman3,4, Sophia Stavros1,2
1Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA.
Insights
Implementing electronic developmental screening tools in a federally qualified health center (FQHC) significantly increased screening rates and identified more children at risk for developmental delay. This digital approach helps overcome barriers in under-resourced communities.
Area of Science:
- Pediatric Health
- Health Informatics
- Developmental Pediatrics
Background:
- Developmental screening is crucial for early detection of delays and autism spectrum disorder (ASD), particularly in under-resourced communities.
- Barriers to effective implementation of developmental screening persist in primary care settings.
- Early intervention (EI) referral is vital for children identified with developmental concerns.
Purpose of the Study:
- To evaluate if a standardized clinical workflow with electronic screening tools improved developmental screening rates.
- To assess if the implementation increased the identification of children at risk for developmental delay in a federally qualified health center (FQHC).
Main Methods:
- A retrospective study was conducted at an academic-affiliated FQHC.
- Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were integrated into well-child visits.
- Staff received training on the new workflow for developmental screening and EI referral.
Main Results:
- ASQ-3 screening rates rose from 62.7% to 73.6% post-intervention.
- A significant increase in children identified with ASQ-3 results below the cutoff was observed (14.7% to 18.2%).
- M-CHAT-R screening rates increased from 56.4% to 59.4%, with a significant rise in electronic screen usage.
Conclusions:
- Electronic screening tools effectively enhanced universal developmental screening within an FQHC setting.
- Digital tools can mitigate screening errors common with paper methods, potentially improving the identification of at-risk children in under-resourced areas.
- This approach supports better developmental surveillance and timely EI referrals.
Objectives:
Many barriers to implementation of developmental screening in primary care exist, especially for children from under-resourced communities. Developmental screening is vital to early detection of developmental delay and autism spectrum disorder, and early intervention (EI) referral. This study sought to examine whether implementation of a standardized clinical workflow using electronic screening tools improved both rates of developmental screening, and the number of children identified at risk for developmental delay, in a federally qualified health center (FQHC).
Methods:
A retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher's Exact analyses were conducted.
Results:
ASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001).
Conclusions For Practice:
Implementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.
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