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McNally Keehn R, Penner M, Shannon J, Sohl K, Weitzman C, Zuckerman KE. Considerations and Actionable Steps to Promote Scaling of Early Autism Diagnosis in Community Primary Care Practice. J Dev Behav Pediatr 2024:00004703-990000000-00189. [PMID: 38996205 DOI: 10.1097/dbp.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/10/2024] [Indexed: 07/14/2024]
Affiliation(s)
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Kristin Sohl
- Department of Pediatrics, School of Medicine, University of Missouri, Columbia, MO
| | - Carol Weitzman
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA; and
| | - Katharine E Zuckerman
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, OR
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Rea CJ, Toomey SL, Hauptman M, Rosen M, Samuels RC, Karpowicz K, Flanagan S, Shah SN. Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2024; 63:512-521. [PMID: 37309813 PMCID: PMC10863332 DOI: 10.1177/00099228231179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Ronald C. Samuels
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Snehal N. Shah
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Smith JV, Menezes M, Brunt S, Pappagianopoulos J, Sadikova E, O Mazurek M. Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236112. [PMID: 38456360 DOI: 10.1177/13623613241236112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
LAY ABSTRACT The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.
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Affiliation(s)
- Jessica V Smith
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Michelle Menezes
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Sophie Brunt
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Jessica Pappagianopoulos
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
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Baum RA, Berman BD, Fussell JJ, Patel R, Roizen NJ, Voigt RG, Leslie LK. Child Health Needs and the Developmental-Behavioral Pediatrics Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678H. [PMID: 38300001 DOI: 10.1542/peds.2023-063678h] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.
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Affiliation(s)
- Rebecca A Baum
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Brad D Berman
- Division of Developmental-Behavioral Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Jill J Fussell
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rohan Patel
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Nancy J Roizen
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Robert G Voigt
- Michael R. Boh Centers for Child Development, Department of Pediatrics, Ochsner Health, and University of Queensland Medical School/Ochsner Clinical School, New Orleans, Louisiana
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Nasir AK, Strong-Bak W, Bernard M. Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care. J Prim Care Community Health 2024; 15:21501319241247997. [PMID: 38650542 PMCID: PMC11036916 DOI: 10.1177/21501319241247997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. METHODS Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. RESULTS Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. CONCLUSIONS This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.
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Affiliation(s)
- Arwa K. Nasir
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Marie Bernard
- University of Nebraska Medical Center, Omaha, NE, USA
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Kleffman N, Snyder K, Pedersen MRL, Dong J, Pereira-Burbach A, Dinkel D. Value of video-based education to enhance infant motor development. Early Hum Dev 2024; 188:105921. [PMID: 38134548 DOI: 10.1016/j.earlhumdev.2023.105921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Parents play a vital role in promoting infant motor development and physical activity; however, there is little information available to parents on how to support healthy movement. Therefore, the purpose of this study was to assess the feasibility of implementing video-based education to improve infant physical activity and motor development. METHODS This multiple case study consisted of semi-structured interviews with mothers (n = 12) and early childhood experts (n = 5, e.g., pediatrician, home visitor). Participants watched pre-recorded videos and answered questions which were developed following Bowens and colleagues guide for designing feasibility studies. Data were analyzed using a directed content analysis approach. RESULTS Most mothers (91.7 %) reported they were highly likely to recommend the videos to others and said the best way to share these videos would be through an app or social media (83.3 %) or health care entities (e.g., hospital, pediatrician, 75 %). Half of mothers (50 %) reported they would be interested in seeing videos once a month or once every couple of months. Further, all experts agreed parents would be somewhat or highly likely to use the videos and a majority (80 %) stated they were highly likely to recommend and share videos like these. Experts' top suggestions for sharing the videos was through an app/social media (40 %) and credible websites (40 %). DISCUSSION Overall, the videos appear feasible for mothers. Both groups primarily suggested that videos be disseminated through social media, online, or through an app. Future research should engage parents and healthcare providers in developing videos.
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Affiliation(s)
- Nicole Kleffman
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA; University of Nebraska Medical Center, Department of Health and Rehabilitation Sciences, 4200 Emile St., Omaha, NE 68198, USA.
| | - Kailey Snyder
- University of Nebraska Medical Center - Munroe Meyer Institute, Department of Education and Child Development, 6902 Pine St., Omaha, NE 68131, USA.
| | - Marlene Rosager Lund Pedersen
- University of Southern Denmark, Department of Sports Sciences and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark.
| | - Jenny Dong
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA.
| | | | - Danae Dinkel
- University of Nebraska at Omaha, School of Health and Kinesiology, 6001 Dodge Street, Omaha, NE 68182, USA.
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Bohnhoff JC, Guyon-Harris K, Schweiberger K, Ray KN. General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis. BMC Pediatr 2023; 23:576. [PMID: 37980515 PMCID: PMC10656818 DOI: 10.1186/s12887-023-04400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Children in need of pediatric subspecialty care may encounter multiple barriers, and multiple strategies have been suggested to improve access. The purpose of this study was to describe the perceptions of general and subspecialty pediatric physicians regarding barriers to subspecialty care and the value of strategies to improve subspecialty access. METHODS We surveyed a national sample of 1680 general pediatricians and pediatric subspecialists in May and June 2020 regarding 11 barriers to subspecialty care and 9 strategies to improve access to subspecialty care, selected from recent literature. Using latent profile analysis, respondents were grouped according to the degree to which they believed each of the barriers impacted access to subspecialty care. Using chi-squared tests, we compared the profiles based on respondent characteristics and perspectives on strategies to improve access. RESULTS The response rate was 17%. In 263 responses completed and eligible for inclusion, the barriers most frequently described as "major problems" were wait times (57%), lack of subspecialists (45%) and difficulty scheduling (41%). Respondents were classified into 4 profiles: "Broad concerns," "Subspecialist availability concerns," "Clinician communication concerns," and "Few concerns." These profiles varied significantly by respondent specialty (p < .001, with medical subspecialists overrepresented in the "Clinician communication" profile, psychiatrists in the "subspecialist availability" profile, and surgeons in the "few concerns" profile); and by respondents' typical wait time for appointments (p < .001, with physicians with the longest wait times overrepresented in the "subspecialist availability" profile). CONCLUSIONS We found specific profiles in clinician views regarding barriers to subspecialty care which were associated with perspectives on strategies aimed at overcoming these barriers. These results suggest that health systems aiming to improve subspecialty access should first identify the barriers and preferences specific to local clinicians.
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Affiliation(s)
- James C Bohnhoff
- Department of Pediatrics, Maine Health, 1577 Congress St Fl 1, Portland, ME, 04102, USA.
- Center for Interdisciplinary Population and Health Research, Maine Health Institute of Research, Scarborough, ME, USA.
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
| | - Katherine Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Academic Pediatrics, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Academic Pediatrics, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, USA
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Rah SS, Jung M, Lee K, Kang H, Jang S, Park J, Yoon JY, Hong SB. Systematic Review and Meta-analysis: Real-World Accuracy of Children's Developmental Screening Tests. J Am Acad Child Adolesc Psychiatry 2023; 62:1095-1109. [PMID: 36592715 DOI: 10.1016/j.jaac.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This review presents a list of developmental screening tests used in clinical settings worldwide and provides a broad estimate of their accuracy (PROSPERO: CRD42021236474). METHOD Following the PRISMA Diagnostic Test Accuracy (DTA) guidelines, this review involved searching PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, and Google Scholar (for manual searching). Inclusion criteria included studies published in English through 2020 that compared the accuracy of developmental screening tests against developmental diagnostic tests among children under 13 years of age. Six researchers, in pairs, independently selected the studies and extracted the data. A hierarchical model was applied to meta-analyze the diagnostic accuracy of the tests, and meta-regression was used to identify the moderators using R 4.1.3 software. RESULTS The meta-analysis included 56 studies (17 screening tests and 61 outcomes). The most frequently used screening tests were the Ages and Stages Questionnaire (ASQ), Denver Developmental Screening Test (DDST), and Parent's Evaluation of Developmental Status (PEDS). The pooled sensitivity and specificity were 0.75 (95% CI = 0.69-0.80) and 0.76 (95% CI = 0.71-0.80), and the overall diagnostic accuracy of the total outcomes (area under the curve) was 0.80. High heterogeneity was observed between the included studies with various thresholds of the tests. Participants' developmental concerns at the baseline significantly moderated the accuracy of the screening tests, resulting in double the positive predictive value and prevalence compared to those without the concerns. CONCLUSION We recommend a standardized process of validation studies for diagnostic accuracy, to ensure the effectiveness of developmental screening tests in clinical settings. STUDY PREREGISTRATION INFORMATION Accuracy of Developmental Screening Tools among Children in Real World: a Systematic Review and Meta Analysis; https://www.crd.york.ac.uk/; CRD42021236474.
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Affiliation(s)
- Sung Sil Rah
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minho Jung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungmin Lee
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Hannah Kang
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Soyoung Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Junghyun Park
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Soon-Beom Hong
- Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Jeung J, Talgo J, Sparks A, Martin-Herz SP. Expanding Developmental and Behavioral Health Capacity in Pediatric Primary Care. Clin Pediatr (Phila) 2023; 62:919-925. [PMID: 36609195 PMCID: PMC10411027 DOI: 10.1177/00099228221147753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians (DBP) to provide developmental-behavioral (DB) care to children referred with mild/moderate complexity needs as determined by a team of clinical psychologists. This pilot study utilizes visit data, chart review, and surveys to assess wait times, need for subspecialty care, and referring clinician satisfaction. In its first 18 months, DBAC decreased the need for subspecialty DB care, providing initial services for 44% of patients referred for DB pediatric care from the study site; 89% did not require subsequent subspecialty evaluation. Among DBAC participants, average wait times for DB care decreased from a baseline of 218 to 41 calendar days. This pilot study provides a model for building DB clinical skills among interested general pediatricians, decreasing wait times, and building the capacity of primary care settings to address mild-to-moderate complexity DB concerns.
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Affiliation(s)
- Joan Jeung
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Julia Talgo
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Aleah Sparks
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Susanne P. Martin-Herz
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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Johnson NL, Fial A, Van Hecke AV, Whitmore K, Meyer K, Pena S, Carlson M, Koth KA. A Scoping Review of Diagnosis of Autism Spectrum Disorder in Primary Care. J Pediatr Health Care 2023; 37:519-527. [PMID: 37178094 DOI: 10.1016/j.pedhc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION This scoping review was performed to collect, examine, and present literature on interventions promoting the diagnosis of Autism Spectrum Disorder (ASD) in U.S. primary health care settings. METHOD The literature searched was from 2011-2022, in the English language, in PubMed, CINAHL, Psych INFO, Cochrane, and Web of Science, for persons with autism or ASD aged ≤ 18 years. RESULTS Six studies met the search criteria, including a quality improvement project, a feasibility study, a pilot study, and three primary care provider (PCP) intervention trials. Measured outcomes included: accuracy of diagnosis (n = 4), practice change maintenance (n = 3), time to diagnosis (n = 2), specialty clinic appointment wait time (n = 1), PCP comfort making ASD diagnosis (n = 1), and increased ASD diagnosis (n = 1). DISCUSSION Results inform future implementation of PCP ASD diagnosis for the most obvious cases of ASD and research evaluating PCP training, using longitudinal measures of PCP knowledge of ASD and intention to diagnose.
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Rah SS, Hong SB, Yoon JY. Development of Parent Guidelines for Parent-Performed Developmental Screening Tests. Soa Chongsonyon Chongsin Uihak 2023; 34:141-149. [PMID: 37035786 PMCID: PMC10080253 DOI: 10.5765/jkacap.230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines. Methods We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences. Results Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents. Conclusion The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.
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Affiliation(s)
- Sung Sil Rah
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, Seoul National University, Seoul, Korea
- Address for correspondence: Ju Young Yoon, Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8817, Fax: 82-2-766-1852,
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Harding KE, Camden C, Lewis AK, Perreault K, Taylor NF. Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2057-2070. [PMID: 35716009 PMCID: PMC10084082 DOI: 10.1111/hsc.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/06/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.
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Affiliation(s)
- Katherine E. Harding
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Chantal Camden
- Sherbrooke University, School of RehabilitationSherbrookeQuébecCanada
| | - Annie K. Lewis
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale‐NationaleQuébec CityQuébecCanada
- Department of Rehabilitation, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Nicholas F. Taylor
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
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Kennelly AM, McIntyre B, Wood AC, Monteiro S, Voigt RG. Patient Satisfaction in Neurodevelopmental Pediatrics: In-Person vs Telemedicine. J Child Neurol 2022; 37:181-185. [PMID: 35410515 DOI: 10.1177/08830738221075451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As a result of the COVID-19 pandemic, medical practices for children with neurodevelopmental disorders urgently adopted telehealth, despite limited data regarding patient satisfaction. OBJECTIVE To compare patient satisfaction survey scores for neurodevelopmental pediatric appointments completed in-person to appointments completed via telemedicine. METHODS Using routinely collected Press Ganey survey results, the proportion of Top Box scores (the percentage of responses in the highest possible category [ie, the percentage of "very good" or "always" responses]) for an in-person only group was compared to the proportion in a telemedicine-only group using Fisher's exact test. RESULTS Most respondents gave Top-Box scores in response to all of the questions for both in-person and telemedicine visits. There were no statistically significant differences in any domain of the Press Ganey surveys in Top Box percentages for in-person vs telemedicine visits. CONCLUSION This study provides preliminary evidence that telehealth may be an acceptable modality for families seeking care for their children with neurodevelopmental concerns.
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Affiliation(s)
- Ann M Kennelly
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Brandon McIntyre
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Alexis C Wood
- USDA Children's Nutrition Research Center, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Sonia Monteiro
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Robert G Voigt
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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14
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Guan X, Zwaigenbaum L, Sonnenberg LK. Building Capacity for Community Pediatric Autism Diagnosis: A Systemic Review of Physician Training Programs. J Dev Behav Pediatr 2022; 43:44-54. [PMID: 34907998 PMCID: PMC8687619 DOI: 10.1097/dbp.0000000000001042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Training primary care providers to provide diagnostic assessments for autism spectrum disorder (ASD) decreases wait times and improves diagnostic access. Outcomes related to the quality of these assessments and the impacts on system capacity have not been systematically examined. This systematic review identifies and summarizes published studies that included ASD diagnostic training for primary care providers (PCPs) and aims to guide future training and evaluation methods. METHODS Systematic searches of electronic databases, reference lists, and journals identified 6 studies that met 3 inclusion criteria: training for PCPs, community setting, and training outcome(s) reported. These studies were critically reviewed to characterize (1) study design, (2) training model, and (3) outcomes. RESULTS All studies were either pre-post design or nonrandomized trials with a relatively small number of participants. There was considerable heterogeneity among studies regarding the training provided and the program evaluation process. The most evaluated outcomes were access to autism diagnosis and accuracy of diagnosis. CONCLUSION Training PCPs to make ASD diagnoses can yield high diagnostic agreement with specialty teams' assessments and reduce diagnostic wait times. Current data are limited by small sample size, poor to fair quality study methodology, and heterogenous study designs and outcome evaluations. Evidence is insufficient to draw conclusions about the overall effects of training PCPs for ASD diagnostic assessments. Since further research is still needed, this review highlights which outcomes are relevant to consider when evaluating the quality of ASD assessments across the continuum of approaches.
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Affiliation(s)
- Xiaoning Guan
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;
| | | | - Lyn K. Sonnenberg
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;
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15
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du Toit MN, van der Linde J, Swanepoel DW. mHealth developmental screening for preschool children in low-income communities. J Child Health Care 2021; 25:573-586. [PMID: 33124463 DOI: 10.1177/1367493520970012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% (n = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; n = 142) and Vineland-3 (87.1%; n = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.
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Affiliation(s)
- Maria N du Toit
- Department of Speech-Language Pathology and Audiology, 56410University of Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, 56410University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, 56410University of Pretoria, South Africa
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16
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Pediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Abstract
OBJECTIVE We developed a colocation "Rapid Developmental Evaluation" (RDE) model for Developmental-Behavioral Pediatrics (DBP) to evaluate young children for developmental concerns raised during routine developmental surveillance and screening in a pediatric primary care Federally Qualified Health Center (FQHC). In this low-income patient population, we anticipated that colocation would improve patient access to DBP and decrease time from referral to first developmental evaluation and therapeutic services. METHODS Children were assessed at the FQHC by a DBP pediatrician, who made recommendations for therapeutic services and further diagnostic evaluations. A retrospective chart review over 27 months (N = 151) investigated dates of referral and visit, primary concern, diagnosis, and referral to tertiary DBP center and associated tertiary DBP center dates of service and diagnoses if appropriate. We surveyed primary care clinicians (PCCs) for satisfaction. RESULTS The DBP pediatrician recommended that 51% of children be referred to the tertiary DBP center for further diagnostic evaluation or routine DBP follow-up. Average wait from referral to an RDE visit was 57 days compared with 137.3 days for the tertiary DBP center. Children referred from RDE to the tertiary DBP center completed visits at a higher rate (77%) than those referred from other sites (54%). RDE-recommended therapeutic services were initiated for 73% of children by the tertiary visit. Fidelity of diagnosis between RDE and the tertiary DBP center was high, as was PCC satisfaction. CONCLUSION Colocation of a DBP pediatrician in an FQHC primary care pediatrics program decreased time to first developmental assessment and referral for early intervention services for an at-risk, low-income patient population.
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18
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Snyder K, Rech JP, Masuda K, Dinkel D. Perspectives of infant active play: a qualitative comparison of working versus stay-at-home parents. BMC Public Health 2021; 21:250. [PMID: 33516184 PMCID: PMC7847006 DOI: 10.1186/s12889-021-10286-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parents play a key role in infant's development through their interactions and the type of environment they provide to promote active play. The amount of time parents are able to spend with their infant is dependent on their working status, yet few studies have explored parent perception of their infant's active play by working status. The purpose of this study was to explore parent perception of active play and compare responses between working and stay-at-home parents. METHODS Twenty-nine parents participated in this qualitative study by completing a one-time, in-person semi-structured interview based on the Theory of Planned Behavior. Themes were developed and compared based on parental working status using a directed content analysis approach. RESULTS All parents believed active play could have a positive effect on their child's development through physical, social and emotional, cognitive, and/or language and communication development. However, stay-at-home parents reported a broader impact of active play across these domains; whereas working parents most often referenced active play as impacting infant's physical development. Social and emotional interactions were the highest reported form of active play among all parents. Additionally, all parents described similar barriers to increasing the time for active play. The most commonly reported barrier for all parents was time or schedule followed by care needs of the infant, environmental concerns, and need for restrictive devices (e.g., car seats). More stay-at-home parents than working parents reported the care needs of the infant as being a barrier. Recommendations for active play were not widely known amongst all parents, with a higher percentage of working parents reporting they would desire advice from a healthcare provider. CONCLUSIONS Working status of parents appears to have implications on perceptions of active play which in turn may influence infants' development. Future studies should objectively assess the impact of parents' working status on infant development and explore how gender of the parent may serve as a confounding variable.
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Affiliation(s)
- Kailey Snyder
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA.
| | - John P Rech
- School of Health & Kinesiology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE, 68182, USA
| | - Kim Masuda
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE, 68182, USA
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19
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Rea CJ, Delano S, Hawryluk EB, Rosen M, Tran KD, Pearl M, Pethe K, Toomey SL. An Innovative Model for Providing Dermatology Services Within Primary Care. Acad Pediatr 2020; 21:723-727. [PMID: 33068810 PMCID: PMC7557161 DOI: 10.1016/j.acap.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Dermatologic complaints are common in outpatient pediatrics. However, pediatric dermatology specialty care can be difficult to access. We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the medical home while decreasing wait times. METHODS The Rapid Assessment of Skin Health (RASH) clinic was created within a hospital-based primary care clinic in 11/2013. The clinic was staffed by 2 pediatricians trained in the dermatology department and supported with specialist advice as needed. Referral volume and wait times to dermatology and RASH clinic were tracked for visits between 11/1/12 and 10/31/18. A chart review was also conducted on a subset of RASH clinic visits. Primary care providers (PCPs) were surveyed about their experiences. RESULTS Fifty-eight percent of patients referred for a dermatologic complaint were scheduled in RASH clinic. Wait times for new patient appointments in RASH clinic were significantly shorter than for new dermatology appointments in the previous 12 months (mean 36 days vs 65 days, P < .001). The monthly number of referrals to dermatology also decreased significantly after the RASH clinic opened (24/month vs 12/month, P < .001). Ten percent of RASH patients were referred on to dermatology. In a survey of PCPs (N = 67), 76% said the RASH clinic was "extremely/very helpful." CONCLUSIONS Providing dermatologic care to low or moderate complexity patients within the medical home is feasible and leads to better access to care. This innovative model could be spread to other clinics and subspecialties.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Address correspondence to Corinna J. Rea, MD, MPH, Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA 02115
| | - Sophia Delano
- Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Dermatology Program, Division of Allergy and Immunology, Boston Children's Hospital (S Delano and EB Hawryluk), Boston, Mass
| | - Elena B. Hawryluk
- Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Dermatology Program, Division of Allergy and Immunology, Boston Children's Hospital (S Delano and EB Hawryluk), Boston, Mass,Department of Dermatology, Massachusetts General Hospital (EB Hawryluk), Boston, Mass. Dr Pethe is now with Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY and also with NewYork-Presbyterian Hospital, New York, NY
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Katherine D. Tran
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Maria Pearl
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Kalpana Pethe
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
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20
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Pediatric subspecialty workforce: undersupply or over-demand? Pediatr Res 2020; 88:369-371. [PMID: 31958801 DOI: 10.1038/s41390-020-0766-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/08/2022]
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21
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Abstract
OBJECTIVE To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted. DESIGN/METHODS This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses. RESULTS Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity. CONCLUSION This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.
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22
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Increasing Access to Autism Spectrum Disorder Diagnostic Consultation in Rural and Underserved Communities: Streamlined Evaluation Within Primary Care. J Dev Behav Pediatr 2020; 41:16-22. [PMID: 31490843 PMCID: PMC6933088 DOI: 10.1097/dbp.0000000000000727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preliminary feasibility and clinical utility research has demonstrated that implementation of a streamlined diagnostic model embedded within primary care (PC) clinics promotes early identification of young children with autism spectrum disorder (ASD). Use of this model results in dramatically reduced waits for diagnostic consultation, high levels of family/provider satisfaction, and reductions in referrals to overtaxed tertiary diagnostic centers. The current study extends this work by providing data before/after implementation of a streamlined model across a diverse range of PC clinics that provide health care to rural and underserved communities. METHODS The streamlined assessment involved record/history review, diagnostic interview, standard rating scales, and an interactive screening tool. Eighty children between the ages of 19 and 47 months were seen across 5 different clinics. Data were collected through chart review. RESULTS Implementation of streamlined model resulted in a significant decrease in latency to diagnostic conclusion from a mean of 144.7 to 49.9 days. Children were likely to experience a greater reduction in wait times if they were a PC patient versus a non-PC patient. CONCLUSION Results show significant reduction in wait times for ASD diagnostic decisions across both PC and non-PC patients. By reducing waits and identifying concerns more efficiently, we may increase the ability of families to access early intervention and support services.
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23
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A Novel Approach to Increasing Access to Developmental-Behavioral Pediatrics Subspecialty Care. J Dev Behav Pediatr 2019; 38:429-430. [PMID: 28661953 DOI: 10.1097/dbp.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Williams-Arya P, Anixt J, Kuan L, Johnson H, Kent B, Bing N, Ehrhardt J, Manning-Courtney P. Improving Access to Diagnostic Assessments for Autism Spectrum Disorder Using an Arena Model. J Dev Behav Pediatr 2019; 40:161-169. [PMID: 30907770 DOI: 10.1097/dbp.0000000000000648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To improve access to diagnostic evaluations for children younger than 3 years with concerns for possible autism spectrum disorder. METHODS A multidisciplinary "arena model" for children younger than 3 years was developed, tested, and implemented over an approximately 2-year period. Arena assessment teams comprised a developmental behavioral pediatrician (DBP), psychologist, and speech language pathologist (SLP). Quality improvement methods were used during the design phase, conducting Plan-Do-Study-Act (PDSA) cycles and collecting feedback from key stakeholders, and during implementation, plotting data on run charts to measure outcomes of the time to initial visit and time to diagnosis. RESULTS Over the 9-month implementation period, 6 arena assessment teams were formed to provide 60 evaluation slots per month for children younger than 3 years. The time to first visit was reduced from a median of 122 days to 19 days, and the time to final diagnosis was reduced from 139 days to 14 days, maintaining these outcomes at <35 and <18 days, respectively, over a 2-year period. Total visits required decreased from 4 to 5 visits to just 2 visits, and the average assessment cost was reduced by $992 per patient. Feedback from both providers and families participating in this model was overwhelmingly positive. CONCLUSION Access for young children referred for developmental assessments can be improved through an understanding of supply and demand and the development of creative and flexible care delivery models.
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Affiliation(s)
- Pamela Williams-Arya
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Anixt
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lisa Kuan
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Heather Johnson
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bridget Kent
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nicole Bing
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer Ehrhardt
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Patricia Manning-Courtney
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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25
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A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children. J Dev Behav Pediatr 2019; 40:1-11. [PMID: 30461593 DOI: 10.1097/dbp.0000000000000621] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. METHODS Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). RESULTS The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. CONCLUSION Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.
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26
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Roberts MY, Stern Y, Hampton LH, Grauzer JM, Miller A, Levin A, Kornfeld B, Davis MM, Kaat A, Estabrook R. Beyond pass-fail: Examining the potential utility of two thresholds in the autism screening process. Autism Res 2018; 12:112-122. [PMID: 30556302 DOI: 10.1002/aur.2045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Access to early intervention as early in development as possible is critical to maximizing long-term outcomes for children with autism spectrum disorders (ASD). However, despite the fact that ASD can be reliably diagnosed by 24 months, the average age of diagnosis is 2 years later. Waitlists for specialized developmental evaluations are one barrier to early diagnosis. The purpose of this study was to examine one potential approach to reducing wait time for an ASD diagnostic evaluation by examining the utility of using more than one threshold for an autism screening tool, the Screening Tool for Autism in Toddlers and Young Children (STAT). Participants included 171 children between 24 and 36 months of age who received a medical diagnostic evaluation through Illinois' Early Intervention Program. This study directly compared the performance of the STAT when scored: (a) using the original single threshold, (b) using seven equally weighted items using a single threshold, and (c) using all items differentially weighted based on how strongly that item predicts a later ASD diagnosis. In addition, this study explored the potential utility of using two thresholds rather than a single threshold for each scoring method. Results of this study suggest that using a two-threshold logistic regression method has potential psychometric advantages over a single threshold and categorical scoring. Using this approach may reduce the wait time for specialty ASD diagnostic evaluations by maximizing true negatives and true positives, such that specialty evaluations may be reserved for those cases that are more ambiguous or more complex. Autism Research 2019, 12: 112-122. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examined the benefits of using two versus one cutoff score when screening for autism. Results indicate that having two scores and weighting test items based on predictive association with an autism diagnosis is better than using a single score and weighting each item equally. Using such an approach may reduce the wait time for specialty autism diagnostic evaluations, such that specialty evaluations may be reserved for those cases that are more ambiguous or more complex.
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Affiliation(s)
- Megan Y Roberts
- Northwestern University, Evanston, Illinois.,Northwestern University Center for Audiology, Speech, Language, and Learning, Evanston, Illinois
| | - Yael Stern
- Northwestern University, Evanston, Illinois
| | | | | | - Amanda Miller
- Northwestern University, Evanston, Illinois.,Northwestern University Center for Audiology, Speech, Language, and Learning, Evanston, Illinois
| | - Amy Levin
- Northwestern University, Evanston, Illinois.,Northwestern University Center for Audiology, Speech, Language, and Learning, Evanston, Illinois
| | - Benjamin Kornfeld
- Northwestern University, Evanston, Illinois.,Northwestern University Center for Audiology, Speech, Language, and Learning, Evanston, Illinois.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Matthew M Davis
- Northwestern University, Evanston, Illinois.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Aaron Kaat
- Northwestern University, Evanston, Illinois
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