348 - Quality Improvement in Medical Home Follow-up for Children with Newly Diagnosed Autism Spectrum Disorder

Poster Number: 348
Publication Number: 348.345

Cara Theoret, Vanderbilt University Medical Center – Graduate Medical Education, Nashville, TN, United States; Laleh Bahrami, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Shari Barkin, Vanderbilt University Medical Center, Nashville, TN, United States; Kathryn Carlson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Tori E. Foster, Vanderbilt University Medical Center / Vanderbilt Kennedy Center TRIAD, Nashville, TN, United States; Abhinaya Ganesh, Vanderbilt Children’s Hospital, Nashville, TN, United States; David P. Johnson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Holly Miller, Vanderbilt Division of General Pediatrics, Nashville, TN, United States; Barron Patterson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Jeffrey Hine, Vanderbilt University Medical Center, Nashville, TN, United States

Background: Parents of children with newly diagnosed autism spectrum disorder (ASD) report inadequate guidance regarding the complexities that often accompany ASD. Primary care providers (PCPs) play an important role in this, however, report insufficient training in discussing diagnosis or providing follow-up care for children with ASD. Using best practice guidelines, we created a standardized template for ASD-specific follow-up appointments within primary care that could help alleviate some of these concerns.

Objective: Our aims were to increase the percentage of children (aged 0-48 months) with newly-diagnosed ASD who attend ASD-specific follow up appointments and to use the novel ASD follow-up template in 80% of those visits.

Design/Methods: Our study population consisted of children aged 0–48 months who are patients of the Vanderbilt Primary Care Clinic (PCC) and received a new diagnosis of ASD. All providers were trained in the use of a novel clinic note template that integrated best practices, including genetic testing and co-occurring medical concerns. Patients were scheduled for a follow-up appointment with a PCC provider. The availability of telehealth for our families has been emphasized if access is a concern. Baseline data were obtained for 12 months and were followed prospectively using statistical process control charts while the team tested changes using Plan-Do-Study-Act (PDSA) Cycles monthly.

Results: Baseline data collected from June 2020 to May 2021 included 71 patients. A mean of 9.8% of patients had ASD-specific follow-up (ASD listed as chief complaint). As seen in Figure 1, our project has demonstrated special cause variation in two consecutive months following project initiation. Also, use of our note template in these ASD follow-up appointments was 78.5% (Figure 2). Confounders included local COVID surges and loss of our scheduling coordinator in August 2021.Conclusion(s): Our initial efforts to improve ASD-specific follow-up and promote a novel template resulted in evidence of special cause variation in the percentage of children with ASD-specific follow-up, though we have not yet demonstrated a shift in our system through a centerline shift. With additional PDSA cycles including new scheduling plans, further provider education, and expansion of telehealth within the clinic, we hope to sustain our goal and improve the consistent evidence-based management for children with newly diagnosed ASD.
CTheoret CV SubmissionCTheoret Residency CV.pdf
Figure 2: Percent of ASD Follow-up Appointments Utilizing the Note Template, P ChartFigure 2: P Chart Demonstrating Percent of ASD Follow Up Appointments Utilizing Novel Clinic Note Template