347 - Increasing Detection of Autism in Primary Pediatric Care

Poster Number: 347

MengMeng Xu, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Mariellen Lane, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Evelyn Berger-Jenkins, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: 1 in 54 children is now diagnosed with autism. Intervention before age 3 is essential for improved outcomes. Although the American Academy of Pediatrics (AAP) recommends all children be screened for autism at 18 and 24 months, identifying these patients  during time-limited well child visits is difficult. Autism is therefore diagnosed at a mean age of 4.5 years. Given this gap, we worked to improve early identification of autism in our clinic well visits.

Objective: Improve early identification of autism in our clinic well visits using QI methodology and iterative PDSA cycles to improve MCHAT screen completion, with a goal of screening 60% of patients by the end of one year.

Design/Methods: At a New York City academic medical center associated primary care clinic, pediatric residents designed and implemented a QI project introducing an electronic medical record (EMR) integrated Modified Checklist for Autism in Toddlers (MCHAT) screen to identify autism risk during 16-26 month well child checks. Key drivers included pediatrician and staff autism education, EMR screening optimization, and family engagement. Education interventions included clinic wide lessons and engagement of all staff in the creation and use of handouts to educate patients. The EMR was also used to screen patients prior to appointments using the patient portal and families were provided with screenshots and job aide instructions during visits.

Results: We initially had < 10% completion of autism screens in our cohort of 16-26 mo patients. Rates increased to 35% after pediatrician education. After clinic-wide staff education and pre-visit EMR integration of the screen, rates increased to 58%. MCHAT completion rates then troughed at 18% despite standardizing MCHAT documentation, posting instructive signs in exam rooms (Fig 1), and creating handouts to increase patient engagement (Fig 2). However, daily reminders in clinic-wide staff EMR “chat” messages then restored completion rates to 23%. Finally, enlisting waiting room volunteers to support parents in completing screens brought our numbers to 53% by the end of the year-long project (Fig 3).Conclusion(s): Using our EMR, we were able to improve completion of an objective autism screen from near 0% to 53% by the end of the year-long project. The most meaningful interventions were automated pre-screens and increasing clinic staff buy in. We had difficulty maintaining rates of autism screening after an initially enthusiastic response, indicating a need for a clinic culture shift which emphasizes the importance of early autism identification and intervention from all clinic staff members.
Figure 1. Patient portal instructions for filling out the MCHAT.English and Spanish versions of the signage posted in waiting rooms and exam rooms giving parents step-by-step instructions on completing the MCHAT screen via the patient portal.
Figure 2. Patient autism education material.The English version of the educational material created and provided to parents that gives basics on what autism is, why providers check for autism, and the importance of early diagnosis.