607 - Provider and Clinic Variability in Referral Rates after a Positive Developmental Screen

Poster Number: 607
Publication Number: 607.310

Mohadeseh Solgi, Oregon Health and Science University, Portland, OR, United States; Catrina A. Calub, Doernbecher Children's Hospital at Oregon Health & Science University, portland, OR, United States; Alicia Feryn, Oregon Health & Science University School of Medicine, Portland, OR, United States; Eric J. Fombonne, Oregon Health & Science University, Portland, OR, United States; Cheryl Matushak, Oregon Pediatric Society, Portland, OR, United States; Abby Bush, Help Me Grow Oregon, Portland, OR, United States; Katharine Zuckerman, Oregon Health & Science University, Portland, OR, United States

Background: Early identification of developmental disabilities can lead to better long-term outcomes for children. Primary care providers screen for developmental disabilities at toddler well-child visits and represent a primary source of referral to Early Intervention (EI). However, not all children with positive screening tests are referred to EI. 

Objective: The goal of this research was to understand which provider-related factors were associated with referral to EI after a positive general developmental or autism screening test result.

Design/Methods: We reviewed screening test results on the Ages & Stages Questionnaire, Third Edition (ASQ-3) and the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), for 1,864 15-, 18-, 24- and 30-month well-child checks performed by 41 providers at 7 community primary care clinics in 4 Oregon counties, in 2021. ASQ-3 domain scores of at least one fail or two borderlines, and M-CHAT-R scores ≥ 3 were considered positive screens. We calculated a referral rate (number of referrals per number of positive screens) for each provider and for each clinic. ASQ-3 and M-CHAT-R screens were considered separately. Bivariate statistics were used to test the association of provider sociodemographic characteristics (race/ethnicity, gender) and professional characteristics (clinic, years in role, medical specialty, provider type) with provider’s referral rate.  

Results: Of 259 children with positive ASQ-3 screens, providers referred 104 to EI (40.1%). Of 92 children with positive M-CHAT-R screens, providers referred 46 (50%). Most providers were white (64.7%), female (79.4%) and pediatricians (88.2%). Overall provider referral rates for positive screens varied from 0% to 100% for both ASQ-3 and M-CHAT-R, with a median referral rate of 33% for ASQ-3 and 50% for M-CHAT-R. Clinic site was significantly associated with referral for ASQ-3 (p < 0.001) and M-CHAT-R (p=0.001; Figure 1). Two clinics had significant variability among providers for ASQ-3, and one clinic had significant variability among providers for M-CHAT-R. No provider sociodemographic or professional characteristics were significantly associated with referral rate.  Conclusion(s): Where, and by whom a child is seen for well-child care impacts whether the child is referred to EI. Provider demographic features were not associated with referral rate. Though the optimal referral rate after a positive screen is unknown, these data suggest that greater provider uniformity in referral decisions may be needed.   
Figure 1: Proportion of children referred given a positive screening test result, ASQ-3 of M-CHAT-R, by primary care clinic in 7 different Oregon counties.