Impact of a digital Modified Checklist for Autism in Toddlers–Revised on likelihood and age of autism diagnosis and referral for developmental evaluation. (October 2020)

• Record Type: Journal Article
• Authors: Major, Samantha; Campbell, Kathleen; Espinosa, Steven; Baker, Jeffrey P; Carpenter, Kimberly LH; Sapiro, Guillermo; Vermeer, Saritha; Dawson, Geraldine
• Is Part Of: Autism. Volume 24:Number 7(2020)
• Page Start: 1629
• Page End: 1638
• Publication Date: 2020-10
• Subjects: ASD -- developmental evaluation -- quality improvement -- screening; Autism -- Periodicals; Autism in children -- Periodicals; 616.85882005
• DOI: 10.1177/1362361320916656
• Languages: English
• ISSNs: 1362-3613

Abstract

The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30 months old seen for 18 and 24 months' well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care. Lay abstract: This was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet's automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them.