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Computer Decision Support to Improve Autism Screening and Care in Community Pediatric Clinics

Bauer, Nerissa S. MD, MPH; Sturm, Lynne A. PhD; Carroll, Aaron E. MD, MS; Downs, Stephen M. MD, MS

doi: 10.1097/IYC.0b013e3182a4ec5e
Original Study

An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess outcomes, such as changes in identification and referrals, we reviewed data captured from the CDSS. Between November 15, 2010 and July 26, 2012, 857 patients were eligible for screening. Of these, 66% (567/857) were screened as determined by the number of forms scanned into the system, of which 30% (171/567) had concerning Modified Checklist for Autism in Toddlers. However, pediatricians failed to respond to alerts for 73 children. Of the remaining 98 children, pediatricians felt 50 (68%) did not have an Autism spectrum disorder, 23 (32%) were referred for autism evaluation, eight (11%) were suspected but not referred and two (3%) were referred for audiology. Seventy percent of all users agreed that automation of the screening process helped them to adhere to recommended guidelines. Automating autism care into a CDSS resulted in moderate adherence to guidelines. Health information technology can facilitate the implementation of autism guidelines in busy pediatric clinics.

Department of General and Community Pediatrics (Drs Bauer, Sturm, Carroll, and Downs) and Section of Children's Health Services Research (Drs Bauer, Carroll, and Downs), Indiana University School of Medicine, Indianapolis.

Correspondence: Nerissa S. Bauer, MD, MPH, Department of General and Community Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Suite 1000, Indianapolis, IN 46202 (

The authors wish to acknowledge the technical expertise and efforts of the individual members of the Child Health Informatics and Research Development Lab (CHIRDL) team, which provided programming and technical support for Child Health Improvement through Computer Automation (CHICA); Naomi Swiezy, PhD, for her thoughtful edits on the behavior JITs (Just-in-Time) for the family and pediatrician; the Pediatric Research Network (PResNet) at Indiana University for administering the CHICA satisfaction survey at the pediatric clinics with CHICA; and the clinic personnel who constantly helped them evaluate and improve CHICA.

This project was supported by grant number R01HS018453 from the Agency for Healthcare Research and Quality.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Clinical Trial Registry Name & Number: Study of the effectiveness of a computer decision support system to improve physicians' screening for autism, Identifier: NCT01612897

The authors declare no conflict of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.