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A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children

Ahlers, Kaitlyn, MA*; Gabrielsen, Terisa P., PhD; Ellzey, Allison, MD; Brady, Anna, PhD§; Litchford, April, MS, RD; Fox, Jason, MPA, MHA; Nguyen, Quang-Tuyen, MD; Carbone, Paul S., MD

Journal of Developmental & Behavioral Pediatrics: January 2019 - Volume 40 - Issue 1 - p 1–11
doi: 10.1097/DBP.0000000000000621
Original Articles
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Objectives: Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures.

Methods: Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18).

Results: The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making.

Conclusion: Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.

This article has supplementary material on the web site: www.jdbp.org.

*Department of Psychology, University of Montana, Missoula, MT;

Department of Counseling, Psychology and Special Education, Brigham Young University, Provo, UT;

Department of Pediatrics, University of Utah, Salt Lake City, UT. Ellzey is now with the Division of Developmental Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA;

§Center for Persons with Disabilities, Utah State University, Logan, UT;

Department of Nutrition, Dietetics and Food Science, Utah State University, Logan, UT.

Address for reprints: Paul S. Carbone, MD, Department of Pediatrics, University of Utah, 295 Chipeta Way, UT 84108; e-mail: paul.carbone@hsc.utah.edu.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org).

Ahlers, Fox, and Litchford, as well as Gabrielsen, Ellzey, Brady, Nguyen, and Carbone contributed to the design, data collection, analysis, and preparation of the manuscript. All authors have read and approved the final manuscript.

Received March , 2018

Accepted August 21, 2018

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