Duke University School of Nursing, Durham, NC, USA.
J Dev Behav Pediatr. 2011 Jan;32(1):48-51. doi: 10.1097/DBP.0b013e3182040aea.
One in 110 children in the United States has autism spectrum disorder (ASD). Early identification and early intervention have been shown to improve outcomes for children with ASD. Although recommended, routine ASD screening at 18 and 24 months of age has not been widely adopted in practice. This quality improvement study examined whether a private primary care practice could overcome screening barriers and implement the recommended universal ASD screening practice using the Modified Checklist for Autism in Toddlers™.
Guided by the Diffusion of Innovations evidence-based conceptual model, a practice change using the Modified Checklist for Autism in Toddlers™ was developed. A retrospective chart review of 99 subjects was done to evaluate screening fidelity and cost.
An overall screening fidelity of 91% was achieved over a 7-month period. The cost of screening to the practice averaged $22.78 per month. This was offset by an average of $38.76 of revenue per month.
These findings suggest that low-cost universal screening can be implemented in primary care when addressed from an organizational perspective.
美国每 110 名儿童中就有 1 名患有自闭症谱系障碍（ASD）。早期识别和早期干预已被证明可以改善 ASD 儿童的预后。尽管推荐在 18 个月和 24 个月大时进行常规 ASD 筛查，但在实践中并未广泛采用这种筛查方法。这项质量改进研究旨在检验一个私人初级保健机构是否可以克服筛查障碍，并使用改良婴儿自闭症检查表（M-CHAT）来实施推荐的普遍自闭症筛查实践。
以创新扩散理论为指导，采用改良婴儿自闭症检查表（M-CHAT）进行实践变革。对 99 名受试者进行了回顾性图表审查，以评估筛查的准确性和成本。
在 7 个月的时间里，总体筛查准确率达到了 91%。筛查的月平均成本为 22.78 美元。每月平均收入为 38.76 美元，这部分抵消了筛查的成本。
这些发现表明，从组织角度出发，可以在初级保健中实施低成本的普遍筛查。
