Harrison Meghan, Jones Persephone, Sharif Iman, Di Guglielmo Matthew D
*Department of General Pediatrics, Division of Developmental Medicine, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE; †Department of General Pediatrics, Division of General Pediatrics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE; ‡Department of General Pediatrics, Division of Gastroenterology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE.
J Dev Behav Pediatr. 2017 Jul/Aug;38(6):353-357. doi: 10.1097/DBP.0000000000000448.
To describe and evaluate the effectiveness of a quality improvement project to decrease wait time to evaluation for children referred to Developmental Behavioral Pediatricians (DBPs).
The authors created a Behavioral/Developmental Access Clinic (BDAC) staffed by a general pediatrician (GP) and pediatric psychologist. Clinicians in the BDAC provided comprehensive developmental evaluations for children in a discrete age range (<5 yr old). We describe the establishment of the BDAC along with referrals, diagnoses, and recommended follow-up for patients seen by the GP. We used 2-tailed t tests to compare the mean time with initial evaluation for patients seen in BDAC versus a DBP.
Sixty-three children were seen in BDAC over 6 months. Referrals from the BDAC included: physical/occupational/speech therapy (71%), psychology (35%), audiology (25%), genetics (14%), and neurology (8%). Five patients (8%) were diagnosed with autism spectrum disorder (ASD). Compared with time to appointment with a DBP (327 d), mean time to developmental assessment was shorter for the 45 patients who accepted earlier appointments in the BDAC (159 d), and for the 18 children seen in the BDAC as new referrals (11 d), p < .001. Follow-up with a DBP was recommended for 9 (50%) of the new patient referrals evaluated in BDAC.
The BDAC allowed for earlier developmental assessment of young children, with potential for earlier diagnosis and treatment of developmental disorders, including ASD. Opportunity for initial evaluation in BDAC decreased the number of patients requiring evaluation by DBPs, improving access to this subspecialty in our institution.
描述并评估一项质量改进项目的效果，该项目旨在缩短转诊至发育行为儿科医生（DBP）处的儿童的评估等待时间。
作者设立了一个行为/发育门诊（BDAC），由一名普通儿科医生（GP）和一名儿科心理学家坐诊。BDAC的临床医生为特定年龄范围（<5岁）的儿童提供全面的发育评估。我们描述了BDAC的设立情况以及GP诊治患者的转诊、诊断和推荐的随访情况。我们使用双尾t检验比较BDAC与DBP处患者初次评估的平均时间。
6个月内BDAC共诊治了63名儿童。BDAC的转诊科室包括：物理/职业/言语治疗（71%）、心理学（35%）、听力学（25%）、遗传学（14%）和神经学（8%）。5名患者（8%）被诊断为自闭症谱系障碍（ASD）。与预约DBP的时间（327天）相比，BDAC中45名接受较早预约的患者的发育评估平均时间较短（159天），BDAC中新转诊的18名儿童的发育评估平均时间也较短（11天），p < .001。BDAC评估的新患者转诊中有9名（50%）被建议随访DBP。
BDAC能够对幼儿进行更早的发育评估，有可能更早地诊断和治疗发育障碍，包括ASD。在BDAC进行初次评估的机会减少了需要DBP评估的患者数量，改善了我院对该亚专业的医疗服务可及性。
