Department of Psychology, University of Montana, Missoula, MT.
Department of Counseling, Psychology and Special Education, Brigham Young University, Provo, UT.
J Dev Behav Pediatr. 2019 Jan;40(1):1-11. doi: 10.1097/DBP.0000000000000621.
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.
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).
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.
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.
自闭症谱系障碍 (ASD) 的评估等待时间较长，从而延迟了获得 ASD 特定服务的机会。我们想知道，与传统的护理模式（要求所有患者都由心理学家进行 ASD 诊断决策）相比，我们的替代模式（更好地利用现有的临床医生，包括言语、听力和儿科医生的初步评估（接受过二级自闭症筛查工具的培训））有何不同。如果儿科医生对诊断有把握，可以立即进行诊断，但如果不确定，可以将不确定的病例转介给心理学。准确性、诊断时间、费用和家长满意度是我们的主要结果衡量标准。
通过记录提取（n=244）和家长问卷调查（n=57）收集数据。我们比较了传统和替代模式的诊断时间、费用和家长满意度。对于一个亚组（n=18），检查了儿科医生和心理学家诊断之间的一致性。
替代模式的诊断时间快了 44%（85 天对 152 天），总费用减少了 33%。对于 ASD 诊断的儿童，诊断一致性为 93%，对于没有 ASD 诊断的儿童，诊断一致性为 100%。儿科医生对自闭症症状水平较高的儿童表示更有把握进行诊断。家长报告说，他们对体验、以家庭为中心的护理和共同决策的满意度没有差异。
高效利用具有二级自闭症筛查额外培训的现有临床医生，可改善诊断时间，并为家庭减少费用。多学科团队的协调使这成为可能，通过工作流程对患者进行战略排序。灵活性不仅使儿科医生能够将不确定的病例转介给心理学进行诊断，而且使儿科医生能够在症状表现明显符合诊断标准时进行诊断，这一点至关重要。
