Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Dev Behav Pediatr. 2019 Apr;40(3):161-169. doi: 10.1097/DBP.0000000000000648.
To improve access to diagnostic evaluations for children younger than 3 years with concerns for possible autism spectrum disorder.
A multidisciplinary "arena model" for children younger than 3 years was developed, tested, and implemented over an approximately 2-year period. Arena assessment teams comprised a developmental behavioral pediatrician (DBP), psychologist, and speech language pathologist (SLP). Quality improvement methods were used during the design phase, conducting Plan-Do-Study-Act (PDSA) cycles and collecting feedback from key stakeholders, and during implementation, plotting data on run charts to measure outcomes of the time to initial visit and time to diagnosis.
Over the 9-month implementation period, 6 arena assessment teams were formed to provide 60 evaluation slots per month for children younger than 3 years. The time to first visit was reduced from a median of 122 days to 19 days, and the time to final diagnosis was reduced from 139 days to 14 days, maintaining these outcomes at <35 and <18 days, respectively, over a 2-year period. Total visits required decreased from 4 to 5 visits to just 2 visits, and the average assessment cost was reduced by $992 per patient. Feedback from both providers and families participating in this model was overwhelmingly positive.
Access for young children referred for developmental assessments can be improved through an understanding of supply and demand and the development of creative and flexible care delivery models.
改善对 3 岁以下有自闭症谱系障碍可能的儿童的诊断评估的获取途径。
为 3 岁以下儿童开发、测试和实施了一种多学科的“竞技模式”。竞技评估团队由发育行为儿科医生（DBP）、心理学家和言语语言病理学家（SLP）组成。在设计阶段使用了质量改进方法，进行了计划-执行-研究-行动（PDSA）循环，并从主要利益相关者那里收集反馈，在实施过程中，通过运行图表绘制数据，以衡量初始就诊时间和诊断时间的结果。
在 9 个月的实施期间，成立了 6 个竞技评估团队，每月为 3 岁以下儿童提供 60 个评估名额。首次就诊时间从中位数 122 天缩短至 19 天，最终诊断时间从 139 天缩短至 14 天，在 2 年期间分别保持在<35 天和<18 天。总就诊次数从 4 次减少到 5 次，再减少到 2 次，每位患者的平均评估费用减少了 992 美元。参与该模式的提供者和家庭的反馈都是非常积极的。
通过了解供需情况并开发创新和灵活的护理提供模式，可以改善对接受发育评估的幼儿的获取途径。
