Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA.
J Dev Behav Pediatr. 2020 Jun/Jul;41(5):340-348. doi: 10.1097/DBP.0000000000000789.
We developed a colocation "Rapid Developmental Evaluation" (RDE) model for Developmental-Behavioral Pediatrics (DBP) to evaluate young children for developmental concerns raised during routine developmental surveillance and screening in a pediatric primary care Federally Qualified Health Center (FQHC). In this low-income patient population, we anticipated that colocation would improve patient access to DBP and decrease time from referral to first developmental evaluation and therapeutic services.
Children were assessed at the FQHC by a DBP pediatrician, who made recommendations for therapeutic services and further diagnostic evaluations. A retrospective chart review over 27 months (N = 151) investigated dates of referral and visit, primary concern, diagnosis, and referral to tertiary DBP center and associated tertiary DBP center dates of service and diagnoses if appropriate. We surveyed primary care clinicians (PCCs) for satisfaction.
The DBP pediatrician recommended that 51% of children be referred to the tertiary DBP center for further diagnostic evaluation or routine DBP follow-up. Average wait from referral to an RDE visit was 57 days compared with 137.3 days for the tertiary DBP center. Children referred from RDE to the tertiary DBP center completed visits at a higher rate (77%) than those referred from other sites (54%). RDE-recommended therapeutic services were initiated for 73% of children by the tertiary visit. Fidelity of diagnosis between RDE and the tertiary DBP center was high, as was PCC satisfaction.
Colocation of a DBP pediatrician in an FQHC primary care pediatrics program decreased time to first developmental assessment and referral for early intervention services for an at-risk, low-income patient population.
我们为发展行为儿科学（DBP）开发了一种共置的“快速发展评估”（RDE）模型，以评估在儿科初级保健联邦合格医疗中心（FQHC）的常规发育监测和筛查中出现发育问题的幼儿。在这个低收入患者群体中，我们预计共置将改善 DBP 的患者获得途径，并减少从转介到首次发育评估和治疗服务的时间。
由 DBP 儿科医生在 FQHC 对儿童进行评估，医生对治疗服务和进一步诊断评估提出建议。对 27 个月的回顾性图表审查（N=151）调查了转介和就诊日期、主要关注点、诊断以及向三级 DBP 中心的转介情况和相关的三级 DBP 中心服务日期和诊断（如果适用）。我们对初级保健临床医生（PCC）进行了满意度调查。
DBP 儿科医生建议 51%的儿童转介到三级 DBP 中心进行进一步的诊断评估或常规 DBP 随访。从转介到 RDE 就诊的平均等待时间为 57 天，而到三级 DBP 中心的等待时间为 137.3 天。从 RDE 转介到三级 DBP 中心的儿童就诊率（77%）高于其他转介来源（54%）。在三级就诊时，RDE 推荐的治疗服务已为 73%的儿童开始实施。RDE 和三级 DBP 中心之间的诊断一致性较高，PCC 的满意度也很高。
在 FQHC 初级保健儿科项目中，将 DBP 儿科医生共置可减少高危、低收入患者群体首次发育评估和早期干预服务的转介时间。
