Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and.
Pediatrics. 2020 Aug;146(2). doi: 10.1542/peds.2019-3876. Epub 2020 Jul 6.
Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.
尽管自闭症谱系障碍（ASD）可以在两岁时可靠地检测到，但平均诊断年龄为 4 至 5 岁。由于无法及时进行 ASD 诊断评估，导致无法及时对已知可改善发育结果的干预措施进行干预。因此，开发和测试用于 ASD 诊断的简化方法是公共卫生和研究的重点。在本报告中，我们描述了早期自闭症评估（EAE）中心系统，这是在初级保健环境中进行 ASD 筛查和诊断的全州性计划。EAE 中心系统的开发涉及向初级保健机构提供有针对性的发育筛查技术援助、社区外展和培训初级保健临床医生进行 ASD 评估。在 EAE 中心，实施了标准的临床途径，用于评估 18 至 48 个月大的 ASD 风险儿童。从 2012 年到 2018 年，共有 2076 名儿童接受了评估（平均年龄：30 个月；中位数评估等待时间：62 天），其中 33%的儿童被诊断为 ASD。我们的研究结果表明，在面临医疗保健获取问题的地理区域，开发分层发育筛查和早期 ASD 评估系统是可行的。通过有针对性地提供教育、外展和强化实践培训，可以在当地的初级保健环境中识别、转介和评估大量有 ASD 风险的幼儿。EAE 中心模式有可能推广到其他面临类似神经发育保健系统负担的州。审查了实施经验教训以及关键系统的成功、挑战和未来方向。
