Division of General Pediatrics, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #76, Los Angeles, CA, 90027, USA.
Keck School of Medicine of USC, Los Angeles, CA, USA.
Matern Child Health J. 2024 Oct;28(10):1716-1725. doi: 10.1007/s10995-024-03970-y. Epub 2024 Aug 12.
Many barriers to implementation of developmental screening in primary care exist, especially for children from under-resourced communities. Developmental screening is vital to early detection of developmental delay and autism spectrum disorder, and early intervention (EI) referral. This study sought to examine whether implementation of a standardized clinical workflow using electronic screening tools improved both rates of developmental screening, and the number of children identified at risk for developmental delay, in a federally qualified health center (FQHC).
A retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher's Exact analyses were conducted.
ASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001).
Implementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.
初级保健中存在许多实施发育筛查的障碍，尤其是对于资源匮乏社区的儿童。发育筛查对于早期发现发育迟缓及自闭症谱系障碍并及时进行早期干预转诊至关重要。本研究旨在探讨在联邦合格医疗中心（FQHC）中使用电子筛查工具实施标准化临床工作流程是否能提高发育筛查率，以及增加识别发育迟缓风险儿童的数量。
本研究在一所学术附属 FQHC 中开展了一项回顾性研究。在儿童常规保健就诊时使用电子版 Ages and Stages Questionnaire 3（ASQ-3）和 Modified Checklist in Autism for Toddlers Revised（M-CHAT-R）进行筛查。同时为医生提供了关于发育筛查和早期干预转诊的新的临床工作流程培训。采用卡方检验和 Fisher 精确检验进行分析。
ASQ-3 筛查率从干预前的 62.7%增加到干预后的 73.6%。干预后，纸质筛查数量显著减少（p<0.001），ASQ-3 结果低于临界值的儿童比例从 14.7%增加到 18.2%（p<0.002）。M-CHAT-R 筛查率从干预前的 56.4%增加到干预后的 59.4%。干预后，电子筛查数量显著增加（p<0.001）。
在 FQHC 中实施电子筛查工具可提高普遍发育筛查率。为减少资源匮乏社区的障碍，电子工具的使用可能会降低纸质筛查中出现的筛查错误率，并有可能更好地识别有发育迟缓风险的儿童。
