Kaitlyn Ahlers, MA1,2, Anna Brady, MS Ed.

1,3, April Litchford, MS, RD1,3, Allison Ellzey, MD4, Jason Fox, MPA/MHA4, Sarah Winter,
MD4, Terisa Gabrielsen, PhD5, Paul S. Carbone, MD4
1URLEND, 2University of Montana, 3Utah State University, 4University of Utah, 5Brigham Young University

No significant differences between the the two groups with regards to race/ethnicity, gender, or type of insurance

BACKGROUND Figure 1: Traditional Model n=143 Figure 2: Alternative Model n=101

RESULTS CONCLUSIONS
Early treatment of autism spectrum disorder (ASD) is Table 1: Comparison of total charges and time to
associated with improved functional outcomes. Alternative model with pediatricians as
Referral made and intake diagnosis between traditional and alternative models.
< 50% with ASD are diagnosed before 3 yrs. old, median Referral made and packet received
initial diagnosticians was shown to
diagnosis is at 53 mos. Traditional Alternative P-value decrease time to diagnosis and total
Wait times for ASD diagnostic evaluations can be 6-12 mos.
intake packet Model Model charges compared to traditional model.
received Time to 152 85 <0.001
diagnosis (CI: 140-164) (CI:72-96) Parent satisfaction with both models was
OBJECTIVES high and did not differ between models.
Compare time to diagnosis between traditional and alternative (days)
Speech Language Pathologist
ASD multidisciplinary evaluation models. Audiologist (all patients) Total 1859 1246 <0.001
(all patients) Pediatricians with advanced training in
Compare total charges and parent satisfaction between charges ($) (CI: 1749-1969) (CI: 1105-1370)
ASD were able rule in or rule out ASD in
models. Audiologist more than half of cases, preventing
Assess diagnostic agreement among pediatricians and (all patients) Pediatrician Alternative model (n=101):
psychologists in children evaluated within the alternative model Evaluation by 57 (56%) ASD ruled in/out by pediatricians
some psychology evaluations.
who saw both providers. interdisciplinary Pediatrician Evaluation ASD
44 (44%) sent to psychology by pediatricians due to
Decrease in time to diagnosis and lower
diagnostic uncertainty
team members (1 appointment) diagnosis 18 sent to psychology by pediatricians despite
charges under alternative model.
based on review Developmental history given; child diagnostic certainty
Acceptable diagnostic agreement.
METHODS Physical examination referred to No significant differences in proportion of children
Prior to spring 2016, ASD diagnoses were made by
Speech of intake packet Review of audiology and ASD-specific diagnosed with ASD by pediatricians (58%) and by
Language Occupational
psychologists with input from a multidisciplinary team (Fig. 1). speech language reports services psychologists (51%) (p=0.479)
In a quality improvement project to reduce wait times, an Pathologist Therapist IMPLICATIONS
Pediatrician-administered Increasing the diagnostic role of
alternative care process model (Fig. 2) was developed. Children Diagnostic agreement among children seen by
Level 2 ASD screening test Non-ASD pediatricians within multidisciplinary
were initially evaluated by audiology and speech-language pediatrician and psychologist within alternative
(STAT or AMSE) diagnosis model when pediatrician had diagnostic certainty teams may shorten the time to ASD
pathology followed by a pediatrician.
Parent-completed Level 2 given; child diagnosis, decrease the cost of
Pediatrician was trained in administration and interpretation (ASD or non-ASD very likely) (n=18):
of: Psychology Evaluation ASD screening test (ASRS) referred to 93% agreement among pediatricians and evaluations and hasten access to
Screening Tool for Autism in Toddlers and Young (3 appointments) appropriate psychologists when ASD was ruled in (n=14) services, with no apparent differences
Pediatrician unable to parent satisfaction.
Children (STAT), Developmental profile services 100% agreement among pediatricians and
rule in or rule out
Autism Mental Status Examination (AMSE), psychologists when ASD was ruled out (n=4)
Autism Spectrum Rating Scales (ASRS).
Cognitive measures ASD
LIMITATIONS
If diagnostic certainty: pediatrician ruled in/ruled out ASD Adaptive measures Parental Satisfaction Survey:
More than half of ASD diagnoses made by
Psychology Evaluation 61.2% of all respondents (n=49) were extremely
and referred to appropriate intervention services. Parent-completed Level 2 (1-2 appointments) satisfied and 28.6% were moderately satisfied pediatricians were not confirmed by a
If diagnostic uncertainty: pediatrician referred to psychology ASD screening test (ASRS) psychologist evaluation.
Developmental profile No statistically significant differences in the
for evaluation and administration of ASD specific diagnostic
test (Autism Diagnostic Observation Schedule-2 [ADOS-2]). Broad behavioral measure Cognitive measures proportion of parents in the two cohorts (traditional
and alternative) who reported overall satisfaction, Parent response rate was unbalanced
Executive function Adaptive measures between the two models, may not be
shared decision making (SDM) and receipt of
We compared time to diagnosis (ASD or non-ASD) and total screener Parent-completed Level 2 ASD representative of all parents.
family-centered care (FCC)
charges for both models.
Autism Diagnostic screening test (ASRS)
Pediatricians self-rated their diagnostic certainty for all children Broad behavioral measure Table 2: Comparison of the percentage of each cohort
(ASD or non-ASD very likely, somewhat likely, somewhat Observation Schedule-2 who endorsed experiencing FCC and SDM.
Executive function screener FUTURE STEPS
unlikely, very unlikely). (ADOS-2) Autism Diagnostic Observation Traditional Alternative P-value Assess diagnostic agreement between
We compared diagnostic agreement for all children within the Schedule-2 (ADOS-2) pediatricians and psychologists in a larger
Model Model
alternative model that were sent on to psychology when sample, including children diagnosed
(n=35) (n=14)
pediatricians self-rated diagnostic certainty was high (ASD or initially by pediatricians.
non-ASD very likely). Family-Centered 85.7 100 0.136
We compared parental satisfaction, family centered care and Care (%)
Collect data from larger sample of parents
shared decision making within each cohort (alternative and ASD diagnosis given; Non-ASD diagnosis given; ASD diagnosis given; child Non-ASD diagnosis given; Shared Decision 77.1 92.9 0.199 regarding satisfaction.
traditional) with a survey. child referred to ASD- child referred to services referred to ASD- specific child referred to Making (%)
specific services appropriate to diagnosis services appropriate services
www.postersession.com