Improving Rates of Screening for Autism and Referral for Early Intervention in Children in a Culturally Diverse Primary Care Clinic

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Thomas, Joslyn
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Background: The prevalence of autism in the United States is one in 54 children; early screening and intervention is key to reducing and preventing morbidity and mortality. Literature shows that use of standardized screening tools, electronic support and educating providers helps obtain early screening. Disparities exist for autism screening and diagnosis.|Purpose: Increase autism screening for pediatric patients in a culturally diverse primary care clinic using the M-CHAT R/F screening tool.|Methods: An educational presentation was provided to increase provider autism screening knowledge. Clinic process changes included screening reminders in the EMR, a plan for screening administration during the visit, multiple languages of the M-CHAT R/F made available, and creation of an EMR screening score documentation tool. Data points collected include the number of children screened at their 18 and 24 months well child visits, the number of patients referred to services for autism evaluation and treatment, and the number of documented ICD-10 billing code Z13.41, “Encounter for Autism Screening”. Data collected during this 14-week project was compared to the 14 weeks prior to the project start through retrospective chart review.|Evaluation: In the 14 weeks after project implementation 17.6% of 51 children were screened with the M-CHAT R/F, compared to 15.6% of 32 children at baseline. 18% of non-English speaking patients were screened compared to 9% at baseline, while 33.3% of the English-speaking patients were screened compared to 37.5% at baseline. The ICD-10 code Z13.41 was used on 5.8% of visits compared to 0% baseline use. No patients were referred to services based on their screenings in either data collection period.|Implications to Practice: Autism screening and reimbursement increased overall, and screening for non-English speaking patients doubled. Screening for autism in a culturally diverse population can be improved by reducing barriers like provider knowledge and refining clinic processes.
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