title: Lowering developmental screening thresholds and raising quality improvement for preterm children.
abstract: OBJECTIVE
  To determine: 1) if preterm children were referred, identified and received early intervention (EI)/ early childhood special education (ECSE) services at rates equivalent to term children after implementation of a universal, periodic Ages and Stages Questionnaire (ASQ) surveillance and screening system; 2) if pediatricians sufficiently lowered their screening thresholds with preterm children;and 3) if quality improvement opportunities exist.
  
  
  METHODS
  Secondary analysis was performed on 64 lower-risk, mostly late-preterm and 1363 term children who originally presented to their 12- or 24-month well- visits. Higher-risk preemies already involved with an EI agency/ identified with a delay were excluded. Board-certified pediatricians (N=18), and nurse practitioners (N = 2), blind to the ASQ results, were secondary participants. Differences between preterm and term developmental agency referrals were examined comparing Pediatric Developmental Impression to the ASQ under natural clinic conditions using a combined in-office or mail-back data collection protocol. Medical record and county EI/ECSE follow-up outcomes were conducted at 36 to 60 months.
  
  
  RESULTS
  At 12 and 24 months, preterm (versus term) referral rates were 9.5%(versus 5.6%) with Pediatric Developmental Impression and 26.2% (versus 8.1%) with the ASQ. By 36 to 60 months, 37.5% of preterm (20.8% term) children were referred to EI/ECSE; of which, 50.0% of preterm (42.4% term) children were eligible for services, 54.2%of preterm children were identified with a developmental-behavioral disorder and 29.2% of preterm (20.8% term) children did not follow-up. For ASQ-only preterm referrals,55.6% were subsequently diagnosed with a developmental delay and/or disorder.Preterm children were 2 times more likely to be eligible than term children [corrected].
  
  
  CONCLUSIONS
  Combined referral, quality improvement and outcome data suggests that clinicians should lower their threshold for administering a psychometrically sound developmental screen when providing surveillance for ex-preemies. Quality improvement opportunities exist with diligent developmental surveillance and a more collaborative, standardized, reliable and interpersonal referral process.
authors.affiliation: Department of Pediatrics, PeaceHealth Medical Group, 1162 Willamette, Eugene, OR 97401, USA. kmarks@peacehealth.org
authors.forename: Kevin
authors.initials: K
authors.lastname: Marks
authors.forename: Hollie
authors.initials: H
authors.lastname: Hix-Small
authors.forename: Kathy
authors.initials: K
authors.lastname: Clark
authors.forename: Judy
authors.initials: J
authors.lastname: Newman
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000534:rehabilitation; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000534:rehabilitation; D018479:Early Intervention, Educational; D004519:Education, Special; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000534:rehabilitation; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D007859:Learning Disabilities / Q000175:diagnosis / Q000534:rehabilitation; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009922:Oregon; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012307:Risk Factors