Use of a Digital Modified Checklist for Autism in Toddlers - Revised with Follow-up to Improve Quality of Screening for Autism.
To assess changes in quality of care for children at risk for autism spectrum disorders (ASD) due to process improvement and implementation of a digital screening form.



The process of screening for ASD was studied in an academic primary care pediatrics clinic before and after implementation of a digital version of the Modified Checklist for Autism in Toddlers - Revised with Follow-up with automated risk assessment. Quality metrics included accuracy of documentation of screening results and appropriate action for positive screens (secondary screening or referral). Participating physicians completed pre- and postintervention surveys to measure changes in attitudes toward feasibility and value of screening for ASD. Evidence of change was evaluated with statistical process control charts and χ2tests.



Accurate documentation in the electronic health record of screening results increased from 54% to 92% (38% increase, 95% CI 14%-64%) and appropriate action for children screening positive increased from 25% to 85% (60% increase, 95% CI 35%-85%). A total of 90% of participating physicians agreed that the transition to a digital screening form improved their clinical assessment of autism risk.



Implementation of a tablet-based digital version of the Modified Checklist for Autism in Toddlers - Revised with Follow-up led to improved quality of care for children at risk for ASD and increased acceptability of screening for ASD. Continued efforts towards improving the process of screening for ASD could facilitate rapid, early diagnosis of ASD and advance the accuracy of studies of the impact of screening.
Duke University School of Medicine. Electronic address: Kathleen.campbell@duke.edu.
Kathleen
K
Campbell
Duke University School of Medicine; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
Kimberly L H
KLH
Carpenter
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Steven
S
Espinosa
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Jordan
J
Hashemi
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Qiang
Q
Qiu
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Mariano
M
Tepper
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Robert
R
Calderbank
Duke University Pratt School of Engineering, Duke University, Durham, NC.
Guillermo
G
Sapiro
Duke University School of Medicine; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
Helen L
HL
Egger
Duke University School of Medicine; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
Jeffrey P
JP
Baker
Duke University School of Medicine; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
Geraldine
G
Dawson
D000367:Age Factors; D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D057189:Checklist / Q000379:methods*; D002675:Child, Preschool; D042241:Early Diagnosis; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D058996:Quality Improvement; D018570:Risk Assessment; D012720:Severity of Illness Index
M-CHAT; early detection