- Computer-based screening and decision support embedded into routine workflow improves timely screening for autism spectrum disorder (ASD) in primary care, but follow-up of positive screenings is limited.
Why this matters
- American Academy of Pediatrics recommends universal screening for ASD at 18- and 24-month visits.
- At intervention clinics, screening rate increased significantly:
- 0% at baseline,
- 68.4% at 6 months, and
- 100% at 24 months.
- At control clinics, screening rate did not increase significantly:
- 10.9% at baseline,
- 15.3% at 6-24 months, and
- 22.2% at 24 months.
- Difference between groups was significant from 6 months onward.
- Likelihood of ASD screening was sharply higher for intervention clinics (OR, 108.23; 95% CI, 22.65-517.2).
- Although 27.0% of intervention children had positive screening result, physicians logged a response to this result for only 57.0% of them.
- Cluster-randomized controlled trial among 4 inner-city pediatric clinics, 274 patients ages 18-24 months.
- Randomization: existing workflow and decision support software with vs without incorporation of ASD screening module (Child Health Improvement Through Computer Automation system).
- Main outcome: ASD screening using standardized instrument.
- Funding: Agency for Healthcare Research and Quality.
- Small number of clinics, U.S. only.
- Unknown generalizability.
- Screening tool has high false-positive rate when follow-up questions are not used.