ASD: computer-based decision support boosts screening

  • Downs SM & al.
  • JAMA Netw Open
  • 02.12.2019

  • von Susan London
  • Clinical Essentials
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Takeaway

  • 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

 Key results

  • 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.

Study design

  • 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.

Limitations

  • Small number of clinics, U.S. only.
  • Unknown generalizability.
  • Screening tool has high false-positive rate when follow-up questions are not used.