817 - Implementation and Provider Perspectives of a Brief Secondary Autism Screener at Well Child Visits

Publication Number: 817.5322

Kirk Bjella, University of Utah School of Medicine, Salt Lake City, UT, United States; Zainab Kagen, University of Utah, Park City, UT, United States; Jose E. Morales Moreno, University of Utah School of Medicine, Salt Lake City, UT, United States; Paul Carbone, Univeristy of Utah, Salt Lake City, UT, United States

Background: Universal autism screening is recommended at 18 and 24 months. The Parents Observation of Social Interactions (POSI) has a high screen positive rate (16%) at our institution at 18- and 24-month well child visits (WCV). We developed a secondary autism screen that can be easily administered during WCVs to assist providers in decisions about whether to refer for autism evaluation.

Objective: Implement a brief secondary autism screener, improve secondary screen completion rates, and evaluate provider perspectives on the screener.

Design/Methods: The Positive Primary care screen Pediatric Presses (P4) was created as a secondary autism screen with 2 historical and 2 observational items (Fig. 1). The P4 and a scoring flowsheet were implemented into the electronic health record (EHR). The monthly proportion of P4 completion following a positive POSI was evaluated at 3 primary care academic clinics in 2 phases:

Phase 1 (Jan ’23 – Sep ’23): Baseline P4 completion rates were analyzed.
Phase 2 (Oct ’23 – Aug ’24): Clinics were provided with training sessions on P4 use.
Differences in proportion of P4 completion between phases were analyzed using SPC p-Charts and χ2-test. A satisfaction survey was subsequently administered to providers in these clinics regarding their perspectives using the P4.

Results: P4 completion after a positive POSI increased from 10.5% to 20.6% (P < 0.001) in phase 2 (Fig. 2). SPC revealed no special cause variation. Among providers completing the satisfaction survey (n=44), 59% (n=26) had used the P4 in clinical practice. Of those, 69% reported that training was adequate, >84% agreed that each item was easy to administer, and 94% reported that it helped in deciding whether to refer. Most (88%) reported having enough time during the visit to complete the P4 with 69% reporting 3 minutes or less to administer. All respondents using the P4 reported plans to use it in the future. Most (75%) reported referring >75% of children who screen positive on the P4. Some (38%) reported inconsistent recording of completed P4 results into the EHR (Table 1).

Conclusion(s): Provider training was associated with an increase in P4 utilization as a secondary autism screener. Most providers using the P4 reported that it can be easily implemented, administered, and assisted in clinical decision making. Some providers report not entering the results of the P4 into the EHR which may hinder efforts to accurately assess the impact of the P4. Next steps are providing feedback to providers on P4 completion after positive POSI, streamline entry of P4 results into the EHR, and evaluate the P4’s accuracy in identifying autism.

Figure 1. Primary Positive screen Pediatric Presses (P4)
Secondary autism screening tool as seen in the electronic health record

Figure 2. SPC Chart with completion rates of P4 after positive POSI.
POSI increased from 10.5% to 20.6% (P <0.001) in phase 2. SPC revealed no special cause variation.

Table1. Results of provider survey data of respondents who have used the P4