059 - How Long Is Too Long To Wait: Evaluation Of A DBP Waitlist

Publication Number: 59.5229

April Perez-Moore, UMass Chan Medical School, Worcester, MA, United States; Michaela Olah, University of Massachusetts Medical School, Worcester, MA, United States; Kyle M. Frost, University of Massachusetts Medical School, Worcester, MA, United States; Marisa Petruccelli, UMass Memorial Children's Medical Center, Worcester, MA, United States

Background: Early identification and intervention improve outcomes for children with autism. Workforce shortages in Developmental-Behavioral Pediatrics (DBP) contribute to long waitlists and delayed intervention. Examining waitlists and waitlist management can point to ways to improve equitable access to care.

Objective: Examine a DBP waitlist to identify (1) time on waitlist, (2) contact outcomes, and (3) differences by language and insurance type.

Design/Methods: This cross-sectional study involved review of children ( < 6 years old) on our institution's DBP evaluation waitlist as of 12/2023. Of the total waitlist (N=993), we attempted to contact the top 20% (n=198) of the waitlist to offer an appointment. We examined descriptive statistics for age at referral, time on the waitlist, referral source, insurance type, and language spoken, collected from the electronic medical record. Contact outcomes included (1) whether we reached families; (2) if reached, whether an evaluation was still wanted; and (3) if not, what was the reason. We then examined whether insurance type (public vs private) or language (English vs. Non-English speaking) was associated with contact outcome (unable to reach vs. declined appointment vs. accepted appointment) using a chi-squared test. Finally, we used logistic regression to determine whether length of time on the waitlist predicted our ability to reach families.

Results: Average time on waitlist was 19 months (SD=7) (Table1). 48% (n=94) of families were unable to be reached. Of the families successfully reached (n=104), 59% declined an appointment, most often because their child was evaluated elsewhere (Figure1). Time on waitlist significantly predicted successful contact (χ2(1)=5.465, p=.019, Nagelkerke R2=4%). Time on waitlist did not differ by primary language (English vs Non-English) or insurance type (public vs private). However, ability to reach families differed significantly between English (56%) and non-English (33%) primary language (χ2(1)=4.62, p=0.03). Furthermore, an analysis of waitlist outcomes by primary language approached significance (χ2(2)=5.17, p=.08) and appeared to be driven by Non-English speaking families being more difficult to reach and less likely to decline an appointment (Table2).

Conclusion(s): Increasing capacity for timely autism evaluations is critical. Findings emphasize a need for ongoing waitlist engagement, especially for non-English speakers, for whom we found evidence of disparities in access to care. Because only 48% of families were reachable, findings are limited in that we cannot generalize the outcomes of families we reached to those we did not.

Table 1. Participant Waitlist Sample Characteristics


Figure 1. Waitlist Sample Outreach Breakdown


Table 2. Waitlist Sample Outcomes Stratified By Primary Language