813 - Using Synchronous and Asynchronous Teleconsultation to Increase Access to Autism Evaluations in Primary Care Settings

Publication Number: 813.7120

Jeffrey F. Hine, Vanderbilt University Medical Center, Nashville, TN, United States; Tori E. Foster, Vanderbilt University Medical Center / Vanderbilt Kennedy Center TRIAD, Nashville, TN, United States; Laleh Bahrami, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Kathryn Carlson, MCJCHV, Nashville, TN, United States; Ryan Coleman, Vanderbilt University Medical Center, Nashville, TN, United States; Holly Miller, Vanderbilt University Medical Centsr, Nashville, TN, United States; Anna Kathleen Spitler, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Caitlin Stone, Vanderbilt University Medical Center, Nashville, TN, United States; Zachary Warren, Vanderbilt University School of Medicine, Nashville, TN, United States

Background: Factors such as limited availability of autism specialists and long wait times for diagnostic confirmation support the need for increased timeliness of action-steps within primary care settings.

Objective: We examined the use of synchronous and asynchronous specialist teleconsultation to improve access to diagnostic assessment within a network of primary care clinics. The objective was to sustain low wait times, an early age of diagnosis, and provider/family satisfaction across clinics that varied in geography, patient volume/demographics, and autism-specific PCP training experience.

Design/Methods: Children under 48 months were referred from six primary care clinics. Families either received a) a clinic-to-clinic (C2C) or direct-to-home (D2H) tele-diagnostic assessment lead by a psychologist or b) an e-consultation procedure through which a psychologist confirmed a diagnosis via a recorded evaluation submitted by a trained PCP. All families were eligible for expedited in-person assessment as necessary. Using data from our in-person clinic as a comparator, we compared patient demographics, age at diagnosis, evaluation type, wait times, need for in-person follow up, and provider/family satisfaction with the assessment. Data were extracted from our EHR as well as via REDCap surveys.

Results: In the last 12 months of service, 80 synchronous teleconsultations and 49 e-consultations were completed. Compared to the same 12 months of our in-person clinic (113 in-person visits via embedded psychologists), results suggest that the teleconsultation model was successful, as shown by sustained low wait times (mdn C2C/D2H = 90 days, e-consult = 35, vs. in-person = 103) and sustained early age of diagnosis (mdn teleconsult clinics = 2.6 years). The number of teleconsult visits that necessitated follow up was low overall (24%), but reasons for follow-up varied (i.e., family/provider preference vs. lack of diagnostic certainty). Teleconsult clinics served a diverse patient population (65% racially/ethnically/linguistically diverse, 70% public insurance). Family/provider feedback showed high rates of satisfaction with teleconsult model overall, with specific areas for improvement identified.

Conclusion(s): Extending our diagnostic program via two types of teleconsultation resulted in sustained improvements in accessibility, timeliness, provider certainty, and provider/family satisfaction. Extension clinics helped minimize common barriers to care (e.g., access to specialty care, rural/under-resourced communities). Discussion will include plans to further address disparities via more longitudinal primary care supports.