Date of Award

Fall 2018

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Degree Name

Other

First Advisor

Pamela DiNapoli

Abstract

Background: According to the most recent report from the CDC (2018), autism spectrum disorder (ASD) affects approximately one in 59 children in the United States (U.S.). In 2007, the American Academy of Pediatrics (AAP) issued a strong recommendation for all primary care providers to screen children for autism, using a validated tool, at the 18 and 24-month well-child visits, in order to begin the referral process for more formal testing, and intervention, promptly. Despite the strong stance of the AAP and evidence supporting the importance of early intervention for children with ASD, not all primary care providers are screening for ASD or developmental delay.

Purpose: To improve the percentage of eligible children, presenting for 18 and 24 month wellchild visits in a pediatric primary care office, who are screened for ASD, by integrating the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool into the electronic medical record with tablets. The specific aims were to increase the percentage of children screened and improve the documentation of the screens performed.

Methods: This quality improvement project utilized a before-after quantitative design to support the improvement. Reports were obtained for three months prior to the implementation of the tablets and process change, and again for three months following the implementation. Manual chart reviews were also performed to verify the data from the reports. The definition used for complete screening for this project included 1) presence of the completed screen in the medical record, 2) provider documentation of the result, interpretation, and plan if indicated, and 3) CPT code entry for charge capture completed in the electronic medical record.

Results: The results of the project revealed improvements in overall percentages of eligible children screened for autism at D-H Nashua Pediatrics. The percentage of complete screening increased from 64.7% to 73.9% following the implementation of the project, a change which is statistically significant (t=31.6105, df=16,p=0.05). Each individual element was also tracked and those results showed that 1) the completeness of provider documentation related to the screening increased from 93.6% to 96% (t=41.3321, df=16, p=0.05) and 2) the M-CHAT screen was present in the electronic health record (EHR) 98.9% of the time, which was an increase from 84.6% (t=295.4084, df=16, p=0.05). The charge capture completion rate remained statistically unchanged at 76.5% (t=0.4664, df=16, p=0.05). Additionally, only one screening was noted to be missed altogether, out of 280 eligible children. Prior to the project, there were four missed screenings (out of 156 eligible children) captured by the chart reviews conducted over three months prior to the implementation of the project. Overall, the results show that the project resulted in an increase the percentage of M-CHAT screening, an increase in the presence of source documentation in the electronic health record (EHR), and more complete provider documentation related to the screening.

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