P3B346: Autism Evaluations in the Medical Home: An Opportunity to Improve Access and Reduce Wait Time

Background: Autism spectrum disorder (ASD) prevalence has increased to 1 in 36 children. The American Academy of Pediatrics (AAP) recommends autism screening starting at 18 months and early detection with implementation of evidence-based interventions improves outcomes. However, fewer than half of autistic children receive diagnostic evaluations before 36 months of age. Shortages in the developmental-behavioral pediatrician workforce call for alternative models of care to support the growing need. Proposed strategies include utilizing primary care providers (PCPs) for ASD assessments, especially if the diagnosis is clear. Completing autism evaluations in the medical home with trained PCPs may decrease wait times for diagnostic evaluation and reduce barriers to care allowing for earlier access to autism services.

Methods: A focused autism evaluation pathway in primary care was created for children under 4 years of age identified as at-risk for ASD by abnormal M-CHAT screening or provider concern. ASD evaluation was completed by a trained PCP +/- resident physician and included an autism-specific interview, clinical observation, and use of a standardized assessment tool (Childhood Autism Rating Scale Second Edition or Tele-ASD-Peds). Patient demographics, evaluation wait times, and diagnoses were collected during a three-month period. A retrospective chart review was completed to obtain similar data for patients within the same clinic who were referred to the institution’s autism center for ASD evaluation from 2019 to present. Descriptive and comparative statistics were used for data analysis. The primary outcomes were 1) wait time from referral to initial ASD evaluation, 2) wait time from referral to ASD diagnosis and 3) age at ASD diagnosis for the primary care group (PC) and autism center group (AC).

Results: Twenty patients were evaluated in the PC group and 16 (80%) received an ASD diagnosis. Twelve patients with ASD in the PC group completed MCHAT screening; two scored medium risk and 10 scored high risk. In the AC group, significant variance was noted in wait time from referral to initial appointment (range 0.8 months – 22.5 months). Patients in the PC group had significantly shorter wait time from referral to initial ASD evaluation (median 2.0 months) than the AC group (median 3.9 months), p< 0.001. For patients diagnosed with ASD, wait time from referral to ASD diagnosis was significantly shorter for the PC group (median 2.2 months) than the AC group (median 4.8 months), p< 0.001 (Figure 1). Average age at ASD diagnosis was lower for the PC group (29.1 months) than the AC group (36.2 months), p< 0.05 (Figure 2).

Conclusion: Completing ASD evaluations in primary care with trained PCPs provides an opportunity to decrease wait time to evaluation and age at diagnosis, thus allowing earlier access to targeted behavioral and developmental services which can improve outcomes.