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Performance Improvement Leadership Development Program University of Missouri – Columbia

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Waitlist? What’s All the Fuss About? Improving Diagnostic Evaluation Wait Times for Children with Suspected Autism. Performance Improvement Leadership Development Program University of Missouri – Columbia February 19, 2010. Members of the Team. Executive Sponsor: Janet Farmer, PhD, ABPP

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Waitlist? What’s All the Fuss About?Improving Diagnostic Evaluation Wait Times for Children with Suspected Autism

Performance Improvement Leadership Development Program

University of Missouri – Columbia

February 19, 2010

members of the team
Members of the Team

Executive Sponsor: Janet Farmer, PhD, ABPP

Advisors: David Sohl, MHA

Carol Nierling, MS, RN

Team Members: Kristin Sohl, MD, FAAP

Steve Kanne, PhD ABPP

Krista Hughes, RN, BSN

Judy Hall, MSW

Katie Dunne, MS

focus area
Focus Area
  • Autism Prevalence Rate now 1 in 110
  • Recognition in Missouri that autism rates are increasing
  • State of Missouri set aside funds to the Thompson Center for early diagnosis, assessment, and treatment of autism
  • Wait time for Thompson Center’s Autism Diagnostic Entry Clinic (ADEC) is too long
aim statement
Aim Statement
  • By April 1, 2010, we aim to decrease the wait time from receipt of paperwork to initial assessment of children ages 2 – 18 with a concern of autism from the current average of six (6) months to an average of two (2) months. We plan to do this by implementing a new evaluation clinic for children whose pre-appointment test scores suggest they are less likely to receive a diagnosis of autism.
relationship to thompson center goals
Relationship to Thompson Center Goals
  • Streamline process for diagnosis, assessment, and treatment of autism
  • Expand capacity for autism clinical services
  • Improve the Center’s interdisciplinary model
  • Increase opportunities for professional training
  • Maintain Center’s financial stability
stakeholders
Stakeholders
  • Children and Families of Missouri (and surrounding states)
  • Governor of Missouri (Governor’s Wait List)
  • University of Missouri Health Care
  • MU Thompson Center
  • Thompson Center Foundation
  • School of Medicine
  • School of Health Professions
  • University Physicians
collecting baseline data
Collecting Baseline Data
  • Children seen in the Autism Diagnostic Entry Clinic (ADEC) each month during CY 2009
  • Calculated the wait time for those children:
    • From date we received their paperwork
    • To date of ADEC appt
factors that impact triage process
Factors that Impact Triage Process

Two Pieces to Triage Issue

1) Call Process – Receiving and

routing calls

2) Screening at intake – placing

Patient in appropriate clinic

interventions considered
Interventions Considered

1. Increase number of children seen in ADEC each day with current staff

Barriers

  • Lack of clinic space
  • Lack of providers (multi-disciplinary clinic)
  • Amount of time needed to evaluate each child
interventions considered1
Interventions Considered

2. Increase number of children seen in ADEC each day by hiring more staff

Barriers

  • Lack of resources
  • Lack of qualified staff
interventions
Interventions

Considered

Chosen

3. Improve the triage process of children needing a diagnostic evaluation

Goal

  • Improve the triage process by screening out individuals less likely to meet criteria for an autism diagnosis, thereby:
    • Reducing the number of children waiting for an ADEC evaluation, and
    • Reducing wait times for that clinic
intervention chosen
Intervention Chosen

Implement the use of a screening tool prior to scheduling an appointment

The Social Communication Questionnaire (SCQ) is a parent report screening measure for autism spectrum disorders.

  • 40 Yes/No Questions
  • Cutoff Score of 15
social communication questionnaire scq
Social Communication Questionnaire (SCQ)

Reviewed 86 past SCQ scores collected in ADEC

  • 32% reviewed scored 12 and below
  • Only 5% diagnosed with ASD scored a 12, none below

Children who scored < 12 – routed to the new “quick look” clinic (SURGE)

Children who scored > 12 – routed to ADEC

surge clinic
SURGE CLINIC
  • Psychology Clinic
    • Offers higher level of triage through in person screening interview with parent/caregiver and child
    • Allows for placement into more appropriate clinic
    • Support services can be expedited
      • Speech Language Therapy
      • Occupational Therapy
      • Early Childhood Special Education
      • Patient/Family Counseling
outcome indicator
Outcome Indicator

Wait time for Autism Diagnostic Entry Clinic (ADEC) is reduced

  • Appears that wait time was reduced
  • Note – pilot project with small “n”:
    • Brief time span and few patients
    • Patients already had a scheduled ADEC appointment
process indicator
Process Indicator
  • All children with SCQ scores 12 or less are appropriately triaged to the SURGE Clinic
anticipated return on investment
Anticipated Return on Investment
  • Decrease wait time for children who need an diagnostic evaluation
  • Save time/money
  • Improve patient/family satisfaction
lessons learned
Lessons Learned
  • Flowchart/fishbone diagrams
    • Show best place to target intervention
    • Show opportunities for future quality improvement projects
  • Difficulties in changing the process
    • Provide data to support need for change
    • Involve many players to facilitate roll-out
summary
Summary
  • Overall, the SURGE clinic seems to be effective, but we need more data
ad