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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



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