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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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Performance improvement leadership development program university of missouri columbia

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