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Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing

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Abstract

Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders. A pilot study evaluated the impact of an academic detailing module in which trainers visited 43 pediatric primary care practices to provide education about implementing developmental screening tools in well-child services. Attendees responded to a post presentation survey stating that they planned to implement screening in their practices. Medicaid billing data showed an increase in the state’s overall rate of screening. An audit of medical charts in five practices that received the training and five that did not showed higher screening rates in practices that received the training as well as higher rates after the training than before. These pilot study results indicate the potential of academic detailing as an effective strategy for improving rates of developmental screening.

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References

  • American Academy of Pediatrics Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, & Medical Home Initiatives for Children with Special Needs Project Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.

    Google Scholar 

  • American Medical Association. (2010). CPT 2010 Professional Edition. Chicago.

  • Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightengale, N., Morgan, K., et al. (1996). Psychological markers in the detection of autism in infancy in a large population. British Journal of Psychiatry, 168, 158–163.

    Article  PubMed  Google Scholar 

  • Bethell, C., Reuland, C., Schor, E., Abrahms, M., & Halfon, N. (2011) Rates of Parent-Centered Developmental Screening: Disparities and Links to Services Access. Pediatrics, doi: 10.1542/peds.2010-0424.

  • Center for Financing, Access and Cost Trends (2007). Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey. Retrieved 11/11/2010.

  • Cloutier, M. M., & Wakefield, D. B. (2011). Translation of a pediatric asthma-management program into a community in Connecticut. Pediatrics, 127(1), 11–18.

    Article  PubMed  Google Scholar 

  • Connecticut Department of Social Services. (personal communication, July 1, 2010).

  • Dosreis, S., Weiner, C. L., Johnson, L., & Newschaffer, C. J. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental and Behavioral Pediatrics, 27(2 Suppl), S88–S94.

    Article  PubMed  Google Scholar 

  • Duncan, P. M., Duncan, E. D., & Swanson, J. (2008). Bright Futures: The screening table recommendations. Pediatric Annals, 37(3), 152–158.

    PubMed  Google Scholar 

  • Earls, M. F., & Hay, S. S. (2006). Setting the stage for success: Implementation of developmental and behavioral screening and surveillance in primary care practice–the North Carolina Assuring Better Child Health and Development (ABCD) Project. Pediatrics, 118(1), e183–e188.

    Article  PubMed  Google Scholar 

  • Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Jr., Dawson, G., et al. (2000). Practice parameter: Screening and diagnosis of autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55(4), 468–479.

    Article  PubMed  Google Scholar 

  • Finkelstein, J. A., Davis, R. L., Dowell, S. F., Metlay, J. P., Soumerai, S. B., Rifas-Shiman, S. L., et al. (2001). Reducing antibiotic use in children: A randomized trial in 12 practices. Pediatrics, 108(1), 1–7.

    Article  PubMed  Google Scholar 

  • Freemantle, N., Harvey, E. L., Wolf, F., Grimshaw, J. M., Grilli, R., & Bero, L. A. (2000). Printed educational materials: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev(2), CD000172.

  • Gaines, R., Missiuna, C., Egan, M., & McLean, J. (2008). Educational outreach and collaborative care enhances physician’s perceived knowledge about Developmental Coordination Disorder. BMC Health Serv Res, 8, 21.

    Article  PubMed  Google Scholar 

  • Glascoe, F. P. (2003). Parents’ evaluation of developmental status: How well do parents’ concerns identify children with behavioral and emotional problems? Clin Pediatr (Phila), 42(2), 133–138.

    Article  Google Scholar 

  • Golnik, A., Ireland, M., & Borowsky, I. W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123(3), 966–971.

    Article  PubMed  Google Scholar 

  • Heckman, J. J. (2006). Skill formation and the economics of investing in disadvantaged children. Science, 312(5782), 1900–1902.

    Article  PubMed  Google Scholar 

  • Hix-Small, H., Marks, K., Squires, J., & Nickel, R. (2007). Impact of implementing developmental screening at 12 and 24 months in a pediatric practice. Pediatrics, 120(2), 381–389.

    Article  PubMed  Google Scholar 

  • Honigfeld, L., & McKay, K. (2006). Barriers to enhancing practice-based developmental services. Journal of Developmental and Behavioral Pediatrics, 27(1 Suppl), S30–33; discussion S34–37, S50–32.

    Google Scholar 

  • Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.

    Article  PubMed  Google Scholar 

  • Kaye, N., & May, J. (2009). State Policy Improvements that Support Effective Identification of Children At-Risk for Developmental Delay: Finding from the ABCD Screening Academy. Portland: National Academy of State Health Policy.

    Google Scholar 

  • King, T. M., Tandon, S. D., Macias, M. M., Healy, J. A., Duncan, P. M., Swigonski, N. L., et al. (2010). Implementing developmental screening and referrals: Lessons learned from a national project. Pediatrics, 125(2), 350–360.

    Article  PubMed  Google Scholar 

  • Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H. C., Esser, E. L., et al. (2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827–839.

    Article  PubMed  Google Scholar 

  • Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116(6), 1480–1486.

    Article  PubMed  Google Scholar 

  • McKay, K. (2006). Evaluating model programs to support dissemination. An evaluation of strengthening the developmental surveillance and referral practices of child health providers. J Dev Behav Pediatr, 27(1 Suppl), S26–29; discussion S34–27, S50–22.

    Google Scholar 

  • Miller, J. S., Gabrielsen, T., Villalobos, M., Alleman, R., Wahmhoff, N., Carbone, P. S., et al. (2011). The each child study: Systematic screening for autism spectrum disorders in a pediatric setting. Pediatrics, 127(5), 866–871.

    Article  PubMed  Google Scholar 

  • O’Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., et al. (2007). Educational outreach visits: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev(4), CD000409.

  • Radecki, L., Sand-Loud, N., O’Connor, K. G., Sharp, S., & Olson, L. M. (2011). Trends in the use of standardized tools for developmental screening in early childhood: 2002–2009. Pediatrics, 128(1), 14–19.

    Article  PubMed  Google Scholar 

  • Robins, D. L. (2008). Screening for autism spectrum disorders in primary care settings. Autism, 12(5), 537–556.

    Article  PubMed  Google Scholar 

  • Robins, D., Fein, D., Barton, M., Jones, G., Byrne, J., Hinchey, M., et al. (1999). The M-CHAT: Early detection of autism. Storrs, CT: University of Connecticut.

    Google Scholar 

  • Robins, D. L., et al. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders’. Journal of Autism and Developmental Disorders, 31(2), 131–144.

    Article  PubMed  Google Scholar 

  • Sand, N., Silverstein, M., Glascoe, F. P., Gupta, V. B., Tonniges, T. P., & O’Connor, K. G. (2005). Pediatricians’ reported practices regarding developmental screening: Do guidelines work? Do they help? Pediatrics, 116(1), 174–179.

    Article  PubMed  Google Scholar 

  • Schechter, N. L., Bernstein, B. A., Zempsky, W. T., Bright, N. S., & Willard, A. K. (2010). Educational outreach to reduce immunization pain in office settings. Pediatrics, 126(6), e1514–e1521.

    Article  PubMed  Google Scholar 

  • Schonwald, A., Huntington, N., Chan, E., Risko, W., & Bridgemohan, C. (2009). Routine developmental screening implemented in urban primary care settings: More evidence of feasibility and effectiveness. Pediatrics, 123, 660–668.

    Article  PubMed  Google Scholar 

  • Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., et al. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 474–483.

    Article  PubMed  Google Scholar 

  • Sia, C., Tonniges, T. F., Osterhus, E., & Taba, S. (2004). History of the medical home concept. Pediatrics, 113(5 Suppl), 1473–1478.

    PubMed  Google Scholar 

  • Sices, L., Feudtner, C., McLaughlin, J., Drotar, D., & Williams, M. (2003). How do primary care physicians identify young children with developmental delays? A national survey. Journal of Developmental and Behavioral Pediatrics, 24(6), 409–417.

    Article  PubMed  Google Scholar 

  • Snow, A. V., & Lecavalier, L. (2008). Sensitivity and specificity of the Modified Checklist for Autism in Toddlers and the Social Communication Questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism, 12(6), 627–644.

    Article  PubMed  Google Scholar 

  • Soumerai, S. B. (1998). Principles and uses of academic detailing to improve the management of psychiatric disorders. The International Journal of Psychiatry in Medicine, 28(1), 81–96.

    Article  Google Scholar 

  • Soumerai, S. B., & Avorn, J. (1990). Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA, 263(4), 549–556.

    Article  PubMed  Google Scholar 

  • Soumerai, S. B., Salem-Schatz, S., Avorn, J., Casteris, C. S., Ross-Degnan, D., & Popovsky, M. A. (1993). A controlled trial of educational outreach to improve blood transfusion practice. JAMA, 270(8), 961–966.

    Article  PubMed  Google Scholar 

  • Squires, J., Bricker, D., & Potter, L. (1997). Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. Journal of Pediatric Psychology, 22(3), 313–328.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The Children’s Fund of Connecticut generously supported this study as well as the EPIC program. The authors thank staff from the Children’s Trust Fund and Child Development Infoline for visiting practices and making EPIC presentations as well as Anne Milanese at the Connecticut Children’s Medical Center for participating in the development of the EPIC ASD presentation. We are also indebted to John Lynch and Karen Pasquale of ProHealth Physicians for completing the chart audit portion of this study.

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Correspondence to Lisa Honigfeld.

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Honigfeld, L., Chandhok, L. & Spiegelman, K. Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing. J Autism Dev Disord 42, 1175–1182 (2012). https://doi.org/10.1007/s10803-011-1344-4

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