Abstract：
OBJECTIVE: Many barriers to implementation of developmental screening in primary care exist, especially for children from under-resourced communities. Developmental screening is vital to early detection of developmental delay and autism spectrum disorder, and early intervention (EI) referral. This study sought to examine whether implementation of a standardized clinical workflow using electronic screening tools improved both rates of developmental screening, and the number of children identified at risk for developmental delay, in a federally qualified health center (FQHC).
METHODS: A retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher\'s Exact analyses were conducted.
RESULTS: ASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001).
CONCLUSIONS: Implementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.
METHODS: A retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher\'s Exact analyses were conducted.
RESULTS: ASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001).
CONCLUSIONS: Implementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.
摘要：
目的：在初级保健中实施发育筛查存在许多障碍，特别是对于资源不足社区的儿童。发育筛查对于早期发现发育迟缓和自闭症谱系障碍至关重要，和早期干预（EI）转诊。这项研究试图检查是否使用电子筛查工具实施标准化的临床工作流程提高了发育筛查率。以及确定有发育迟缓风险的儿童数量，在联邦合格的健康中心（FQHC）。
方法：在一个学术附属的FQHC进行了一项回顾性研究。年龄和阶段问卷3（ASQ-3）的电子版本和幼儿自闭症修订清单（M-CHAT-R）在儿童访视中实施。提供了有关发育筛查和EI转诊的新临床工作流程培训。进行卡方和费舍尔精确分析。
结果：ASQ-3筛查率从干预前后的62.7％增加到73.6％。干预后，纸张屏幕显着减少（p<.001），ASQ-3儿童的百分比显着增加，结果在14.7至18.2％的截止范围内（p<.002）。M-CHAT-R筛查率从干预前后的56.4％增加到59.4％。干预后，电子屏幕显着增加（p<.001）。
结论：电子筛查工具的实施改善了FQHC中的普遍发育筛查。减少资源不足社区的障碍，电子工具的使用可能会降低纸质筛查的筛查错误率，并有可能更好地识别有发育迟缓风险的儿童。
方法：在一个学术附属的FQHC进行了一项回顾性研究。年龄和阶段问卷3（ASQ-3）的电子版本和幼儿自闭症修订清单（M-CHAT-R）在儿童访视中实施。提供了有关发育筛查和EI转诊的新临床工作流程培训。进行卡方和费舍尔精确分析。
结果：ASQ-3筛查率从干预前后的62.7％增加到73.6％。干预后，纸张屏幕显着减少（p<.001），ASQ-3儿童的百分比显着增加，结果在14.7至18.2％的截止范围内（p<.002）。M-CHAT-R筛查率从干预前后的56.4％增加到59.4％。干预后，电子屏幕显着增加（p<.001）。
结论：电子筛查工具的实施改善了FQHC中的普遍发育筛查。减少资源不足社区的障碍，电子工具的使用可能会降低纸质筛查的筛查错误率，并有可能更好地识别有发育迟缓风险的儿童。
