Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing
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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.
KeywordsDevelopmental screening Autism screening Primary care Physician education Early detection of developmental disorders
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.
- 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.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.Google Scholar
- Connecticut Department of Social Services. (personal communication, July 1, 2010).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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.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
- 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
- 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.PubMedCrossRefGoogle 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
- 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.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
- 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.PubMedCrossRefGoogle Scholar