Computer Automated Developmental Surveillance and Screening

Approximately one in six children in the U.S. has a developmental disability. Early intervention for these children is critical, as pediatric primary care providers are in the best position to identify and refer children to intervention programs in a timely manner. However, developmental surveillance and screening programs are not routinely implemented in primary care settings, and when screening does occur, standardized protocols and tools are used infrequently. Barriers to successful programs include lack of time and staff, logistical challenges in administering screening tools, inadequate reimbursement, and language barriers.

The project sought to determine if a computer decision support (CDS) system integrated with routine care could improve standardized developmental screening during 9, 18, and 30 month well-child visits and surveillance for developmental disabilities at all pediatric visits.

The specific aims of this project were to:

• Expand and modify an existing computer-based decision support system, the Child Health Improvement through Computer Automation (CHICA), to include the 2006 American Academy of Pediatrics developmental surveillance and screening algorithm.
• Evaluate the effect of the CHICA system on the developmental surveillance and screening practices of four pediatric clinics.
• Evaluate the effect of the CHICA system on referrals for developmental and medical evaluations, and for early developmental intervention and early childhood services.
• Develop and follow a cohort of children with identified developmental disabilities to look at the end results and effects of developmental screening.

The system was evaluated with a randomized controlled trial at four primary care pediatric clinics, two of which served as intervention sites and two as control sites. A developmental surveillance and screening (DSS) module was added to CHICA, a CDS system that delivers relevant guidelines to physicians during patient visits. The control sites used CHICA without the DSS module. During the study period, more than 6,000 children of the four practices’ combined patient population of 35,782 were screened for developmental disabilities. The charts of 360 children in the developmental screening portion of the study and 120 in the developmental surveillance portion of the study were reviewed to assess screening, surveillance, and diagnosis. Additionally, 95 children had parents who agreed to participate in interview sessions and reviews of their children’s medical record.

The use of CHICA with DSS increased the numbers of children screened at 9, 18, and 30 months of age, and significantly improved consistent surveillance at other ages. The number of children diagnosed with developmental delays increased, and referrals for timely services at an earlier age increased. This study showed that using a CDS system to automate the screening of children for developmental delay significantly increased the number of children screened. Upcoming efforts include determining if the increase in screening leads to improved outcomes for children. The project team is working on moving CHICA on to commercial platforms to make it more widely available.