Session: Quality Improvement/Patient Safety 2 Works in Progress
WIP 144 - Rapid Interactive Screening Test for Autism in Toddlers (RITA-T): Improving access to early diagnosis and supportive services in a pediatric resident continuity clinic
Resident Johns Hopkins Children's Center Baltimore, Maryland, United States
Background: Routine screening for autism is recommended by the AAP, as early diagnosis and supportive services improves outcomes. There are significant disparities in early diagnosis and access to services among children from minoritized racial and ethnic groups and low socioeconomic communities, who represent most patients seen in resident continuity clinics. The Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), a level 2 screener, has shown to reduce time to diagnosis. Yet, few have studied its implementation in resident clinics. We implemented a quality improvement project to train resident physicians in the use of RITA-T and form a referral system with our local ASD center. Objective: To shorten wait time between initial ASD screening to diagnosis from 36 weeks to 12 weeks using the RITA-T, in a resident-based, primary care clinic over a 1-year period. Design/Methods: Our QI project took place at a resident continuity clinic affiliated with a major academic institution. The clinic has 51 resident providers and serves a majority population of minoritized children with a form of public insurance. Patients were referred by their primary provider for a RITA-T evaluation. Those with “medium to high-risk” were referred to our ASD diagnostic center. The project was submitted to and acknowledged as a QI project by our institution’s IRB. Our primary outcome is time between initial screen for ASD to diagnosis. Our secondary measures include time between appointments, time to access services, and inter-rater reliability. Descriptive statistics will be used to summarize patient demographics and measure outcomes. Over the last 11 months, 30 patients were referred, 25 have been seen for a RITA-T. Of those, 21 patients were referred for diagnostic evaluation, among whom 11 received a diagnosis, 3 were lost to follow up, and 7 awaiting diagnostic evaluation. Based on preliminary data, the average wait time from initial referral for screening to final diagnosis was 13.2 weeks. We anticipate referrals to continue through December 2023 with data analysis conducted in January 2024.
