Adding developmental surveillance and screening to a computerized clinical decision support system led to a more than threefold greater proportion of children being screened for developmental disabilities, according to results from a randomized trial.
The American Academy of Pediatrics has recommended since 2006 that all children be screened for developmental delays at 9, 18, and 30 months. This study, led by Dr. Aaron E. Carroll of the Indiana University in Indianapolis, and published in JAMA Pediatrics (2014 [doi:10.1001/jamapediatrics.2014.464]), randomized 360 children at their 9-, 18- or 30-month check-ups to screening under the Child Health Improvement through Computer Automation (CHICA) system, which prompts clinicians toward diagnostic and management strategies based on guidelines and patient records.
The study was conducted in four linked primary care clinics in Indianapolis, with the vast majority of patients covered by Medicaid. Patients in the control clinics (n = 180) were assessed using standard CHICA, while those in the intervention clinics (n = 180) were assessed with CHICA modified to include a developmental surveillance and screening component, which automatically printed a questionnaire aimed at parents. If a parent indicated any area of concern, a standardized screening tool for developmental delay was then printed for use by the physician.
The group randomized to CHICA with the developmental module saw 85% of children screened for developmental delays during the target visits, compared with 24% in the standard care group (P < .001).
Among children screened, the rate of a positive result was 19.6% for the intervention group and 18.2% for controls; this did not reach statistical significance. “This finding implies that the number of children at risk for developmental delay was similar between groups, but that more children were picked up in the intervention group because of higher screening rates,” Dr. Carroll and his colleagues wrote in their analysis.
Diagnoses of developmental delay following a target visit were shown to occur markedly earlier in the intervention group (mean age at diagnosis, 17.2 vs. 27.9 months; P < .001). “Because optimal outcomes of developmental delay depend on early detection, this finding is a critically important finding, although our study was not designed to detect changes in clinical outcomes,” the researchers wrote.
Dr. Carroll and his colleagues also looked at an additional 60 patient records in both the control and intervention clinics to determine developmental surveillance rates outside target visits. They found that the intervention led to a significant increase in the percentage of parents who were asked about concerns regarding their children’s development during those nontarget visits (71.7% vs. 41.7%, P = .04).
The researchers cited as a weakness of their study its use of the clinic as the basis of randomization, creating the potential for preexisting practice differences to affect results.
The study was funded by the Agency for Healthcare Research and Quality. None of the authors reported conflicts of interest.