Developmental screening in a pediatric care practice.

in 2006, the American Academy of Pediatrics (AAP) formally recommended the use of developmental surveillance at each well child visit and the use of standardized developmental screening tools at nine, 18, and 30 (or 24) month visits. In 2007 the AAP recommended the incorporation of an autism-specific screening at the 18 and 24-month visits. In 2006 the Rhode Island Department of Health conducted a survey of 241 primary care pediatricians to better understand the current pediatric practice related to developmental surveillance and screening, identify barriers to developmental screening and assess the interest in training and support regarding developmental screening. All of the respondents indicated that they were providing developmental surveillance for their patients less than five years of age, largely using questions during the course of the exam or using surveillance checklists. At that time only 21.8% were using a standardized screening tool and the most widely used tool was the Denver Developmental Screening Test II. The most commonly cited barriers to developmental screening in the office setting were time limitations (76%), lack of staff (47%), and inadequate reimbursement (41%). All respondents indicated that they were somewhat or very familiar with supports and services for children with developmental risks or delays, 43.6% indicated that these services were adequate and those considered most lacking were supports for behavioral or mental problems and the availability of specialty evaluation following a failed screening. In 2007, a pediatric primary care office implemented a developmental screening program according to the recommendations of the 2006 AAP guidelines. Three months after the implementation of the screening program, a quality improvement study was conducted to determine physician responses to the results of the developmental screening program and to identify barriers to that process within the practice. Methods setting The study site, a private-practice pediatric primary care office, implemented developmental screening using Parents’ Evaluation of Developmental Status (PEDS) and Modified Checklist for Autism in Toddlers (M-CHAT) screening tools. The practice consisted of six board certified general pediatricians (three male, three female) and two pediatric nurse practitioners (female) serving approximately 12,000 children. The experience of the physicians involved in the study ranged from seven to 25 years post-residency training with a mean of 13 years. Review of insurance status revealed that 82% of children in the practice were covered by commercial insurance plans, 11% were covered by commercial managed care, and 7% were covered by a state administered health care plan. The study received institutional review board approval.