Increasing Access to Autism Diagnostic Care: A Quality Improvement Model

Background: Timely access to autism spectrum disorder (ASD) diagnostic services is a well known problem. Demand for diagnostic services is expected to increase as reported prevalence rates continue to increase and awareness efforts continue.

Objectives: Demonstrate access to ASD diagnostic evaluations can be improved using Quality Improvement methodology and employment of access principles.

Methods: Cincinnati Children’s Hospital Medical Center (CCHMC) is a member of the Autism Speaks-Autism Treatment Network. CCHMC participated in yearlong consultation from access consultants, Mark Murray and Associates, to improve access to ASD diagnostic services.  After mapping the diagnostic process, and identifying constraints, access principles were employed to identify opportunities for interventions and systems change. CCHMC specifically employed strategies to increase clinician supply without adding additional clinical providers (FTE), and manage and reduce patients on waitlists.  Access principles employed included supply demand management, backlog reduction and reducing system complexity. Specifically, CCHMC reduced visit lengths for some providers, implemented standardized clinic blocks and utilized incentives to temporarily increase clinician supply to address backlog reduction. CCHMC also developed a new, more efficient clinical model for the diagnosis of children under age 3 years at risk for ASD, which decreased redundancy in clinical assessments that were occurring at different times. 

Results: Time to first ASD diagnostic visit was improved at CCHMC from 122 days to 52 days in patients referred under the age of 6 years and from 404 days to 78 days for patients referred over 6 years of age.  These gains have been sustained through ongoing collection and analysis of demand and supply data. Time from first diagnostic appointment to final diagnosis was reduced from 119 days to 21 days using a same day diagnostic model for children under age 3 referred for risk of ASD.

Conclusions: Despite increasing demand for ASD diagnostic services, improvement in access to ASD diagnostic services can be obtained through implementation of Quality Improvement Methodology and access principles.