Team Evaluation: A Streamlined Method for the Clinical Assessment of Autism Spectrum Disorder

Background:   Diagnostic evaluations for autism spectrum disorder (ASD) are generally either multi-disciplinary or single discipline (often with a psychologist).  While these evaluations are comprehensive, they likely contribute to long waiting lists across the country since they generally include multiple visits on separate days, possibly several weeks apart. This presents an opportunity to examine the essential features of diagnostic evaluations to create a streamlined process for some families and thereby alleviating wait times. At the Seattle Children’s Autism Center (SCAC), we have developed an interdisciplinary team evaluation approach involving a series of appointments with two providers, allowing two families to be seen in a single day. Thus, it may be a viable option for decreasing cost and improving wait times. 

Objectives:  To explore and compare family satisfaction, evaluation hours, and diagnostic outcomes in team evaluations versus more traditional ASD diagnostic evaluation methods. We also examined team members’ diagnostic confidence ratings.

Methods: Following an initial visit with a SCAC pediatric nurse practitioner, patients were triaged to one of three ASD evaluation tracks: multi-visit evaluation with a psychologist (“Psychology”), visit with a physician generally preceded by speech-language testing (“MD Confirm”), or interdisciplinary team evaluation described above (“Team”). See Figure 1 for visit information about tracks and Figure 2 for Team evaluation template. Medical records were reviewed from 346 Team, 60 MD Confirm, and 92 Psychology evaluations conducted in 2014-2015.  

Results: In Team evaluations, 61% of cases were diagnosed with ASD, 29% were not diagnosed with ASD, and 10% required further information in order to come to a diagnostic decision.  Clinician confidence ratings were available for 23% of cases and were highly correlated (r = .83, p <.001), with 63% of ratings being identical and 32% within 1 point. After excluding Team patients who required further information to come to a decision, ASD diagnostic rates were similar across evaluation models (Team: 68%, MD: 73%, Psych: 72%, χ²(2) = 0.89,  p = .64). The Team model required, on average, 4 fewer billing hours compared to Psychology and approximately the same number of hours as MD Confirm. Family satisfaction data were collected on a random sampling of patients seen in the three tracks. Results of family surveys suggested the majority of families were satisfied with their experience (M=8.88 out of 10) and scores did not differ across diagnostic tracks, F(2,62) = 0.32, p = .73.

Conclusions:   ASD Interdisciplinary Team Evaluations shortened billing time and resulted in diagnostic determination in 90% of patients. Family satisfaction and overall rate of ASD diagnosis were similar across ASD evaluation methods, and comparable to a previous report of a 61% ASD diagnostic rate in a different diagnostic center (Monteiro
et al., 2015). A focused team approach to ASD clinical diagnosis appears sufficient for many patients and may decrease the number of hours required for evaluation, while maintaining consistency in diagnostic rates and without detriment to family satisfaction. Thus, incorporating the Team model into diagnostic centers may decrease billing costs and improve clinic wait times.