Improving Access to Care at Autism Treatment Centers: A System Analysis Approach.

Abstract:

OBJECTIVE:The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need. METHODS:Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children's Hospital Medical Center (CCHMC) and Nationwide Children's Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC). RESULTS:Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC. CONCLUSIONS:This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Austin J,Manning-Courtney P,Johnson ML,Weber R,Johnson H,Murray D,Ratliff-Schaub K,Tadlock AM,Murray M

doi

10.1542/peds.2015-2851M

subject

Has Abstract

pub_date

2016-02-01 00:00:00

pages

S149-57

eissn

0031-4005

issn

1098-4275

pii

peds.2015-2851M

journal_volume

137 Suppl 2

pub_type

杂志文章
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    pub_type: 杂志文章,评审

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  • Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants.

    abstract:OBJECTIVE:Recommendations to prevent vertical transmission of group B Streptococcus (GBS) infections have resulted in many women's receiving antibiotics during labor with an associated reduction in early-onset GBS infections in their newborn infants. However, a potential relationship of intrapartum antibiotics (IPA) to...

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    authors: Glasgow TS,Young PC,Wallin J,Kwok C,Stoddard G,Firth S,Samore M,Byington CL

    更新日期:2005-09-01 00:00:00

  • Maternal mosaicism confounds the neonatal diagnosis of type 1 Timothy syndrome.

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    pub_type: 杂志文章

    doi:10.1542/peds.2012-2941

    authors: Dufendach KA,Giudicessi JR,Boczek NJ,Ackerman MJ

    更新日期:2013-06-01 00:00:00

  • Fatal hepatitis B in early infancy: the importance of identifying HBsAg-positive pregnant women and providing immunoprophylaxis to their newborns.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Delaplane D,Yogev R,Crussi F,Shulman ST

    更新日期:1983-08-01 00:00:00

  • Addressing parental smoking in pediatrics and family practice: a national survey of parents.

    abstract:BACKGROUND:Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child's visit to prim...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.112.5.1146

    authors: Winickoff JP,McMillen RC,Carroll BC,Klein JD,Rigotti NA,Tanski SE,Weitzman M

    更新日期:2003-11-01 00:00:00

  • Considering complementary and alternative medicine alternatives in cases of life-threatening illness: applying the best-interests test.

    abstract::In this article we explore decision-making about treatment when a child faces a life-threatening illness but conventional treatment presents substantial risk and uncertain benefit. When is it acceptable for parents to decide to use complementary and alternative medicine as an alternative, rather than a complement, to ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2010-2720F

    authors: Gilmour J,Harrison C,Asadi L,Cohen MH,Aung S,Vohra S

    更新日期:2011-11-01 00:00:00

  • Disabling conditions and registration for child abuse and neglect: a population-based study.

    abstract:OBJECTIVE:To study the relationship between disabling conditions and registration for child abuse and neglect in a 19-year whole-population birth cohort. SETTING:West Sussex area of the United Kingdom. STUDY DESIGN:Retrospective whole-population cohort. MAIN OUTCOMES:Child-protection registration, physical abuse, se...

    journal_title:Pediatrics

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    doi:10.1542/peds.2004-1882

    authors: Spencer N,Devereux E,Wallace A,Sundrum R,Shenoy M,Bacchus C,Logan S

    更新日期:2005-09-01 00:00:00

  • Toward creating family-friendly work environments in pediatrics: baseline data from pediatric department chairs and pediatric program directors.

    abstract:OBJECTIVE:The objective was to determine baseline characteristics of pediatric residency training programs and academic departments in regard to family-friendly work environments as outlined in the Report of the Task Force on Women in Pediatrics. METHODS:We conducted Web-based anonymous surveys of 147 pediatric depart...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-2397

    authors: McPhillips HA,Burke AE,Sheppard K,Pallant A,Stapleton FB,Stanton B

    更新日期:2007-03-01 00:00:00

  • Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study.

    abstract::Thirty-eight consecutive children with recurrent abdominal pain underwent lactose tolerance tests; 28 of these were also given sucrose tolerance tests. Abdominal pain and abnormal lactose tolerance tests were noted in 11 of 38, while none of the 28 had an abnormal sucrose tolerance test; however, 1 had abdominal pain....

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Liebman WM

    更新日期:1979-07-01 00:00:00

  • FDA's pediatric device consortia: national program fosters pediatric medical device development.

    abstract:OBJECTIVES:This article reports on the progress made in addressing pediatric medical device needs through the establishment of the Pediatric Device Consortia Grant Program. Pediatric practitioners should be aware of both the imperative for well-studied devices for children and the existence of recently created resource...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-1534

    authors: Ulrich LC,Joseph FD,Lewis DY,Koenig RL

    更新日期:2013-05-01 00:00:00

  • Fomepizole treatment of ethylene glycol poisoning in an infant.

    abstract::The enzyme alcohol dehydrogenase metabolizes ingested ethylene glycol (EG) to the toxic compounds glycolic and oxalic acids. Renal failure, acidosis, hypocalcemia, and death may follow. Traditional treatment of EG poisoning may require ethanol, a competitive substrate of alcohol dehydrogenase, and hemodialysis, that r...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.106.6.1489

    authors: Baum CR,Langman CB,Oker EE,Goldstein CA,Aviles SR,Makar JK

    更新日期:2000-12-01 00:00:00

  • Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies.

    abstract::Infants, children, and adolescents can be exposed unexpectedly to ionizing radiation from nuclear power plant events, improvised nuclear or radiologic dispersal device explosions, or inappropriate disposal of radiotherapy equipment. Children are likely to experience higher external and internal radiation exposure leve...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2018-3000

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    更新日期:2018-12-01 00:00:00

  • Controlled evaluation of muscle relaxation in the ventilated neonate.

    abstract::To assess the effects of muscle relaxation on the critically ill ventilated neonate, pancuronium bromide was administered for a 12-hour period to ten low-birth-weight neonates (960 to 2,000 gm) of 26 to 34 weeks gestation, all whom required mechanical ventilation and were studied within 48 hours of birth (six to 39 ho...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

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    更新日期:1981-05-01 00:00:00

  • Enterobacter aerogenes primary bacteremia in pediatric patients.

    abstract::Enterobacter aerogenes bacteremia associated with the infusion of contaminated admixed intravenous (IV) fluid occurred in seven patients in a pediatric hospital over a five-day period. Clinical illness was characterized by spiking fever in all patients. The temporal clustering of cases allowed for rapid recognition of...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Edwards KE,Allen JR,Miller MJ,Yogev R,Hoffman PC,Klotz R,Marubio S,Burkholder E,Williams T,Davis AT

    更新日期:1978-09-01 00:00:00

  • Intima-media thickness and flow-mediated dilatation in the Helsinki study of very low birth weight adults.

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    journal_title:Pediatrics

    pub_type: 杂志文章,随机对照试验

    doi:10.1542/peds.2010-2199

    authors: Hovi P,Turanlahti M,Strang-Karlsson S,Wehkalampi K,Järvenpää AL,Eriksson JG,Kajantie E,Andersson S

    更新日期:2011-02-01 00:00:00

  • Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults.

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    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2015-2970

    authors: McCarthy NL,Gee J,Sukumaran L,Weintraub E,Duffy J,Kharbanda EO,Baxter R,Irving S,King J,Daley MF,Hechter R,McNeil MM

    更新日期:2016-03-01 00:00:00

  • Perinatal human immunodeficiency virus-1 transmission and intrauterine growth: a cohort study in Butare, Rwanda.

    abstract:OBJECTIVE:To study the association of perinatal human immunodeficiency virus (HIV)-1 transmission with birth outcomes, including birth weight, gestational age, ponderal index, head circumference, and weight/head ratio. METHODS:Data from a prospective cohort study of 627 pregnant women and their infants in Butare, Rwan...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.102.2.e24

    authors: Weng S,Bulterys M,Chao A,Stidley CA,Dushimimana A,Mbarutso E,Saah A

    更新日期:1998-08-01 00:00:00

  • Phenothiazine-induced sleep apneas in normal infants.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Kahn A,Hasaerts D,Blum D

    更新日期:1985-05-01 00:00:00

  • Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis.

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    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2017-0925

    authors: Puopolo KM,Mukhopadhyay S,Hansen NI,Cotten CM,Stoll BJ,Sanchez PJ,Bell EF,Das A,Hensman AM,Van Meurs KP,Wyckoff MH,NICHD Neonatal Research Network.

    更新日期:2017-11-01 00:00:00

  • Prospective evaluation of postnatal steroid administration: a 1-year experience from the California Perinatal Quality Care Collaborative.

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    pub_type: 杂志文章

    doi:10.1542/peds.2005-0796

    authors: Finer NN,Powers RJ,Ou CH,Durand D,Wirtschafter D,Gould JB,California Perinatal Quality Care Collaborative Executive Committee.

    更新日期:2006-03-01 00:00:00

  • Maternal, neonatal, and placental features associated with diffuse chorioamniotic hemosiderosis, with special reference to neonatal morbidity and mortality.

    abstract:OBJECTIVE:Our purpose was to examine the significance of diffuse chorioamniotic hemosiderosis (DCH) on neonatal morbidity and mortality. METHODS:Using data from a retrospective case-control study, we analyzed 46 singleton placentas with DCH from infants who were delivered and/or admitted to the neonatal intensive care...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.113.4.800

    authors: Ohyama M,Itani Y,Yamanaka M,Goto A,Kato K,Ijiri R,Tanaka Y

    更新日期:2004-04-01 00:00:00

  • Duration of protection after infant hepatitis B vaccination series.

    abstract:BACKGROUND:Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before a...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1542/peds.2013-2940

    authors: Middleman AB,Baker CJ,Kozinetz CA,Kamili S,Nguyen C,Hu DJ,Spradling PR

    更新日期:2014-06-01 00:00:00

  • Heat stress from enclosed vehicles: moderate ambient temperatures cause significant temperature rise in enclosed vehicles.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2004-2368

    authors: McLaren C,Null J,Quinn J

    更新日期:2005-07-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.107.4.719

    authors: Maalouf EF,Duggan PJ,Counsell SJ,Rutherford MA,Cowan F,Azzopardi D,Edwards AD

    更新日期:2001-04-01 00:00:00

  • Human granulocytic ehrlichiosis presenting as abdominal pain.

    abstract::Human granulocytic ehrlichiosis (HGE) is an emerging infectious disease that primarily affects adults. Typical clinical features include fever, headache, and myalgias. This case represents the youngest reported patient with HGE. Her clinical presentation was unusual in that she presented with severe abdominal pain. In...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.106.3.602

    authors: Gershel JC

    更新日期:2000-09-01 00:00:00

  • Population-based impact of pneumococcal conjugate vaccine in young children.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2003-0592-F

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    pub_type: 杂志文章

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    doi:10.1542/peds.2012-0689

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    更新日期:2012-12-01 00:00:00

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    pub_type: 杂志文章

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    authors: Mitchell WG,Tseng-Ong L

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

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