A Novel Population Health Approach to Improving Autism Screening at a Community Health Center

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Screening for autism improves early diagnosis and long-term outcomes. Hispanic and Black children disproportionately experience diagnosis delays. In our community health center serving an urban, low-income, majority Hispanic and Black population, we aimed to increase autism screening rates through a novel approach using population health data, a community health worker (CHW), and telemedicine. During the 6-month effort, we generated reports of 18-30 mo patients who lacked a documented M-CHAT, ordered by risk of high healthcare costs. The CHW contacted families, provided brief education on autism screening, and scheduled telemedicine visits with a pediatrician. During the visit, the pediatrician completed the M-CHAT, provided developmental counseling, and referred to services as indicated. In total 469 families of children lacking an M-CHAT were called, 225 were scheduled for a visit, 182 completed screenings, and 21 screened positively. The proportion of children with a documented M-CHAT increased from 48% to 78%. This work revealed improvement opportunities in clinic workflows and data collection. We demonstrate that a novel effort to increase autism screening using a population health approach is possible in an urban community health center environment.


  • Lacey Whitmire, MD, MPH, Medical Director, Fair Haven Community Health Care