Increasing Use of M-CHAT-R/Follow-up in Pediatric Care through Clinician Participation in a Maintenance of Certification Quality Improvement Project
Objectives: Compare 6-month baseline average M-CHAT-R/F screening rates to 6-month post-MOC QI project rates to assess influence of physician participation in an MOC project on improving ASD screening.
Methods: All physicians enrolled in this MOC QI project completed a 10 minute online educational module on autism screening, diagnosis, and intervention. Physicians also met with coaches monthly for one hour to identify barriers to screening in his/her practice and plan QI activities to overcome them using the Plan-Do-Study-Act framework. Coaches reviewed run charts tracking the impact of QI activities on ASD screening rates with physicians. To assess practice-level impact of MOC-related QI activities, the number of M-CHAT-R/Fs completed using the CHADIS system was examined for the 6 months prior compared to the 6 months following MOC enrollment.
Results: MOC participation and M-CHAT-R/F screening data was analyzed from 138 clinicians representing 47 practices ranging from solo practitioner to multi-physician hospital settings across the U.S. On average, these physicians reported 24 years of clinical experience. Before MOC participation, 71% reported routinely screening for ASD at ages 18 and 24 months. Many barriers to appropriate use of the M-CHAT-R/F were identified, including inefficient office workflows, failure to administer follow-up interviews for all positive screens, and limited task-sharing and communication between clinical support and administrative staff. In the 6 months prior to MOC enrollment, an average of 21 M-CHATS-R/Fs were completed per month across practices. After MOC enrollment, the average number of M-CHAT-R/Fs completed in the CHADIS system increased to 30 per month, a 43% increase. Percent change in screening between baseline and follow up was positive among all enrolled practices and ranged from 12% to 180% increases in screening after implementing the Plan-Do-Study-Act QI framework and tailored improvement activities.
Conclusions: Physician participation in the MOC-4 quality improvement project offered through CHADIS increased rates of M-CHAT-R/F use across a 6-month period. Future projects engaging physicians in quality improvement at the practice level should be considered to reduce barriers to implementing routine ASD screening in pediatric care.