The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians’ alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts. A total of 146 out of 1738 parent reports (8%) triggered alerts for 98 patients. One hundred and eleven alerts (76%) required immediate clinician review. Nurses successfully contacted parents for 68 (61%) of actionable alerts; 46% (31/68) led to a change in care plan prior to the next scheduled appointment. Compared to patients without alerts, patients with alerts demonstrated worsened ADHD severity (β = 5.8, 95% CI: 3.5–8.1 [p < 0.001] within 90 days prior to an alert. The trigger algorithm facilitated timely changes in the care plan in between face-to-face visits.
Please answer all questions as they apply to your child OVER THE LAST 6 MONTHS. All children function differently from very early skills to more complex skills. If there is a skill listed that your child has already mastered independently without prompting or reminders, please mark as Always. If there is a skill listed beyond your child's developmental level, please mark Never. Please fill this form out to the best of your ability and discuss any additional concerns with your physician.Please fill in ONLY one bubble in each row. Communication and Social SkillsWhen your child wants to communicate, how often does he or she use each of the following: Never Rarely Sometimes Often Always 1. Spoken language 2. Sign language 3. Picture communication system (e.g., PECS) 4. An electronic communication device (e.g., iPad, iPhone, Dynavox) 5. What is your child's primary form of communication? Spoken language Sign Language A picture communication system An electronic communication device 6. When your child communicates, how many words/signs/pictures does your child put together to communicate? My child does not yet communicate (Note: please skip questions 8-15) My child uses one word/sign/picture at a time My child uses two words/signs/pictures at a time My child uses three words/signs/pictures at a time My child uses full sentences
Objectives While national medical guidelines recommend genetic testing for all individuals with non-syndromic autism spectrum disorder (ASD), there is underutilization of genetic testing. This study aims to define the perspectives and approaches to initial genetic testing of ASD diagnosticians in order to improve utilization. Methods A prospective cross-sectional study was conducted using an anonymous online survey distributed to 59 staff neurologists, developmental-behavioral pediatricians, psychologists, post-graduate physician fellows, and nurse practitioners from a single academic medical center. Questions explored knowledge, attitudes, and practices of initial genetic testing for ASD among diagnosticians. Results Among the 30 respondents (51% response rate), a lack of comprehensive pre-test genetic counseling was identified and forgetfulness was the most prevalent reason for not recommending genetic testing (n = 7/23, 30%). Insurance prior authorization (PA) for genetic testing was a major barrier for clinicians. More than half of respondents (n = 13/25, 52%) reported being uncomfortable with the PA process. Conclusions Variability in knowledge and practices among ASD diagnosticians regarding genetic testing was identified. Therefore, potential interventions like clinician and administrative staff education, as well as genetic counselor integration into ASD clinics, may be useful to improve genetic testing utilization.
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