TIERED EVALUATION MODEL TO OPTIMIZE FASD DIAGNOSTIC CAPACITY IN A DEVELOPMENTAL & BEHAVIORAL PEDIATRICS CLINIC

ABSTRACT

Purpose: FASD is a highly prevalent disorder where the majority of affected individuals remain undiagnosed. Reliance on multidisciplinary diagnostic models hold little hope of meeting needed diagnostic capacity, creating barriers to care. Therefore, a new clinical model aiming to optimize access to diagnostic evaluation was tested. In this model, referred children with symptoms of FASD needing evaluation were triaged into a single discipline model (Nurse Practitioner (NP) or physician (MD)) or a multidisciplinary model (NP + neuropsychologist), depending on factors including age, results of past psychoeducational testing, alcohol confirmation, and growth data. The purpose of this study was to evaluate the impact of this new model utilizing clinical data. Methods: Retrospective review and analysis of clinical data extracted from the billing and electronic medical records for the time period between April, 2014 and November, 2021. Data During the 6.5 year time period studied, 402 patients received a FASD diagnosis. Of these, 196 (48.8%) were diagnosed using the multidisciplinary model, and 206 (51.2%) were diagnosed using the single discipline model. There was steady growth in diagnostic capacity from initiation through 2019, with an almost 6-fold increase in diagnosed patients. Patients came from a wide geographic region, including 34 NYS counties, and 2 bordering states. Diagnosed children ranged from <1 - 20 years of age (m = 7.19), with 140 (36.5%) female and 244 (63.5%) male. Of single discipline evaluations, 205 (89.1%) were conducted in person and 25 (10.9%) by telemedicine, primarily during peak periods of the Covid-19 pandemic. MDs and NPs had roles in both models, with team medical examinations completed by NPs for 192 (98%), MDs, 4 (2%) and single discipline evaluations by NPs in 105 (51%), and MDs 101 (49%). Results: Use of a tiered model of FASD diagnostic evaluation more than doubled diagnostic capacity in the studied clinical setting, and allowed continued evaluation during pandemic conditions. Conclusions: Use of a tiered model of evaluation, in which evaluation of more straight forward cases are provided by a physician or nurse practitioner utilizing psychoeducational testing completed in the school setting, and evaluation of children with more a more complex diagnostic presentation utilizing an interdisciplinary team, has the potential to expand diagnostic capacity.