P3.D074: Pediatric Primary Care Telemedicine Follow-Up After Autism Evaluation

Background: Telemedicine improved patient care access during the COVID-19 pandemic. Thus, our Federally Qualified Health Center (FQHC) developed a telemedicine follow-up program for children with suspected autism spectrum disorders (ASDs) after sub-specialty evaluation.

Telemedicine tools may be necessary to follow these high-risk patients requiring early intervention (EI) for successful long-term outcomes.

Methods: The telemedicine follow-up program aimed to 1) schedule a telemedicine visit within two months of receiving sub-specialty evaluation results, 2) review the diagnosis determined at the sub-specialty evaluation with the caregivers (e.g. ASD or developmental delay), 3) assess connection to current EI therapies and make necessary referrals to services and resources , 4) determine the need for additional medical evaluations, and 5) review follow-up recommendations within the primary care medical home and with sub-specialists as necessary.

Workflow consisted of one general pediatrician at the FQHC receiving completed sub-specialty evaluation reports through the electronic medical record and then attempting to schedule a telemedicine visit. With IRB approval, retrospective chart review was performed for pediatric patients evaluated by a developmental-behavioral pediatrician for possible ASD from January 2022 to December 2023.

Results: Out of 38 eligible participants, 84% followed up via telemedicine, 13% in-person (per caregiver request), and 2.6% via telephone (Table 1). The average wait-time for the follow-up encounter was 58 days. 92% of patients were diagnosed with ASD, 5% with global developmental delay, and 1% with language delay alone. 92% of patients were referred to our FQHC care coordinators for connection to EI services, including applied behavior analysis (ABA) therapy if diagnosed with ASD, as well as other resources to address identified social determinants of health. Within 12 months of the follow-up encounter, 89% of patients had documentation of an audiology evaluation and 21% had genetic testing ordered (e.g. CMA, Fragile X). Figure 1 shows connection to services over time.

Conclusion: Implementation of telemedicine follow-up for pediatric primary care patients after sub-specialty ASD evaluation facilitated timing of the encounter and care coordination through our FQHC. Planned adaptations include improving recommendations for genetic testing, while continuing to assess family satisfaction to inform best practices and advocate for improved access to EI and ABA therapy.