Can a novel telemedicine tool reduce disparities related to the identification of preschool children with autism?

新型远程医疗工具能否减少学龄前自闭症儿童识别方面的差异？

• 批准号: 10551873
• 负责人: Zachary E Warren
• 金额: $ 25.95万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-17 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10551873
• 关键词: Address; African American; Age; Age Months; Agreement; Assessment tool; Attention; Behavior; Behavior Disorders; Behavioral; Blinded; COVID-19; COVID-19 pandemic; Caring; Child; Classification; Clinical; Computer Analysis; Data; Data Set; Decision Making; Development; Diagnosis; Diagnostic; Disparity; Disparity in diagnosis; Early Diagnosis; Early Intervention; Engineering; Ethnic Origin; Evaluation; Evidence based intervention; Face; Family; Geography; Health Services Accessibility; Hispanic; Home; Improve Access; Investigation; Linguistics; Machine Learning; Measures; Methodology; Methods; Mining; Modeling; Nursery Schools; Parents; Performance; Persons; Phenotype; Play; Population; Populations at Risk; Preschool Child; Procedures; Process; Production; Property; Provider; Psychometrics; Race; Registries; Reporting; Risk Assessment; Sampling; School-Age Population; Scientist; Services; Socioeconomic Status; Specialist; Stress; Structural Racism; Structure; Symptoms; System; Target Populations; Techniques; Telemedicine; Testing; Time; Toddler; Translating; Underserved Population; Wait Time; Waiting Lists; Work; access restrictions; autism spectrum disorder; autistic children; barrier to care; community clinic; design; diagnostic tool; disorder risk; disparity reduction; formative assessment; geographic barrier; health assessment; health disparity; improved; innovation; novel; remote administration; satisfaction; service intervention; sound; telehealth; tertiary care; tool; tool development; underserved community; usability

PROJECT SUMMARY Families seeking evaluation for autism spectrum disorder (ASD) often face barriers such as low availability of specialists, lengthy waitlists, and long distances to tertiary care diagnostic centers. This is especially true for children from traditionally underserved groups and communities. Without innovative approaches for enhanced identification of ASD, families and clinicians will continue to struggle with accessing and providing care. Telemedicine offers tremendous potential for addressing this need, but there are few psychometrically sound, validated tools that can be administered remotely, via telehealth platforms, in order to guide service and action. Our team developed and conducted a preliminary evaluation of a novel parent-administered, clinician-guided tele-diagnostic tool, the TAP (TELE-ASD-PEDS), designed specifically for direct-to-home and community clinic use with toddlers. Remote administration of the TAP yielded a very high level of agreement with blinded comprehensive evaluation regarding ASD risk classification. Subsequently, the unanticipated broad dissemination of the TAP during COVID-19 demonstrated its value for traditionally underserved groups, spanning broad geographies. Although promising, this work was limited by its specific focus on toddlers with ASD concerns. A telemedicine tool designed for the unique context and population of preschool-aged children referred for diagnostic assessment could have tremendous value in terms of both accurate identification as well as family engagement with service. In the current work, we propose a computationally informed co-production in which we involve our targeted population as active partners in designing a new telemedicine tool, the TAP– Preschool, for ASD risk assessment in preschoolers. This approach will follow our innovative methodology for fusing advanced computational analyses with stakeholder expertise (1) by mining our large clinical registry to identify key ASD behavior targets and (2) rigorously translating these key behaviors to generate telehealth assessment techniques. With input from our computational experts, clinical scientists, and end-users, we will then evaluate the performance, usability, and utility of the TAP–Preschool. We will gather critical data not only regarding its structure and accuracy, but also its potential deployment across systems responsible for engaging children and families from underserved groups in meaningful service. This work has potential to transform the ASD evaluation process and dramatically improve care access for traditionally underserved groups.

项目概要 寻求自闭症谱系障碍 (ASD) 评估的家庭经常面临障碍，例如缺乏可用的自闭症谱系障碍 (ASD) 评估 专家、漫长的候补名单以及距三级护理诊断中心的距离尤其如此。 来自传统上服务不足的群体和社区的儿童没有创新的方法来加强。 自闭症谱系障碍（ASD）、家庭和人群的识别将继续在获得和提供护理方面遇到困难。 远程医疗为满足这一需求提供了巨大的潜力，但在心理测量方面却很少有， 经过验证的工具可以通过远程医疗平台进行远程管理，以指导服务和行动。 我们的团队开发了一种新型的由家长管理、临床医生指导的药物，并进行了初步评估 远程诊断工具 TAP (TELE-ASD-PEDS)，专为直接到家和社区诊所而设计 与幼儿一起使用 TAP 的远程管理获得了盲人的高度认同。 随后，关于 ASD 风险分类的综合评估，出现了意想不到的广泛影响。 在 COVID-19 期间传播 TAP 证明了其对传统上服务不足的群体的价值，涵盖 尽管这项工作前景广阔，但由于其对自闭症谱系障碍幼儿的具体关注而受到限制。 专为学龄前儿童的独特背景和人群设计的远程医疗工具。 转诊进行诊断评估在准确识别方面也具有巨大价值 在当前的工作中，我们提出了一种基于计算的联合制作。 我们让目标人群作为积极的合作伙伴来设计一种新的远程医疗工具，即 TAP – 学前班，用于学龄前儿童的 ASD 风险评估。这种方法将遵循我们的创新方法。 通过挖掘我们的大型临床注册表，将先进的计算分析与利益相关者的专业知识相融合 (1) 确定关键的 ASD 行为目标，并 (2) 严格转化这些关键行为以产生远程医疗 根据我们的计算专家、临床科学家和最终用户的意见，我们将 然后评估 TAP-Preschool 的性能、可用​​性和实用性 我们不仅会收集关键数据。 关于其结构和准确性，以及其跨负责参与的系统的潜在部署 这项工作有可能改变服务水平低下群体的儿童和家庭。 自闭症谱系障碍（ASD）评估流程并显着改善传统上服务不足的群体的护理机会。