Alternative Developmental Evaluation Model for a Changing Health Care Environment ♦ 86

Abstract

The interdisciplinary evaluation (IE) model has been well established in Centers for Neurodevelopmental Disabilities. This model may be less competitive in a health care environment dominated by patient volume, economics, and outcomes. IE generates long waiting lists resulting in delayed diagnosis and access to care. An alternative evaluation model addressed staff cut-backs, cost accountability, timing and delivery of appropriate services without compromising quality of care. Patients (N=88) in the alternative model(AM) were compared to those (N=94) in the routine clinic (RC). IE averaged 6 hrs per patient with medical, psychological, speech, social, vision and hearing evaluations at a minimum for RC. In AM a decision protocol was used to select appropriate patients for a 90 minute medical and social assessment including standardized developmental screening tools. Of new patients, 49(56%) received AM. Trained social workers used the decision protocol after medical records were procured and considered age, reason for visit, previous testing, and driving distance. AM patients were 3 and 10 years old, 76.9% were males, 88.5% received Medicaid, and 84.6% were referred in by physicians or health clinics. Compared to RC, the time on the waiting list was shortened by 2 months (10.2 vs 18.5 wks) for AM families. The charge per AM patient decreased by 30% ($548 vs $779), with similar level of reimbursement over the 5 mo. AM patients had fewer clinical contacts (6.9 vs 8.1). Surveyed by mail, AM caregiver satisfaction was high (80%), with 72% reporting their questions or concerns were addressed. All surveyed student clinicians (N=8) agreed AM provided a good IE learning opportunity. Outcomes from AM were medical referrals (15.4% for genetics, 15.4% for further laboratory studies, 11.5% for MRI studies, 26.9% for ADHD testing, 15.4% for hearing reassessment, 15.4% for optometry, and 11.5% for physical therapy), IQ testing (42.3%), speech/language therapy (26.9%) and other interventions (family counseling 11.5% preschool 23%). Over half (52%) of families reported recommended services were easily obtained. AM used an IE team effectively to screen for neurodevelopmental disabilities, shorten staff time, costs and waiting lists. Medical concerns were identified sooner by AM and its decision protocol used more community resources than RC.