Evaluating Autism diagnosis agreement between primary care physicians/practitioners and experts through ECHO Autism STAT

Background: Even though early intervention leads to improved outcomes for children with autism spectrum disorder (ASD), delays in diagnosis can have an impact on both children and families. ASD diagnostic practices have significantly evolved over time, in part, because of the lack of specialists to meet the demand. ECHO Autism STAT is one innovative model that increased the capacity of community primary care providers (PCPs) to reliably diagnose ASD within their own practices via hands-on training and virtual guidance and support from ASD specialists. The current study evaluated PCPs agreement with ECHO Autism experts in making independent clinical decisions related to ASD diagnosis in unambiguous cases. Method: After obtaining reliability on the STAT and attending 6 mo of ECHO Autism sessions, PCPs agreement with expert impressions was evaluated for (a) diagnosing unambiguous ASD and (b) identifying symptoms that met DSM-5 criteria. Results: The proportion of cases that achieved the highest PCP agreement score with ASD experts for overall ASD diagnostic impressions was 90% across all cases, 94% across unambiguous cases, and 84% across more complex cases. PCP agreement for DSM-5 symptom impressions was 79%, 87%, and 66% across all, unambiguous, and more complex cases, respectively. Results were significant for unambiguous cases when compared to more complex cases. Conclusions: PCPs can develop clinical expertise in the evaluation and diagnosis of young children with unambiguous ASD that is accurate and reliable. Development of this expertise can expand access for community-based diagnosis that is critical for early detection of ASD.