Table 3.

Outcome Evaluation: Increased Access to ASD Diagnosis and Accuracy of Diagnosis

	Increased Access to ASD Diagnosis				Accuracy of ASD Diagnosis
	Method	Control	Sample Size	Outcome	Method	Control	Sample Size	Diagnostic Decision	Expert Team Diagnosis	Accuracy of Diagnosis
Warren, 2009	NR	NR	NR	NR	Pediatric providers referred selected cases for further evaluation. Initial result was blinded for assessment	Autism diagnostic clinic	21 patients	ASD vs not ASD: Rank certainty of diagnosis on a 5-point Likert scale (1 = highly uncertain to 5 = highly certain)	71% ASD (n = 15) 29% non-ASD (n = 6)	71% agreement overall. 74% (n = 19) when diagnosed as ASD and 50% when not ASD (n = 2). Agreement in the 4 pediatricians ranged from 57% to 100%
McClure, 2010	Retrospective chart review	AAT	38 patients	Wait time for local teams was 13 wk compared with 36 wk for specialists	Traditional team assessed video-recorded ASD histories conducted by trained providers while blinded to result	AAT	38 patients	ASD vs not ASD: Specific diagnosis within the spectrum	41% ASD (n = 16) 59% non-ASD (n = 22)	87% (33/38) full agreement on diagnosis; 92% agreement as to whether the child was on the spectrum
Swanson, 2014	Self-reported surveys	NA	22 PCP participants	Number of children diagnosed within practice by providers involved in this training increased by 85%.	Pediatric providers referred selected cases for further evaluation. Initial result was blinded for assessment	Comprehensive psychological assessments	14 patients	ASD vs not ASD: Rank certainty on a 5-point Likert scale (1 = highly uncertain to 5 = highly certain)	57% ASD (n = 8) 43% non-ASD (n = 6)	86% diagnostic agreement in forced-choice classifications and 93% agreement when uncertain cases were counted as agreement
Harrison, 2017	Retrospective chart review	Developmental pediatricians	63 patients	Wait time to see a developmental pediatrician was 327 d vs 159 d to see a GP. Wait time was 11 d for new referrals to the access clinic.	NR	NR	NR	NR	NR	NR
Mazurek, 2018	Self-reported surveys	NA	15 PCP participants	80% of PCPs reported increase in the number of children with autism on their caseload. 73% reported accepting referrals for ASD assessments at the end of the program. Average of 173 miles of travel avoided for families	NR	NR	NR	NR	NR	NR
Ahlers, 2019	Retrospective chart review	Traditional assessment model	143 patients in traditional and 101 patients in alternative models (91 seen by general pediatricians)	Time to diagnosis was shorter for all children evaluated by trained pediatricians compared with the traditional assessment model (85 vs 152 d, p < 0.001)	Pediatric providers referred selected cases for further evaluation. Initial result was blinded for assessment	Traditional assessment model	18 patients	ASD vs not ASD: Rank certainty on a 4-point Likert scale (very likely, somewhat likely, somewhat unlikely, or very unlikely)	78% ASD (n = 14) 22% non-ASD (n = 4)	93% diagnostic agreement among pediatricians and psychologists when ASD was ruled in (n = 14) and 100% when ASD was ruled out (n = 4)

AAT, ASD assessment team; ASD, autism spectrum disorder; GP, general practitioner; NA, not applicable; NR, not reported; PCPs, primary care providers.