Research Review

Children With Suspected Development Problems May Not Get Needed Referrals

Many pediatricians score high on screening their patients for developmental delays, but barely make a passing grade in referring children with suspected delays for further testing or treatment, according to a study from Johns Hopkins Children’s Center and other institutions to appear in Pediatrics.

Because screening is only effective if followed by referral and treatment, pediatricians need two separate formalized systems in their practices—one for screening and one for referral—the investigators wrote. The report also notes that pediatricians and their patients would fare better if the doctor’s office places the referral on a patient’s behalf instead of handing the family a phone number to do so on their own.

In 2006, the American Academy of Pediatrics (AAP) issued guidelines that call for informal clinical evaluation of development of all children younger than the age of 3 during all well-child visits, and the use of a standard developmental screening test in all children at 9, 18, and 24 (or 30) months. The AAP recommends that children who fail a screening test be referred to a specialist for more testing and to an early intervention program.

The new study analyzed screening and referrals over nine months among 17 pediatric practices in 15 states, whose physicians and staff were trained on the new AAP guidelines. Although screening rates improved from 68% of patients to 85% of patients after the training, referrals remained low, with only 61% of those with suspected delays sent for further testing and therapy.

Among pediatricians who referred patients for further testing and treatment, many failed to follow up with the family to check whether the family acted on the referral. The investigators say many families don’t follow up and some don’t understand the reason for the referral in the first place.

Researchers say referrals work best if they are placed by the pediatrician’s office on the patient’s behalf and tracked much like any other medical referral. Historically, referrals for developmental delays have not been treated as medical referrals but rather informally, by handing the parents a phone number and telling them to follow up with an early intervention program or a therapy provider.

To increase referral and follow-up, each practice should establish a separate referral log and tracking system that prompts staff, nurses, and doctors not only to refer a patient, but to call and check with the family periodically to ensure action.

— Source: Johns Hopkins Medicine