Electronic Health Record Monitoring Dashboard and Developmental Screening in Pediatric Patients

Importance: Early identification of developmental delay and autism in young children improves outcomes, but screening rates in young children are low, particularly for some patient groups. Objective: To examine patient- and system-level characteristics associated with screening return rates and timelines and evaluate the association of an electronic health record (EHR)-based dashboard with these outcomes. Design, Setting, Participants: This retrospective cohort study using EHR data from a large integrated health care system analyzed screening questionnaire return rates and time to return among children aged 6 to 66 months referred to a secondary screening program. A cross-sectional analysis (September 1, 2022, to September 1, 2023) used adjusted modified Poisson regression and restricted mean survival time (RMST). Changes in return rates, as well as time to return and time to case completion, were assessed before (November 2, 2022, to March 31, 2023) and after (November 2, 2023, to March 31, 2024) implementation of an EHR-embedded monitoring dashboard. Data were analyzed from December 5, 2023, to February 20, 2026. Exposures: Patient and organizational characteristics based on EHR data and indicators for dashboard implementation. Main Outcomes and Measures: Return rates of screening questionnaires, time to return questionnaires in days, and time to case completion in days (review questionnaire, recommendations to families, and place relevant referrals). Results: A total of 17 303 screening referral orders (11 351 65.6% among males; mean SD age, 27.73 12.79 months; 15 853 91.6% aged 16-66 months) for 16 038 unique patients were included in this study. Questionnaires were returned for 7500 referrals (43.3%). Lower return rates were associated with older age (adjusted relative risk ARR, 0.71 95% CI, 0.68-0.75), non-English language preference (ARR range, 0.65 95% CI, 0.47-0.89 to 0.73 95% CI, 0.65-0.83), Black race (ARR, 0.79 95% CI, 0.72-0.86) or Hispanic ethnicity (ARR, 0.85 95% CI, 0.81-0.89), highest neighborhood deprivation quintile (ARR, 0.92 95% CI, 0.86-0.98), and Medicaid insurance (ARR, 0.85 95% CI, 0.81-0.89). Online portal account access was linked to higher return rates (ARR, 1.99 95% CI, 1.75-2.26) and faster return times (adjusted RMST difference, -6.42 days 95% CI, -7.26 to -5.59 days). Older age was associated with longer return times (adjusted RMST difference, 6.82 days 95% CI, 5.90-7.75 days). After dashboard implementation, return rates increased from 41.2% (2823 of 6854) to 54.7% (3883 of 7097) (ARR, 1.34 95% CI, 1.29-1.38), while decreases were observed for time to return (adjusted RMST difference, -6.62 days 95% CI, -7.18 to -6.07 days) and completion (adjusted RMST difference, -37.07 days 95% CI, -38.47 to -35.67 days). Conclusions and Relevance: The findings of this cohort study suggest that completion of recommended developmental screening can be challenging for certain patient populations. EHR-based tools may be useful to improve return rates and reduce return and case completion times.