Abstract for: Decision thresholds in developmental-behavioral screening: Gaining insight through system dynamics modeling

To identify and treat young children with developmental disability, physicians use various parent-report questionnaires as screening tools. However, it is unclear how pediatricians use screening instruments in practice, particularly whether they follow recommended decision thresholds or set their own based on their past screening experience. In practice, a high proportion of children with disabilities are not accurately identified until school age or later, indicating a high false negative rate for young children. We developed a system dynamic (SD) model to evaluate factors that influence physicians’ decision thresholds when identifying developmental disabilities in pediatric settings. The model was informed by the literature on medical errors and decision-making, regret theory, and a prior SD model of thresholds in social policy. We conducted a series of virtual experiments to simulate interventions to improve detection of developmental and behavioral disorders among children, including introduction of a high-quality screening instrument. Our results suggest that if physicians adjust their decision thresholds based on feedback regarding patient outcomes, then detection rates may be improved not only by improving the accuracy of screening instruments, but also by improving feedback to physicians regarding medical errors or by decreasing regret associated with false positive results.