The full text of an HCM 340 Module 5 Milestone Two paper analyzing an existing initiative: how Indiana's Early Autism Evaluation Hub system moves diagnosis into primary care, its measured diagnostic accuracy and family satisfaction, two comparison models, and its strengths, limits and transferability. Searches like "hcm 340 module 5 assignment", "hcm340 module 5 final project milestone two" and "hcm 340 module 5 example" land here.
The HCM 340 Module 5 example, in full
Milestone Two: Indiana's Early Autism Evaluation Hub System as an Initiative to Shorten the Wait for Diagnosis
[Student Name]
Southern New Hampshire University
HCM 340: Healthcare Delivery Systems
Module Five Final Project Milestone Two
[Instructor Name]
[Date]
Milestone Two: Indiana's Early Autism Evaluation Hub System as an Initiative to Shorten the Wait for Diagnosis
The Gap Revisited
Milestone One identified a gap in delivery: young children who screen positive for autism often wait a year or more for a diagnostic evaluation, because diagnosis is concentrated in a small number of specialty centers. Nationally, the median age at earliest known diagnosis in 2022 was 47 months (Shaw et al., 2025), even though autism can be diagnosed reliably by about 18 to 24 months. Any initiative that addresses this gap must add diagnostic capacity, move it closer to families or make each evaluation faster, and ideally all three.
The Initiative and How It Works
Indiana's Early Autism Evaluation Hub system takes the first two approaches. Rather than sending every child to a specialty center, it trains community primary care clinicians at practices around the state, known as hubs, to evaluate and diagnose autism in young children themselves. Specialists at the state's academic center provide the training and continue to support hub clinicians through collaboration and consultation, so that complex cases still reach them (McNally Keehn et al., 2023). The model rests on a simple observation about the delivery system: primary care clinicians already see young children repeatedly, know their families and are located in the communities where families live, so they are the part of the system with the most available reach.
In delivery system terms, the initiative changes where a service sits. Diagnosis moves from tertiary specialty care to primary care, and the specialist's role shifts from evaluating every child to training, supporting and handling the hardest cases. The model does not add specialists; it multiplies the effect of the ones who already exist. That is important because the specialist shortage cannot be solved quickly by training more developmental-behavioral pediatricians.
What the Evidence Shows
The central question for any model that moves diagnosis into primary care is whether diagnoses remain accurate. McNally Keehn et al. (2023) addressed it directly. Hub clinicians referred 126 children aged 14 to 48 months for a blinded follow-up evaluation by autism experts. The hub clinicians' diagnosis agreed with the experts' in 82 percent of cases. Sensitivity was 81.5 percent and specificity 82.4 percent, and when a hub clinician diagnosed autism, the experts agreed 92.6 percent of the time. Accuracy did not differ by clinician or site. Most disagreements were cases in which hub clinicians did not diagnose autism in children the experts did, often children with global developmental delay, where the two conditions are hard to separate.
Family experience is a second test. In a mixed-methods study of caregivers whose children were evaluated through the hub system, satisfaction was high across multiple dimensions and did not differ by family demographics, diagnostic outcome or diagnostic accuracy (Martin et al., 2024). Caregivers' main suggestion was for clearer explanation of the diagnosis and of the services to seek afterward, which points to a weakness in the step after diagnosis rather than in the evaluation itself.
Two Related Approaches
The hub system is one of several strategies. A primary care practice in another state built a similar model in which the pediatrician served as the primary diagnostician within the medical home; in a small cohort, median age at diagnosis was 34.5 months, well below the national average the authors cited, and the mean interval from referral to diagnosis was 3.5 months (Nasir et al., 2024). A different approach keeps diagnosis with specialists but removes the need to travel. During the COVID-19 pandemic, one center adopted a caregiver-mediated tele-assessment tool, the TELE-ASD-PEDS, in which parents carry out structured activities with their child at home while a psychologist observes by video, and reported that it allowed evaluations to continue with good clinician acceptability (Wagner et al., 2021). These approaches can be combined: a hub clinician could use tele-assessment to consult a specialist on a difficult case.
How the Initiative Matches the Causes of the Gap
Milestone One traced the gap to four causes, and the hub model can be checked against each. The concentration of diagnosis in specialty centers is addressed directly, since evaluations move to community practices. The length of the traditional multidisciplinary evaluation is addressed partly: hub evaluations are designed for young children with a clear presentation and leave the most complex cases to specialists, so each specialist hour goes further. The lack of training and payment for primary care diagnosis is addressed on the training side through the state program, although payment remains a local problem each practice must solve. The role of diagnosis as a gateway to services is not addressed by the model itself; a faster diagnosis only helps if therapy, early intervention and school services can take the child promptly afterward. In short, the initiative fits the supply side of the gap well and leaves the demand for downstream services to other parts of the system.
Strengths and Limitations
The initiative's strengths are clear. It adds capacity without requiring scarce specialists, brings evaluation into communities, keeps specialists available for complex cases and has published evidence of accuracy and family satisfaction. It also builds on primary care's continuity: the same clinician who diagnoses a child will see that child for years.
Its limitations are also clear. The accuracy study found that roughly one in five children were classified differently by hub clinicians and experts, and missed diagnoses concentrated among children with global developmental delay, so a negative hub result may need follow-up. The model depends on sustained training, specialist time and payment for longer primary care visits, which requires funding that fee-for-service rates may not cover. And the published evaluations come mainly from one state's network, so results elsewhere depend on local primary care capacity and state support. Finally, diagnosis is only the gateway; if therapy services are also scarce, families will simply wait at the next step instead.
Transferability
The hub model appears transferable to states with a central academic program able to train and support community clinicians and with primary care practices willing to take on the role. A state adopting it would need three things: a funded training and consultation program, payment that covers the time an evaluation takes, and a plan for linking diagnosed children to services. The final project will assess whether such a model, possibly combined with tele-assessment, could close the gap for the populations Milestone One identified as waiting longest.
References
Martin, A. M., Huskins, J., Paxton, A., Nafiseh, A., Ciccarelli, M. R., Keehn, B., & McNally Keehn, R. (2024). Mixed methods analysis of caregiver satisfaction with the Early Autism Evaluation Hub system. Journal of Patient Experience, 11. https://doi.org/10.1177/23743735241305531
McNally Keehn, R., Swigonski, N., Enneking, B., Ryan, T., Monahan, P., Martin, A. M., Hamrick, L., Kadlaskar, G., Paxton, A., Ciccarelli, M., & Keehn, B. (2023). Diagnostic accuracy of primary care clinicians across a statewide system of autism evaluation. Pediatrics, 152(2), e2023061188. https://doi.org/10.1542/peds.2023-061188
Nasir, A. K., Strong-Bak, W., & Bernard, M. (2024). Diagnostic evaluation of autism spectrum disorder in pediatric primary care. Journal of Primary Care & Community Health, 15. https://doi.org/10.1177/21501319241247997
Shaw, K. A., Williams, S., Patrick, M. E., Valencia-Prado, M., Durkin, M. S., Howerton, E. M., Ladd-Acosta, C. M., Pas, E. T., Bakian, A. V., Bartholomew, P., Nieves-Muñoz, N., Sidwell, K., Alford, A., Bilder, D. A., DiRienzo, M., Fitzgerald, R. T., Furnier, S. M., Hudson, A. E., Pokoski, O. M., . . . Maenner, M. J. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years: Autism and Developmental Disabilities Monitoring Network, 16 sites, United States, 2022. MMWR Surveillance Summaries, 74(2), 1-22. https://doi.org/10.15585/mmwr.ss7402a1
Wagner, L., Corona, L. L., Weitlauf, A. S., Marsh, K. L., Berman, A. F., Broderick, N. A., Francis, S., Hine, J., Nicholson, A., Stone, C., & Warren, Z. (2021). Use of the TELE-ASD-PEDS for autism evaluations in response to COVID-19: Preliminary outcomes and clinician acceptability. Journal of Autism and Developmental Disorders, 51(9), 3063-3072. https://doi.org/10.1007/s10803-020-04767-y
How this HCM 340 Module 5 example is structured
Milestone Two asks students to identify an initiative and analyze it, so the paper moves from description to evaluation. It recalls the gap in one paragraph, describes the initiative's design and the problem it targets, and then reviews the evidence on accuracy and family experience with specific figures. Two comparison models show the initiative is one of several strategies. Strengths and limitations are weighed separately, and a closing section assesses whether the model could close the gap elsewhere.
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HCM 340 Module 5 questions, answered
What does HCM 340 Milestone Two require?
In Milestone Two, students are generally asked to identify an existing initiative that addresses the gap chosen in Milestone One and to analyze it: what it does, who runs and funds it, how well it works according to evidence, and what its strengths and limitations are, usually in a paper of two to three pages.
What is the Early Autism Evaluation Hub system?
It is a statewide network in Indiana that provides specialized training and ongoing collaborative support to community primary care clinicians so they can evaluate and diagnose autism in young children locally, rather than referring every child to a distant specialty center.
How accurate are primary care clinicians at diagnosing autism?
In a study of the Indiana hub system, trained primary care clinicians agreed with expert evaluators on the autism diagnosis in 82 percent of children, with sensitivity of 81.5 percent and specificity of 82.4 percent. Most disagreements involved children with global developmental delay, which is harder to distinguish from autism.