Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.
Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.
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DOI：
10.1097/dbp.0000000000000490
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发表时间：
2017-10
期刊：
影响因子：
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通讯作者：
Power TJ
中科院分区：
文献类型：
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作者：
Fiks AG;Mayne SL;Michel JJ;Miller J;Abraham M;Suh A;Jawad AF;Guevara JP;Grundmeier RW;Blum NJ;Power TJ
评估远程学习，质量改进干预，以改善儿科初级保健提供者使用ADHD评定量表。初级保健实践被随机分组到3部分远程学习，质量改进干预（基于网络的教育，与ADHD专家的协作咨询，以及性能反馈报告/电话），资格认证维护（MOC）第四部分学分，或等待列表控制。我们使用按实践聚类的逻辑回归（主要分析），比较了研究组评定量表使用相对于基线期的变化，并检查了临床医生参与水平的影响。在干预期之前，在所有地点实施了一个电子健康记录链接系统，用于收集家长和教师的ADHD评级量表。评定量表的使用通过手动图表审查确定。19个研究中心的105名临床医生参与了研究。组间差异不显著。从基线到干预期以及电子系统实施后，两个研究组的临床医生更有可能管理和接受家长和教师的评分量表。在干预临床医生中，那些参与至少一个反馈电话或有资格获得MOC信用的人更有可能给父母评分量表，分别为14.2（95%置信区间：0.6，27.7）和18.8（95%置信区间：1.9，35.7）个百分点。一个由3部分组成的以临床医生为中心的远程学习，质量改进干预并没有改善评级量表的使用。可能需要支持工作流程和更充分地吸引临床医生的补充策略来加强护理。收集评级量表的电子系统可能有助于实现这一目标。
To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of ADHD rating scales. Primary care practices were cluster-randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented prior to the intervention period at all sites. Rating scale use was ascertained by manual chart review. 105 clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and following implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least one feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval: 0.6, 27.7) and 18.8 (95% confidence interval: 1.9, 35.7) percentage points, respectively. A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal.