Shared Decision Making in ADHD

描述（由申请人提供）：Alexander Fiks， M.D， MSCE是一名城市初级保健儿科医生，研究健康信息技术（HIT）以改善儿童健康结果。Fiks博士的研究发现，尽管以临床医生为中心的HIT干预措施是有效的，但通过促进临床医生和家庭之间的信息交流，以澄清治疗偏好和目标，这一过程被称为共同决策（SDM），可以增加其影响。虽然菲克斯博士的长期职业目标是成为一名独立的研究专家，在大规模实施SDM中使用HIT治疗多种儿科疾病，但这次职业发展奖将重点关注注意力缺陷/多动障碍（ADHD）。ADHD是SDM的理想原型条件：家庭在多种循证治疗中进行选择；个人/文化价值观影响他们的选择；治疗差异存在；到目前为止，人们还没有做多少工作来理清这些影响，以支持决策。在此奖项期间，菲克斯博士将：(1)评估SDM在全国代表性ADHD儿童样本的初级保健中的患病率，决定因素和影响，(2)开发一种工具来衡量家庭对ADHD治疗的偏好和目标，(3)评估可行性和可接受性，并探索ADHD，基于hit的SDM试点干预初级保健的结果。该应用的假设是，在基于hit的系统中，使用一种工具来捕获家庭的ADHD治疗偏好和目标，将促进SDM并提高治疗的依从性和结果。这项研究，利用儿科实践为基础的研究网络，将补充正式的课程，研讨会/会议的参与，并熟练的指导，以培养菲克斯博士实现他的职业目标。Fiks博士的具体教育目标是：(1)发展专家技能，以评估支持HIT的SDM的有效性，包括纵向/集群数据的研究和临床试验的进行；(2)发展健康测量和仪器开发方面的高级技能；(3)提高他对鼓励SDM的方法的了解，包括使用决策辅助工具和HIT。这个为期5年的奖项将为Fiks博士提供启动r01水平的SDM治疗ADHD试验所需的培训和试点数据。

DESCRIPTION (provided by applicant): Alexander Fiks, M.D., MSCE is an urban primary care pediatrician who studies health information technology (HIT) to improve child health outcomes. Dr. Fiks' research has found that although clinician-focused HIT interventions are effective, their impact could be increased by facilitating information exchange between clinicians and families in order to clarify treatment preferences and goals, a process called shared decision making (SDM). Although Dr. Fiks' long-term career goal is to become an independent investigator expert in the large-scale implementation of SDM using HIT for multiple pediatric conditions, this career development award will focus on Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD is an ideal prototype condition for SDM: families choose between multiple evidence-based treatments; personal/cultural values influence their selection; treatment disparities exist; and little work has so far been done to untangle these effects to support decision making. During this award, Dr. Fiks will: (1) assess the prevalence, determinants, and impact of SDM in primary care for a nationally representative sample of children with ADHD, (2) develop an instrument to measure families' preferences and goals for ADHD treatment, and (3) assess the feasibility and acceptability, and explore the outcomes of an ADHD, HIT-based SDM pilot intervention in primary care. The hypothesis of this application is that use of an instrument to capture families' ADHD treatment preferences and goals within an HIT-based system will facilitate SDM and improve adherence to and outcomes from treatment. This research, utilizing a pediatric practice-based research network, will complement formal coursework, workshop/conference participation, and skilled mentorship to train Dr. Fiks to achieve his career goals. Dr. Fiks' specific educational aims are to (1) develop expert skills to evaluate the effectiveness of HIT-enabled SDM including the study of longitudinal/clustered data and the conduct of clinical trials, (2) develop advanced skills in health measurement and instrument development, and (3) advance his knowledge of approaches to encourage SDM including the use of decision aids and HIT. This 5 year award will provide Dr. Fiks with the training and pilot data needed to launch an R01-level trial of SDM for ADHD. PUBLIC HEALTH RELEVANCE: Prioritized by the Institute of Medicine, shared decision making (SDM) promises to match families to acceptable treatments and improve child health outcomes. By capturing, transferring, and processing health information, computer systems can support SDM on a large-scale. This grant explores the role of these systems to facilitate SDM for ADHD, a condition impairing more than 4 million children in this country.