Shared Decision Making in ADHD

描述（由申请人提供）：Alexander Fiks，医学博士，MSCE 是一位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，虽然以临床医生为中心的 HIT 干预措施是有效的，但可以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来增加其影响，这一过程称为共享决策 (SDM)。尽管 Fiks 博士的长期职业目标是成为使用 HIT 大规模实施 SDM 治疗多种儿科疾病的独立调查专家，但该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之间进行选择；个人/文化价值观影响他们的选择；存在待遇差异；迄今为止，在理清这些影响以支持决策方面所做的工作还很少。在此奖项期间，Fiks 博士将：(1) 评估 SDM 在初级保健中对具有全国代表性的 ADHD 儿童样本的患病率、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，以及 (3) 评估可行性和可接受性，并探索 ADHD、基于 HIT 的 SDM 试点干预在初级保健中的结果。该应用的假设是，在基于 HIT 的系统中使用工具来捕获家庭的 ADHD 治疗偏好和目标将促进 SDM 并提高治疗的依从性和结果。这项研究利用基于儿科实践的研究网络，将补充正式课程、研讨会/会议参与和熟练指导，以培训 Fiks 博士实现其职业目标。 Fiks 博士的具体教育目标是 (1) 培养专家技能来评估 HIT 支持的 SDM 的有效性，包括纵向/聚类数据的研究和临床试验的进行，(2) 培养健康测量和仪器开发方面的高级技能，以及 (3) 增进对鼓励 SDM 的方法的了解，包括使用决策辅助和 HIT。这项为期 5 年的奖项将为 Fiks 博士提供启动 SDM 治疗 ADHD 的 R01 级试验所需的培训和试点数据。 公共卫生相关性：共同决策 (SDM) 是医学研究所的优先事项，承诺为家庭提供可接受的治疗方案并改善儿童健康结果。通过捕获、传输和处理健康信息，计算机系统可以支持大规模的SDM。这笔赠款探讨了这些系统在促进 ADHD 的 SDM 方面的作用，ADHD 是该国超过 400 万儿童的一种疾病。

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.