A Tool for Supporting and Monitoring Decision Making in ADHD

描述（由申请人提供）：本提案旨在完成并验证一种新的基于网络的工具，以协助筛查、诊断和管理精神健康障碍（此处重点关注ADHD）、质量改进（QI）文档和有效的大规模研究。CHADIS是一个筛查，评估和决策支持系统，为健康，发展和精神健康状况（包括ADHD）提供在线工具。CHADIS为家长、青少年和教师提供在线问卷，供他们在访问前完成。这些都是自动评分，以产生一个工作表上的结论链接到电子章节的临床医生指导和无数的资源，为家庭成为讲义。临床数据在专业人员之间安全共享，也形成了一个去识别的研究数据库。 该提案旨在调整CHADIS工具，以优化ADHD护理，QI和研究的使用。注意力缺陷多动障碍（ADHD）是一种常见的可治疗的精神健康状况，需要正确的诊断，评估合并症和多个观察者的输入。CHADIS的工具之一是一个全面的家长调查问卷（CHADIS-DSM），用于根据DSM-IV和DSM-PC的逻辑评估儿童心理健康问题，并产生临时DSM诊断。虽然CHADIS DSM的试点数据令人鼓舞，但需要对ADHD及其合并症进行额外的验证。该项目还建议在CHADIS内创建“个案模板”，以接收所有家长、青少年或教师问卷的答复，为临床医生提供具体指导。CST将为临床医生提供基于证据的提示，例如，要探索的症状，建议的问题措辞，从中选择的观察菜单，以及相关文本，以帮助进一步确认，反驳或更改来自父母/青少年数据的推定结论。CST的使用将记录诊断标准的证据，更准确地诊断，改善护理，并编制研究数据库。本研究将验证CHADIS-DSM用于ADHD及其合并症，并评估CST对诊断准确性的影响。将对2个现有的CHADIS实践网络中的1 100名4-12岁奥尔兹进行筛查。这300名寻求行为问题治疗的人，以及800名来井访问的人中的所有阳性者，加上那些阴性者的随机样本，将完成比较和金标准测量。儿科医生必须在使用循证实践方面进行QI努力，以保持通过美国儿科委员会（ABP）的专业认证。ABP批准的QI计划要求对批准的护理文件进行图表审计，实践难以实施。该提案的另一个产品是使CHADIS成为第一个收集患者数据和临床医生反应的儿科护理系统，从而为QI认证提供自动化的护理文件。

DESCRIPTION (provided by applicant): This proposal is to complete and validate a new web-based tool to assist in the screening, diagnosis and management of mental health disorders (focusing here on ADHD), quality improvement (QI) documentation and efficient large scale research. CHADIS is a screening, assessment and decision support system delivering tools online for care of health, development, and mental health conditions including ADHD. CHADIS provides online questionnaires for parents, teens and teachers to complete prior to a visit. These are automatically scored to yield conclusions on a worksheet linked to electronic chapters of clinician guidance and myriad resources for families which become handouts. Clinical data is shared securely among professionals, also forming a deidentified research database. This proposal is to adapt CHADIS tools to optimize use for ADHD care, QI and research. Proper care of ADHD (Attention Deficit Hyperactivity Disorder), a common treatable mental health condition, calls for accurate diagnosis, assessment for comorbidity and multiple observer input. Among CHADIS' tools is a comprehensive previsit parent questionnaire (CHADIS-DSM) for assessing child mental health problems based on the logic of both DSM-IV and DSM-PC and producing provisional DSM diagnoses. While pilot data on CHADIS DSM is encouraging, additional validation focusing on ADHD and its comorbidities is needed. This project also proposes creating "case-specific templates" (CST) within CHADIS to receive the responses from all previsit parent, teen or teacher questionnaires to provide specific guidance to clinicians. CSTs will provide the clinician with evidence-based prompts, e.g. symptoms to explore, suggested wording for questions, menus of observations from which to select, and related text to help further confirm, refute or change the presumptive conclusions from parent/teen data. CST use will document evidence of diagnostic criteria, diagnose more accurately, improve care, and compile a research database. This study will validate CHADIS-DSM for ADHD and its comorbidities and assess the impact of CSTs on accuracy of diagnoses. 1100 4-12 year olds presenting for care in 2 existing CHADIS practice networks will be screened. Those 300 seeking care for behavior problems, and all positive among 800 coming for well visits plus a random sample of those negative will complete comparison and gold standard criterion measures. Pediatricians are required to conduct a QI effort in use of evidence based practices in order to maintain professional certification through the American Board of Pediatrics (ABP). ABP approved QI programs require chart audits for documentation of approved care, difficult for practices to implement. Another product of this proposal is making CHADIS the first system for pediatric care that collects both patient data and clinician responses thus providing automated documentation of care for QI accreditation.