A Tool for Supporting and Monitoring Decision Making in ADHD

支持和监控多动症决策的工具

• 批准号: 8542892
• 负责人: Barbara Jo Howard
• 金额: $ 50万
• 依托单位: TOTAL CHILD HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-07 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8542892
• 关键词: 12 year old; Accreditation; Affect; Age; American; Anxiety; Area; Attention deficit hyperactivity disorder; Behavior; Behavioral; Cardiac; Caring; Certification; Child; Child Mental Health; Childhood; Clinical Data; Comorbidity; Computer software; Conduct Disorder; Consult; Consultations; DSM-IV; Data; Data Analyses; Databases; Decision Making; Decision Support Systems; Development; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Diagnostic tests; Disease; Disease Management; Documentation; Electronics; Evaluation; Evidence based practice; Family; Feedback; Focus Groups; Gold; Healthcare; Healthcare Systems; Intervention; Interview; Link; Logic; Measures; Medical History; Mental Depression; Mental Health; Mental disorders; Modification; Monitor; Online Systems; Oppositional Defiant Disorder; Outcome; Output; Parents; Patients; Pediatrics; Phase; Primary Care Physician; Primary Health Care; Problem behavior; Process; Progress Reports; Provider; Quality of Care; Questionnaires; Recommendation; Recording of previous events; Reporting; Research; Research Project Grants; Resources; Sampling; Schedule; Sleep; Structure; Surveys; Symptoms; System; Teenagers; Testing; Text; Time; Training; Validation; Visit; Writing; aged; base; care seeking; diagnostic accuracy; evidence base; evidence based guidelines; improved; innovation; pediatrician; post intervention; programs; public health relevance; response; screening; teacher; tool

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.

描述(由申请者提供)：本提案旨在完成并验证一个新的基于网络的工具，以帮助筛查、诊断和管理精神健康障碍(这里侧重于ADHD)、质量改进(QI)文档和高效的大规模研究。CHADIS是一个筛查、评估和决策支持系统，提供在线工具，用于护理健康、发展和精神健康状况，包括ADHD。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。这些自动评分，以在工作表上得出结论，该工作表链接到临床医生指导的电子章节和成为讲义的家庭的无数资源。临床数据在专业人员之间安全共享，也形成了一个身份明确的研究数据库。这项建议是调整CHADIS工具，以优化ADHD护理、QI和研究的使用。ADHD(注意力缺陷多动障碍)是一种常见的可治疗的心理健康状况，适当的护理需要准确的诊断、共病评估和多个观察者的意见。CHADIS的工具之一是一份全面的探视前家长问卷(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，但还需要对ADHD及其共病进行更多的验证。该项目还建议在CHADIS中创建“特定于病例的模板”(CST)，以接收所有访问前家长、青少年或教师的调查问卷，以向临床医生提供具体指导。CSTS将为临床医生提供循证提示，例如要探索的症状、问题的建议措辞、可供选择的观察菜单以及相关文本，以帮助进一步确认、驳斥或更改来自家长/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。这项研究将验证CHADIS-DSM对ADHD及其合并症的诊断，并评估CST对诊断准确性的影响。将对在两个现有CHADIS实践网络中提出护理的1100名4-12岁儿童进行筛查。300名寻求行为问题护理的人，以及800名来探井的人中所有人都是阳性的，加上那些阴性的人的随机抽样，将完成比较和金标准标准测量。儿科医生被要求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。总部基地批准的QI计划要求对批准的护理记录进行图表审计，这对实践来说很难实施。这项提议的另一个产品是使CHADIS成为第一个同时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。