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个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（重点是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，为包括多动症在内的健康、发育和精神健康状况的护理提供在线工具。CHADIS为家长、青少年和教师提供在线问卷，让他们在访问前完成。系统会自动对这些问题进行评分，并在工作表上得出结论，该工作表与临床医生指导的电子章节以及成为讲义的无数家庭资源相关联。临床数据在专业人员之间安全地共享，也形成了一个去识别的研究数据库。本建议是调整CHADIS工具以优化ADHD护理、QI和研究的使用。注意缺陷多动障碍（ADHD）是一种常见的可治疗的精神健康状况，对其进行适当的护理需要准确的诊断、对合并症的评估和多个观察者的输入。CHADIS的工具之一是基于DSM- iv和DSM- pc的逻辑来评估儿童心理健康问题的综合预诊家长问卷（CHADIS-DSM），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及其合并症进行进一步的验证。该项目还建议在CHADIS内创建“个案模板”（CST），以接收所有访问前家长、青少年或教师问卷的回答，为临床医生提供具体指导。CSTs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，要选择的观察菜单，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对ADHD及其合并症的诊断，并评估CSTs对诊断准确性的影响。将对1100名4-12岁儿童进行筛查，这些儿童在两个现有的乍得发展援助系统实践网络中就诊。这300名寻求行为问题治疗的人，在800名前来探病的人中都是阳性的加上那些阴性的随机样本将完成比较和金标准标准测量。为了保持美国儿科委员会（ABP）的专业认证，儿科医生需要在基于证据的实践中进行QI工作。ABP批准的质量保证计划需要对批准的护理文件进行图表审核，很难实施。该提案的另一个成果是使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档。

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.