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（由申请人提供）：该提案旨在完成和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（此处重点关注多动症）、质量改进（QI）记录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、发育和心理健康状况（包括多动症）。 CHADIS 为家长、青少年和教师提供在线调查问卷，供他们在访问前完成。这些都会自动评分，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和为家庭提供的无数资源相关联，这些资源将成为讲义。临床数据在专业人员之间安全共享，也形成了一个去识别化的研究数据库。 该提案旨在调整 CHADIS 工具，以优化 ADHD 护理、QI 和研究的使用。 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，对其进行适当护理需要准确的诊断、共病评估和多个观察者的参与。 CHADIS 的工具包括综合性预访家长问卷 (CHADIS-DSM)，用于根据 DSM-IV 和 DSM-PC 的逻辑评估儿童心理健康问题，并生成临时 DSM 诊断。虽然 CHADIS DSM 的试点数据令人鼓舞，但还需要针对 ADHD 及其合并症进行额外的验证。该项目还建议在 CHADIS 内创建“案例特定模板”(CST)，以接收所有预访家长、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、问题的建议措辞、可供选择的观察菜单以及帮助进一步确认、反驳或改变父母/青少年数据的推定结论的相关文本。 CST 的使用将记录诊断标准的证据、更准确地诊断、改善护理并编译研究数据库。这项研究将验证 CHADIS-DSM 针对 ADHD 及其合并症的效果，并评估 CST 对诊断准确性的影响。将对在 2 个现有 CHADIS 实践网络中就诊的 1100 名 4-12 岁儿童进行筛查。那些因行为问题而寻求护理的 300 人，以及来访的 800 人中所有呈阳性的人，加上那些阴性者的随机样本，将完成比较和黄金标准衡量标准。儿科医生必须使用基于证据的实践开展 QI 工作，以便通过美国儿科委员会 (ABP) 保持专业认证。 ABP 批准的 QI 计划需要对批准的护理记录进行图表审核，这对于实践来说很难实施。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档。