Using Handheld Technology to Reduce Errors in ADHD Care

ADHD是儿科实践中最常见的精神疾病之一，影响了4-12%的儿童。许多ADHD儿童目前接受的评估不充分，治疗不适当，和/或随访护理不足。因此，ADHD儿童的实践差异很普遍，ADHD儿童可能有未确诊的精神合并症和不适当的药物治疗。这项随机对照试验旨在通过使用实时护理点手持计算机决策支持设备（DS-ADHD）提供的信息，实现持续减少治疗注意缺陷/多动障碍（ADHD）的医疗差错。我们系统中广泛的决策算法将允许提供者根据患者的具体需求调整ADHD治疗。我们将3个初级保健实践的提供者随机分配到DS-ADHD或常规护理。我们假设DS-ADHD会减少医疗差错，提高患者对ADHD护理的满意度。具体来说，我们假设使用DS-ADHD将使提供者不太可能错过ADHD儿童常见的合并症；将使患者更有可能按照既定的指导方针进行随访；将提高患者对ADHD治疗的满意度；并将提高提供者对ADHD治疗的满意度和信心。

ADHD is one of the most common psychiatric conditions seen in pediatric practices, affecting 4-12% of children. Many children with ADHD currently receive inadequate assessment, inappropriate treatment, and/or insufficient follow-up care. As a result, practice variation is widespread for children with ADHD, and children with ADHD may have undiagnosed psychiatric comorbidities and inappropriate pharmacotherapy. This randomized controlled trial aims to achieve sustainable reductions in medical errors in the treatment of attention-deficit/hyperactivity disorder (ADHD), through the use of information delivered by a real-time point of care hand held computer decision support device (DS-ADHD). The extensive decision algorithms embedded in our system will allow providers to adapt ADHD treatment to the specific needs of their patient. We will randomize providers in 3 primary care practices to DS-ADHD or usual care. We hypothesize that DS-ADHD will result in reduced medical errors and increased patient satisfaction with ADHD care. Specifically, we hypothesize that use of the DS-ADHD will make providers less likely to miss comorbidities common among children with ADHD; will make patients more likely to have follow-up visits in accordance with established guidelines; will increase patient satisfaction with their ADHD care; and will increase provider satisfaction and confidence regarding ADHD treatment.