Economic Impact of Pediatric ADHD Intervention

描述（由申请人提供）：本提案是一项成本效益研究，恰逢其时，利用基于网络的决策支持系统CHADIS的随机对照试验，作为初级保健医生在照顾ADHD儿童时的教育干预。在这项研究的第一阶段，由思科Fda支持。在密西西比州的六个学区，使用CHADIS对5800多名同意的儿童进行了筛查，发现有900多名儿童有患多动症的风险。这显然是同类样本中最大的一个。通过图表审计和调查为儿童和医生制定了基准措施。干预阶段将于2009年秋季开始，届时如果该项目获得资助，也可以开始收集成本数据。将对至少450个家庭的样本进行评估。虽然这项拟议的成本效益研究将重复先前MTA项目的各个方面，但它在许多方面是独一无二的。首先，我们研究中的儿童是通过系统的教师筛选来选择的，这是一个具有代表性的社区人群，而不是临床病例，因为临床病例在家庭动机或儿童严重程度方面不具有代表性。其次，不是使用由三级护理中心专家完成的研究干预，这里评估的干预是基于一个基于网络的决策支持系统，该系统是可扩展的，设计用于初级保健临床医生而不是心理健康专家。使用早期发现和初级保健社区干预模式将对成本产生不同的、可能更大的影响。以前对ADHD经济影响的所有估计都是基于在各种临床环境中观察到的成熟的临床病例。此外，这项研究的独特之处在于对多动症的潜在经济影响进行了非常广泛的研究。虽然健康保险数据是该提案的一部分，但它并不局限于成本领域。学校的相关数据是针对同一群孩子收集的。我们将有关于班级留校和不必要使用特殊班级安排的任何减少的基线和对照科目数据。我们将使用标准措施来评估可能已自掏腰包的与健康有关的费用，以及与未报销的治疗和父母因干预需要或因学校纪律措施（如开除）而失去的工作时间有关的费用。此外，这项研究将是前瞻性的，并在干预措施的时间范围内从父母那里收集数据，而不是过度依赖对过去事件的记忆。这项研究通过一种创新的基于网络的筛查、诊断和决策支持工具（CHADIS）促进了对ADHD儿童初级保健的成本效益，该研究采用了有助于协调学校数据和早期发现的技术，提高了儿童诊断的准确性，因此对所有受影响的家庭都有很大的潜在益处。如果该项目表明，在初级保健系统中使用CHADIS不仅能提高护理质量，而且能证明护理具有成本效益，那么世界各地的儿童和家庭都将受益于该项目。家庭、保险公司、学校、护理系统和各州的成本节约都可能由此产生，并且可以通过拟议的研究记录下来。

DESCRIPTION (provided by applicant): This proposal is a cost-effectiveness study perfectly timed to take advantage of a randomized control trial of a web-based decision support system, called CHADIS, as an educational intervention for primary care physicians in their care of children with ADHD. In phase 1 of this study, supported by the Cisco Fda., over 5,800 consenting children were screened in six Mississippi School Districts using CHADIS and over 900 children were found to be at risk for ADHD. This is clearly the largest sample of its kind. Baseline measures for the children and physicians through chart audits and surveys are in place. The intervention phase will start Fall 2009 when cost data collection can also begin if this project is funded. A sample of at least 450 families will be assessed. Although this proposed cost-effectiveness study will replicate aspects of the prior MTA project, it is unique in a number of ways. First, the children in our study are selected by systematic teacher screening which is representative of a community population rather than clinical cases that are not representative in terms of family motivation or child severity. Secondly, instead of using a research intervention completed by tertiary care center specialists, the intervention being evaluated here is based is on a web-based decision support system that is scalable and designed to be used by primary care clinicians rather than mental health specialists. Use of an early detection and primary care community intervention model will have a different and potentially greater impact on costs. All previous estimates of the economic impact of ADHD have been based on well established clinical cases seen in a variety of clinical settings. In addition, this proposed study is unique in taking a very broad view of the potential economic impact of ADHD. While health insurance data is a part of this proposal it is not limited to that domain of costs. School related data is collected for the same children. We will have baseline and control subject data regarding any reductions in class retention and unnecessary use of special class placement. We will be using standard measures to assess health related costs that may have been out of pocket and costs related to unreimbursed therapies and parental time lost from work related to intervention needs or because of school disciplinary measures such as expulsions. Furthermore, the study will be prospective and collect data from parents in time proximity to the interventions rather than an over reliance on memory of past events. This research into cost effectiveness of primary care for children with ADHD facilitated by an innovative web-based screening, diagnostic and decision support tool (CHADIS) employs technology assisting with coordination of data from schools and early detection and improved accuracy of diagnosis for children therefore having great potential benefit to all affected families. Children and families everywhere will be helped by this project if it shows that the use of CHADIS in the primary care system results, not only in better care, but is also care shown to be cost-effective. Cost savings for families, insurers, schools, systems of care and states may all result and can be documented by the proposed study.