Economic Impact of Pediatric ADHD Intervention

描述(由申请人提供)：这项提案是一项成本效益研究，恰到好处地利用了一种名为CHADIS的基于网络的决策支持系统的随机对照试验，作为初级保健医生在护理ADHD儿童方面的教育干预。在这项研究的第一阶段，在思科FDA的支持下，使用CHADIS对密西西比州六个学区的5800多名儿童进行了筛查，发现900多名儿童有患ADHD的风险。这显然是此类样本中最大的一次。通过图表审计和调查为儿童和医生制定了基线措施。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个家庭进行抽样调查。虽然这项拟议的成本效益研究将复制以前的中期技术援助项目的各个方面，但它在许多方面都是独一无二的。首先，我们研究中的儿童是通过系统性的教师筛选来选择的，这是代表社区人群的，而不是在家庭动机或儿童严重性方面不具有代表性的临床病例。其次，这里评估的干预措施不是使用由三级护理中心专家完成的研究干预，而是基于一个基于网络的决策支持系统，该系统可扩展，设计为供初级保健临床医生使用，而不是精神健康专家。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的经济影响的所有估计都是基于在各种临床环境中看到的公认的临床病例。此外，这项拟议的研究在从非常广泛的角度看待ADHD的潜在经济影响方面是独一无二的。虽然医疗保险数据是这项提议的一部分，但它并不局限于费用领域。与学校有关的数据是为相同的孩子收集的。我们将有关于任何减少课堂保留率和不必要地使用特殊班级安排的基线和控制主题数据。我们将使用标准衡量标准来评估可能自掏腰包的与健康相关的成本，以及与未报销治疗相关的成本，以及因干预需要或因学校纪律措施(如开除)而损失的父母时间。此外，这项研究将是前瞻性的，并从父母那里收集数据，及时接近干预措施，而不是过度依赖对过去事件的记忆。在创新的网络筛查、诊断和决策支持工具(CHADIS)的推动下，这项关于ADHD儿童初级保健成本效益的研究采用了协助协调学校数据和早期发现的技术，并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好处。如果该项目表明在初级保健系统中使用CHADIS不仅能带来更好的护理，而且证明护理具有成本效益，那么各地的儿童和家庭都将得到帮助。这项拟议的研究可能会为家庭、保险公司、学校、护理系统和各州节省成本，并可将其记录在案。

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.