Economic Impact of Pediatric ADHD Intervention

儿科多动症干预的经济影响

• 批准号: 7937024
• 负责人: Raymond STURNER
• 金额: $ 49.99万
• 依托单位: TOTAL CHILD HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7937024
• 关键词: Academy; Accidents; Address; Affect; American; Attention deficit hyperactivity disorder; Caregivers; Caring; Child; Child Care; Child health care; Childhood; Clinical; Clinical effectiveness; Communities; Consent; Cost Savings; Data; Data Collection; Decision Support Systems; Development; Diagnostic; Early Diagnosis; Educational Intervention; Event; Family; Funding; Guidelines; Health; Health Insurance; Healthcare; Home environment; Injury; Insurance Carriers; Intervention; Investments; Link; Measures; Memory; Mental Health; Mississippi; Modeling; Motivation; Office Visits; Online Systems; Parents; Pediatrics; Phase; Physicians; Population; Primary Care Physician; Primary Health Care; Process; Questionnaires; Randomized Controlled Trials; Recruitment Activity; Reliance; Research; Risk; Sampling; Schools; Screening procedure; Seminal; Severities; Specialist; Structure; Surveys; System; Technology; Time; Visit; base; care systems; community intervention; cost; cost effectiveness; design; diagnostic accuracy; economic impact; falls; improved; innovation; lost work time; phase 1 study; post intervention; prospective; service utilization; standard measure; teacher; tertiary care; tool

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.

描述（由申请人提供）：该提案是一项成本效益研究，完美地利用了基于网络的决策支持系统（称为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。在本研究的第1阶段，由思科FDA支持，在六个密西西比学区使用CHADIS筛查了超过5，800名同意的儿童，发现超过900名儿童有患ADHD的风险。这显然是同类产品中最大的样本。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，如果该项目得到资助，也将开始收集成本数据。将对至少450个家庭进行抽样评估。虽然这项拟议的成本效益研究将复制以前的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选出的，这是一个社区人口的代表，而不是临床病例，在家庭动机或儿童严重程度方面不具有代表性。其次，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措施，而是基于一个基于网络的决策支持系统，该系统是可扩展的，旨在由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的使用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，这项拟议的研究是独一无二的，它对ADHD的潜在经济影响有着非常广泛的看法。虽然健康保险数据是本提案的一部分，但并不限于费用领域。学校相关的数据是为同样的孩子收集的。我们将有基线和对照受试者的数据，关于任何减少类保留和不必要的使用特殊类安置。我们将使用标准措施来评估与健康相关的费用，这些费用可能是自付的，与未报销的治疗有关的费用，以及与干预需求有关的工作或由于学校纪律措施（如开除）而损失的父母时间。此外，这项研究将是前瞻性的，并从父母那里收集与干预措施时间接近的数据，而不是过度依赖对过去事件的记忆。这项关于ADHD儿童初级保健的成本效益的研究通过创新的基于网络的筛查，诊断和决策支持工具（CHADIS）提供便利，采用技术协助协调来自学校的数据，早期发现和提高儿童诊断的准确性，因此对所有受影响的家庭都有很大的潜在利益。如果该项目表明，在初级保健系统中使用CHADIS不仅可以改善保健，而且还可以证明保健具有成本效益，那么世界各地的儿童和家庭都将得到该项目的帮助。家庭、保险公司、学校、护理系统和州的成本节省都可能导致，并可以通过拟议的研究记录下来。