Disseminating a Model Intervention to Promote Improved ADHD Care in the Community

描述（由申请人提供）：美国儿科学会（AAP）已经建立了一套共识指南，供儿科医生遵循。这些准则在典型的社区做法中执行起来可能具有挑战性。辛辛那提儿童医院医疗中心（CCHMC）制定了一个名为ADHD协作的计划，以促进社区儿科医生采用这些指南。该计划的重点是使用学术细节和质量改进（QI）方法来修改办公室系统，以适应规定的实践变化。ADHD协作在大辛辛那提地区招募实践方面非常成功，改变了实践行为，并以最低的项目成本和办公室实践成本维持了这些实践行为。既然已经建立了可持续性和有效性，下一步就是修改ADHD协作模型，使其适合广泛传播。拟议研究的主要目标是修改ADHD协作干预措施，使其可移动，然后在有效性，消费者满意度和成本方面评估该版本。描述了一种利用远程医疗视频会议、门户网站和远程数据收集的可移动干预。最初，将招募三名儿科医生来测试和完善远端介入输送方法。然后，8个新的儿科实践将被随机分配到接受远端干预或对照组（治疗照常）。将在基线、基线后6个月和1年收集有关儿科实践行为的信息。研究设计将允许对远端干预的可行性和有效性进行初步评估，包括患者循证实践行为的发生率、儿科医生态度的变化、消费者满意度和成本。重要性：拟议的研究具有很高的公共卫生意义，因为它解决了社区精神卫生服务的核心问题，促进对儿童的循证护理。这项研究提出了一套创新的干预技术，将允许提供一个有效的干预模式，以更大的数量和更多的地理多样性的儿科实践比目前使用现有的方法是可行的。公共卫生相关性：PI制定并测试了一项质量改进计划，旨在促进社区儿科医生采用循证实践。该计划的重点是使用学术细节和质量改进（QI）方法来修改办公室系统，以适应规定的医生实践变化。拟议的研究将评估向不同地域的受众传播这种经过测试的干预措施的方式。

DESCRIPTION (provided by applicant): The American Academy of Pediatrics (AAP) has established a set of consensus guidelines for pediatricians to follow. These guidelines can be challenging to implement in typical community-based practices. Cincinnati Children's Hospital Medical Center (CCHMC) has developed a program called the ADHD Collaborative to promote the adoption of these guidelines among community pediatricians. The program focuses on modifying the office system using academic detailing and quality improvement (QI) methodology to accommodate prescribed practice changes. The ADHD Collaborative has been very successful at recruiting practices in the Greater Cincinnati area, changing practice behaviors, and sustaining these practice behaviors over time at minimal cost to the project and to the office practice. Now that sustainability and effectiveness have been established, the next step is to modify the ADHD Collaborative model to make it amenable to widespread dissemination. The primary goal of the proposed study is to modify the ADHD Collaborative intervention to make it transportable and then evaluate this version in terms of effectiveness, consumer satisfaction, and costs.. A transportable intervention is described that utilizes telehealth videoconferencing, a web portal, and long-distance data collection. Initially, three pediatric practices will be recruited to test and refine the distal intervention delivery methodology. Then, eight new pediatric practices will be randomly assigned to receive the distal intervention or to a control group (treatment as usual). Information about pediatric practice behavior will be collected at baseline, 6-months, and 1-year post- baseline. The study design will allow for a preliminary assessment of the feasibility and effectiveness of the distal intervention in terms of rates of evidence-based practice behaviors to patients, change in pediatrician attitudes, consumer satisfaction, and costs. Significance: The proposed research has high public health significance since it addresses a core issue in community mental health delivery, the promotion of evidence-based care to children. This research proposes an innovative set of intervention techniques that will allow the delivery of an effective intervention model to a greater number and more geographically diverse set of pediatric practices than is currently feasible using existing methods. PUBLIC HEALTH RELEVANCE: A quality improvement program has been developed and tested by the PI that promotes the adoption of evidence-based practices among community pediatricians. The program focuses on modifying the office system using academic detailing and quality improvement (QI) methodology to accommodate prescribed physician practice changes. Modes of disseminating this tested intervention to a geographically diverse audience will be evaluated by the proposed research.