Evaluation of an Intervention for Improving Community-Based Pediatric ADHD Care

描述（由申请人提供）：ADHD是儿童时期最常见的心理健康障碍。大多数多动症儿童在初级保健机构接受治疗。虽然美国儿科学会（AAP）为儿科医生发布了基于证据的指南和建议，但大多数儿科医生都难以遵守这些指南。鉴于观察到的以证据为基础的ADHD护理的缺陷以及对儿童结局的可能影响，开发和测试旨在改善初级保健机构中ADHD护理的干预措施是必要的。辛辛那提儿童医院医学中心开发了一种干预模式，称为ADHD协作，以全面解决这个问题。ADHD协作干预模式包括学术细节、质量改进方法和创新工具（如门户网站），旨在促进和支持AAP指南的系统使用。这种干预模式已被用于培训大辛辛那提地区55家诊所的200多名医生。干预似乎产生了2- 4倍的使用证据为基础的adhd相关的实践行为参与医生。迄今为止，该干预措施一直作为质量改进项目实施，几乎没有实验控制。本研究的主要目的是开展ADHD协作干预的实验对照集群随机试验。36个儿科诊所将被随机分配接受ADHD协作干预或提供常规护理。大约108名医生和648名ADHD患者将被纳入研究。将收集图表评论、家长访谈和家长和教师评分量表。组间和组内分层线性模型分析将检验干预是否在儿科医生实践行为、患者对ADHD护理的满意度和儿童结局方面产生显著改善，超过典型的ADHD护理。此外，ADHD协作干预相对于典型护理的成本效益将通过使用成本和效应大小估计计算增量成本效益比来确定。

DESCRIPTION (provided by applicant): ADHD is the most prevalent mental health disorder of childhood. The majority of children with ADHD receive their care in primary care settings. While the American Academy of Pediatrics (AAP) issued evidence-based guidelines and recommendations for pediatricians, most pediatricians have difficulty adhering to these guidelines. Given observed deficiencies in evidence-based ADHD care and the likely effects on child outcomes, the development and testing of interventions aimed at improving ADHD care in primary care settings is necessary. Cincinnati Children's Hospital Medical Center has developed a model intervention, termed the ADHD Collaborative, to comprehensively address this issue. The ADHD Collaborative intervention model includes academic detailing, quality improvement methods, and innovative tools (e.g., web portal) designed to promote and support the systematic use of the AAP guidelines. This intervention model has been used to train over 200 physicians at 55 practices in the Greater Cincinnati area. The intervention appears to produce 2- to 4-fold increases in the use of evidence-based ADHD-related practice behaviors in participating physicians. To date, the intervention has been implemented as a quality improvement project with few experimental controls. The primary goal of the proposed study is to conduct an experimentally-controlled cluster randomized trial of the ADHD Collaborative intervention. Thirty-six pediatric practices will be randomly assigned to receive the ADHD Collaborative intervention or to provide usual care. Approximately 108 physicians and 648 of their ADHD patients will be included in the study. Chart reviews, parental interviews, and parent and teacher rating scales will be collected. Between- and within-group hierarchical linear modeling analyses will examine whether the intervention produces significant improvements in pediatrician practice behaviors, patient satisfaction with ADHD care, and child outcomes over and above typical ADHD care. Also, the relative cost effectiveness of the ADHD Collaborative intervention over typical care will be established by computing incremental cost-effectiveness ratios using cost and effect size estimates. PUBLIC HEALTH RELEVANCE: The public health significance of this proposal is substantial. With demonstration of intervention effectiveness, the proposed quality improvement intervention model has the potential for widespread dissemination which could potentially improve the ADHD care of millions of children nationwide.