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

描述（由申请人提供）：ADHD是儿童期最常见的心理健康障碍。大多数患有ADHD的儿童在初级保健机构接受护理。虽然美国儿科学会（AAP）为儿科医生发布了循证指南和建议，但大多数儿科医生很难遵守这些指南。鉴于在循证ADHD护理中观察到的缺陷以及对儿童结局的可能影响，有必要制定和测试旨在改善初级保健环境中ADHD护理的干预措施。辛辛那提儿童医院医疗中心已经开发了一种干预模式，称为ADHD协作，以全面解决这个问题。ADHD协作干预模型包括学术细节，质量改进方法和创新工具（例如，门户网站），旨在促进和支持系统地使用AAP准则。这种干预模式已被用于在大辛辛那提地区的55个实践中培训200多名医生。干预似乎产生2- 4倍增加使用循证ADHD相关的实践行为在参与医生。到目前为止，干预措施已作为一个质量改进项目实施，几乎没有实验控制。本研究的主要目的是进行ADHD协作干预的实验对照随机分组试验。36名儿科医生将被随机分配接受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。图表评论，家长访谈，家长和教师的评级量表将收集。组间和组内分层线性模型分析将检查干预是否能显著改善儿科医生的实践行为、患者对ADHD护理的满意度以及儿童结局。此外，ADHD协作干预相对于典型护理的相对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.