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

描述(申请人提供)：ADHD是儿童中最常见的心理健康障碍。大多数患有ADHD的儿童在初级保健环境中接受护理。虽然美国儿科学会(AAP)为儿科医生发布了循证指南和建议，但大多数儿科医生难以遵守这些指南。鉴于在循证ADHD护理方面观察到的缺陷及其可能对儿童结局的影响，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开发了一种名为ADHD协作性的干预模式，以全面解决这一问题。ADHD协作干预模式包括学术细节、质量改进方法和创新工具(例如，门户网站)，旨在促进和支持AAP指南的系统使用。这一干预模式已用于培训大辛辛那提地区55家诊所的200多名医生。在参与的医生中，干预似乎使基于证据的ADHD相关实践行为的使用增加了2到4倍。到目前为止，干预措施一直是作为一个质量改进项目实施的，几乎没有实验控制。这项拟议研究的主要目标是进行ADHD协作性干预的实验对照整群随机试验。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患者将被纳入这项研究。将收集图表回顾、家长访谈以及家长和教师评分表。组内和组内的分层线性建模分析将检验干预是否在儿科医生执业行为、患者对ADHD护理的满意度以及儿童结局方面产生超过典型ADHD护理的显著改善。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果大小估计来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.