Nationwide dissemination of a web-based quality improvement intervention to improve the quality of ADHD care among community-based pediatricians

摘要 大多数患有ADHD的儿童在初级保健机构接受护理。虽然美国学院 美国儿科学会（AAP）为儿科医生发布了循证指南和建议， 儿科医生很难遵守这些指导方针。儿科医生、家长和老师的意见 调查小组制定了一个基于网络、技术辅助、质量改进的 (QI)采用质量改进方法和技术创新的干预措施（mehealth for ADHD），以促进基于证据的ADHD护理的实施。使用这种干预措施会导致 儿童多动症治疗的质量。此外，使用这种干预措施的儿科医生的患者 比那些接受典型的社区ADHD治疗的人更好的治疗效果。伙伴合作下 AAP，我们已经试点了5个州的ADHD软件的mehealth传播。在这项研究计划中， 调查小组将与美国儿科学会合作，在解决 在试点推广工作中，三个最常见的采用障碍， 使软件具有功能（即，在线培训，计划-执行-学习-行动向导）， 传播。利益相关者咨询小组，代表儿科医生、患者/家长 倡导者，专业医疗保健提供系统，付款人，政策制定者，制药业，以及 技术创业将向该小组提供传播战略方面的咨询意见。调查小组将 确定、优先考虑、实施和持续评估推荐的传播战略（目标1）。 此外，在向全国58，726名儿科医生传播这一干预措施的背景下，我们将 确定哪些具体的传播策略是最有效的参与儿科医生从具体的 社会人口细分（子目标#1）。此外，使用RE-AIM传播阶段框架， 我们将描述和检查实践水平、儿科医生水平和患者群体水平的社会人口统计学 a）覆盖范围，B）采用，c）实施和d）使用维护的预测因素（目标#2）。最后，输入 从我们的利益相关者咨询小组，我们将确定和优先考虑的模式，财务可持续性的 用于ADHD干预平台的mehealth将允许该平台得到维护并继续 在拨款结束后免费提供给儿科医生。在赠款的最后一年，我们将采取具体的 采取步骤，试行和实施选定的财务可持续性模式（目标3）。 意义：这项建议的公共卫生意义重大。随着传播的成功， 这种基于证据的干预有可能提高ADHD护理的质量， 全国数百万儿童。此外，本研究的结果将作为一个模型和 为其他以技术为基础的质量改进工作制定路线图，准备广泛传播。

ABSTRACT 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. With input from pediatrician, parent, and teacher stakeholders, the investigative team has developed a web-based, technology-assisted, quality improvement (QI) intervention that uses quality improvement methodology and technological innovation (mehealth for ADHD) to facilitate implementation of evidence-based ADHD care. Use of this intervention results in higher quality of ADHD care in pediatric settings. Moreover, patients of pediatricians using this intervention have better treatment outcomes than those receiving typical community-based ADHD care. In partnership with the AAP, we have piloted a 5-state dissemination of the mehealth for ADHD software. In this research proposal, the investigative team will partner with the AAP to disseminate the intervention nationwide after addressing the three most commonly reported barriers to adoption during the pilot dissemination effort and having adapted the software with functionality (i.e., online trainings, Plan-Do-Study-Act wizard) for nationwide dissemination. A stakeholder advisory panel representing leaders from pediatricians, patients/parent advocates, professional health care delivery systems, payers, policy makers, pharmaceutical industry, and technology entrepreneurship will advise the team on dissemination strategies. The investigative team will identify, prioritize, implement, and continuously evaluate recommended dissemination strategies (Aim #1). Moreover, in the context of disseminating this intervention to the 58,726 pediatricians nationwide, we will determine which specific dissemination strategies are most effective at engaging pediatricians from specific sociodemographic segments (sub-Aim #1). Additionally, using the RE-AIM dissemination stages framework, we will describe and examine practice-level, pediatrician-level, and patient population-level sociodemographic predictors of a) reach, b) adoption, c) implementation, and d) maintenance of use (Aim #2). Finally, with input from our stakeholder advisory panel, we will identify and prioritize models for financial sustainability of the mehealth for ADHD intervention platform that will allow the platform to be maintained and continue to be offered after the grant ends at no cost to pediatricians. During the final year of the grant, we will take concrete steps towards piloting and implementing selected financial sustainability models (Aim #3). Significance: The public health significance of this proposal is substantial. With successful dissemination, this evidence-based intervention has the potential to improve the quality of ADHD care and the outcomes of millions of children nationwide. Moreover, the results of this research will both serve as a model and a roadmap for other technologically-based quality improvement efforts preparing for widespread dissemination.