Computer Decision Aid for ADHD Management (CDAAM)

注意缺陷/多动障碍（ADHD）是最常见的儿童行为障碍。初级保健医生，尤其是儿科医生，历来在ADHD的诊断和治疗中扮演着重要的角色。尽管存在权威的指导方针，以协助初级保健医生，充分的证据表明，他们继续诊断和治疗这种疾病的次优。这在一定程度上是由于缺乏培训和繁琐的交付系统设计。现代计算机决策支持策略为全科医生处理多动症提供了最大的希望。我们开发了一种新的决策支持系统，用于在儿科实践中实施临床指南。CHICA（通过计算机自动化改善儿童健康）结合了三个要素：(1)用Arden语法编码的儿科指南；(2)动态、可扫描的纸张用户界面；(3)与现有电子病历系统兼容的hl7接口。其结果是，这个系统既能在会诊过程中向医生提供“及时”的患者相关指导，又能准确地从所有与之互动的人那里获取结构化数据。与CHICA的初步工作已经证明了使用该系统实施和评估临床指南的可行性。我们建议扩大cica，纳入ADHD治疗和诊断模块。本提案的具体研究目的是：(1)扩展和修改现有的基于计算机的决策支持系统（CHICA），使其包括ADHD治疗和诊断指南规则以及将数据直接传真到医疗记录的能力；(2)评估CHICA系统对儿科实践中ADHD护理过程的影响，包括对ADHD治疗和诊断指南的遵守情况。本研究将包括一项随机试验，以比较干预和控制实践中ADHD患者护理质量的变化。为了衡量CHICA系统对ADHD相关患者护理过程的影响（目的2），我们将从医疗记录和护士和提供者的调查中收集数据。此外，关于实践特征的信息将在基线处收集。我们将在基线和实施后12个月再次评估ADHD服务的质量。这些方法将允许对干预措施的作用进行全面的描述

: Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed pediatric behavioral disorder. Primary care physicians, especially pediatricians, have historically played a large role in the diagnosis and treatment of ADHD. Despite the existence of authoritative guidelines to assist primary care physicians, ample evidence demonstrates that they continue to diagnose and treat this disorder sub optimally. This is due, in part, to a lack of training and cumbersome delivery system designs. Modern computer decision support strategies offer the best hope of equipping general practitioners to deal with ADHD. We have developed a novel decision support system for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scan able paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers “just-in-time” patient-relevant guidelines to physicians during encounters, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines. We propose to expand CHICA to include ADHD treatment and diagnosis modules. The specific research aims of this proposal are to (1) expand and modify an existing computer based decision support system (CHICA) to include ADHD treatment and diagnosis guideline rules as well as the capability to fax data directly into the medical record, and (2) evaluate the effect of the CHICA system on the processes of ADHD care in pediatric practices, including adherence to guidelines for ADHD treatment and diagnosis. This study will include a randomized trial to compare the change in quality of ADHD patient care in intervention and control practices. To measure the effect of the CHICA system on the process of ADHD related patient care (aim 2), we will collect data from medical records and surveys of nurses and providers. Additionally, information about practice characteristics will be collected at baseline. We will assess the quality of ADHD services at baseline and again at 12 months post implementation. These methods will allow a thorough description of the intervention's role in the process of ADHD management.