Attention Deficit Hyperactivity Disorder
Conditions
Keywords
ADHD
Brief summary
The American Academy of Pediatrics (AAP) has established a set of consensus guidelines for pediatricians to follow. These guidelines can be challenging to implement in typical community-based practices. Cincinnati Children's Hospital Medical Center (CCHMC) has developed a program called the ADHD Collaborative to promote the adoption of these guidelines among community pediatricians. The program focuses on modifying the office system using academic detailing and quality improvement (QI) methodology to accommodate prescribed practice changes. The ADHD Collaborative has been very successful at recruiting practices in the Greater Cincinnati area, changing practice behaviors, and sustaining these practice behaviors over time at minimal cost to the project and to the office practice. Now that sustainability and effectiveness have been established, the next step is to modify the ADHD Collaborative model to make it amenable to widespread dissemination. The primary goal of the proposed study is to modify the ADHD Collaborative intervention to make it transportable and then evaluate this version in terms of effectiveness, consumer satisfaction, and costs.. A transportable intervention is described that utilizes telehealth videoconferencing, a web portal, and long-distance data collection. Initially, three pediatric practices will be recruited to test and refine the distal intervention delivery methodology. Then, eight new pediatric practices will be randomly assigned to receive the distal intervention or to a control group (treatment as usual). Information about pediatric practice behavior will be collected at baseline, 6-months, and 1-year post-baseline. The study design will allow for a preliminary assessment of the feasibility and effectiveness of the distal intervention in terms of rates of evidence-based practice behaviors to patients, change in pediatrician attitudes, consumer satisfaction, and costs.
Interventions
OTHERADHD Collaborative
This intervention includes mapping and redesign of office flow to facilitate adherence to AAP ADHD guidelines as well as didactic sessions related to diagnosis and treatment of ADHD. Didactics emphasize the importance of obtaining parent and teacher behavioral ratings (e.g. Vanderbilt ADHD Rating Scales) at the time of the initial assessment for ADHD and during follow-up after initiating medication treatment and making a DSM-IV based ADHD diagnosis. Practices are given a web-based ADHD portal to assist them in creating a patient registry and to help in obtaining parent and teacher ratings scales.
Sponsors
Children's Hospital Medical Center, Cincinnati
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* pediatric practice with at least 2 physicians
Exclusion criteria
* no electronic billing system
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Physician ADHD Practice Behavior | Baseline and 6 months | Percentage of patients across pediatricians in each randomized group for whom the pediatrician collected teacher ratings to monitor treatment response |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Wait-list Control Wait-list control group | 22 |
| ADHD Collaborative Intervention This intervention includes mapping and redesign of office flow to facilitate adherence to AAP ADHD guidelines as well as didactic sessions related to diagnosis and treatment of ADHD. Didactics emphasize the importance of obtaining parent and teacher behavioral ratings (e.g. Vanderbilt ADHD Rating Scales) at the time of the initial assessment for ADHD and during follow-up after initiating medication treatment and making a DSM-IV based ADHD diagnosis. Practices are given a web-based ADHD portal to assist them in creating a patient registry and to help in obtaining parent and teacher ratings scales. The intervention lasts for 6 months.
ADHD Collaborative: This intervention includes mapping and redesign of office flow to facilitate adherence to AAP ADHD guidelines as well as didactic sessions related to diagnosis and treatment of ADHD. Didactics emphasize the importance of obtaining parent and teacher behavioral ratings (e.g. Vanderbilt ADHD Rating Scales) at the time of the initial | 27 |
| Total | 49 |
Baseline characteristics
| Characteristic | Wait-list Control | ADHD Collaborative Intervention | Total |
|---|---|---|---|
| Age, Continuous | 47.0 Years STANDARD_DEVIATION 10.3 | 46.6 Years STANDARD_DEVIATION 11.3 | 46.8 Years STANDARD_DEVIATION 10.7 |
| Gender Female | 15 Participants | 14 Participants | 29 Participants |
| Gender Male | 7 Participants | 13 Participants | 20 Participants |
| Region of Enrollment United States | 22 participants | 27 participants | 49 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Physician ADHD Practice Behavior
Percentage of patients across pediatricians in each randomized group for whom the pediatrician collected teacher ratings to monitor treatment response
Time frame: Baseline and 6 months
Population: Patient chart reviews were conducted with 174 patients in the ADHD Collaborative Intervention group and 64 patients in the Wait-list control group
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Wait-list Control | Physician ADHD Practice Behavior | Baseline | 0 percentage of patients | Standard Deviation 0 |
| Wait-list Control | Physician ADHD Practice Behavior | 6-months | 6.3 percentage of patients | Standard Deviation 25 |
| ADHD Collaborative Intervention | Physician ADHD Practice Behavior | Baseline | 0 percentage of patients | Standard Deviation 0 |
| ADHD Collaborative Intervention | Physician ADHD Practice Behavior | 6-months | 38.7 percentage of patients | Standard Deviation 36.1 |
Comparison: The percentage of patients with whom pediatrician in each group utilized each practice behavior at baseline and 6-months was computed. The reported statistical analysis did not account potential clustering due to the small number of practices in this study.p-value: =0.003t-test, 2 sided