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.

Public Health Relevance

The public health significance of this proposal is substantial. With demonstration of intervention effectiveness, the proposed quality improvement intervention model has the potential for widespread dissemination which could potentially improve the ADHD care of millions of children nationwide.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH083665-04
Application #
8473279
Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Chambers, David A
Project Start
2010-08-12
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
4
Fiscal Year
2013
Total Cost
$453,876
Indirect Cost
$93,667
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229
Gordon, Megan K; Baum, Rebecca A; Gardner, William et al. (2016) Comparison of Performance on ADHD Quality of Care Indicators: Practitioner Self-Report Versus Chart Review. J Atten Disord :
Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca et al. (2016) Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes. Pediatrics 138:
Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J et al. (2016) Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity. J Am Acad Child Adolesc Psychiatry 55:289-94
O��Connor, Briannon C; Garner, Annie A; Peugh, James L et al. (2015) Improved but still impaired: symptom-impairment correspondence among youth with attention-deficit hyperactivity disorder receiving community-based care. J Dev Behav Pediatr 36:106-14
Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca et al. (2014) Variability in ADHD care in community-based pediatrics. Pediatrics 134:1136-43
Epstein, Jeffery N; Langberg, Joshua M; Lichtenstein, Philip K et al. (2013) The myADHDportal.com Improvement Program: An innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol 1:55-67
Garner, Annie A; Oʼconnor, Briannon C; Narad, Megan E et al. (2013) The relationship between ADHD symptom dimensions, clinical correlates, and functional impairments. J Dev Behav Pediatr 34:469-77
Baum, Rebecca A; Epstein, Jeffery N; Kelleher, Kelly (2013) Healthcare reform, quality, and technology: ADHD as a case study. Curr Psychiatry Rep 15:369
Epstein, Jeffery N (2012) How can the internet help improve community-based pediatric ADHD care? Expert Rev Neurother 12:501-3
Langberg, Joshua M; Becker, Stephen P (2012) Does long-term medication use improve the academic outcomes of youth with attention-deficit/hyperactivity disorder? Clin Child Fam Psychol Rev 15:215-33

Showing the most recent 10 out of 11 publications