Alexander Fiks, MD, MSCE is an urban primary care pediatrician who studies health information technology (HIT) to improve child health outcomes. Dr. Fiks's research has found that although clinician-focused HIT interventions are effective, their impact could be increased by facilitating information exchange between clinicians and families in order to clarify treatment preferences and goals, a process called shared decision making (SDM). Although Dr. Fiks's long-term career goal is to become an independent investigator expert in the large-scale implementation of SDM using HIT for multiple pediatric conditions, this career development award will focus on Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD is an ideal prototype condition for SDM: families choose between multiple evidence-based treatments;personal/cultural values influence their selection;treatment disparities exist;and little work has so far been done to untangle these effects to support decision making. During this award. Dr. Fiks will (1) assess the prevalence, determinants, and impact of SDM in primary care for a nationally representative sample of children with ADHD, (2) develop an instrument to measure families'preferences and goals for ADHD treatment, and (3) assess the feasibility and acceptability, and explore the outcomes of an ADHD, HIT-based SDM pilot intervention in primary care. The hypothesis of this proposal is that use of an instrument to capture families'ADHD treatment preferences and goals within an HIT-based system will facilitate SDM and improve adherence to and outcomes from treatment. This research, utilizing a pediatric practice-based research network, will complement formal coursework, workshop/conference participation, and skilled mentorship to train Dr. Fiks to achieve his career goals. Dr. Fiks's specific educational aims are to (1) develop expert skills to evaluate the effectiveness of HIT-enabled SDM including the study of longitudinal/clustered data and the conduct of clinical trials, (2) develop advanced skills in health measurement and instrument development, and (3) advance his knowledge of approaches to encourage SDM including the use of decision aids and HIT. This 5 year award will provide Dr. Fiks with the training and pilot data needed to launch an R01-level trial of SDM for ADHD.

Public Health Relevance

(See Instructions): Prioritized by the Institute of Medicine, shared decision making (SDM) promises to match families to acceptable treatments and improve child health outcomes. By capturing, transferring, and processing health information, computer systems can support SDM on a large-scale. This grant explores the role of these systems to facilitate SDM for ADHD, a condition impairing more than 4 million children in this country.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Pediatrics Subcommittee (CHHD)
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Haverkos, Lynne
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Children's Hospital of Philadelphia
United States
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Fiks, Alexander G; Mayne, Stephanie L; Michel, Jeremy J et al. (2017) Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial. J Dev Behav Pediatr 38:573-583
Power, Thomas J; Michel, Jeremy; Mayne, Stephanie et al. (2016) Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant. Adv Sch Ment Health Promot 9:201-218
Gruver, Rachel S; Bishop-Gilyard, Chanelle T; Lieberman, Alexandra et al. (2016) A Social Media Peer Group Intervention for Mothers to Prevent Obesity and Promote Healthy Growth from Infancy: Development and Pilot Trial. JMIR Res Protoc 5:e159
Fiks, Alexander G; DuRivage, Nathalie; Mayne, Stephanie L et al. (2016) Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study. J Med Internet Res 18:e172
Fiks, Alexander G; Mayne, Stephanie L; Karavite, Dean J et al. (2015) Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics 135:e965-73
Fiks, Alexander G; Zhang, Peixin; Localio, A Russell et al. (2015) Adoption of electronic medical record-based decision support for otitis media in children. Health Serv Res 50:489-513
Lipstein, Ellen A; Brinkman, William B; Fiks, Alexander G et al. (2015) An emerging field of research: challenges in pediatric decision making. Med Decis Making 35:403-8
Fiks, Alexander G (2015) Centralized reminder/recall: collaboration to promote the effective use of technology. JAMA Pediatr 169:314-6
Fiks, Alexander G; Grundmeier, Robert W (2014) Elucidating challenges and opportunities in the transition to ICD-10-CM. Pediatrics 134:169-70
Mayne, Stephanie L; duRivage, Nathalie E; Feemster, Kristen A et al. (2014) Effect of decision support on missed opportunities for human papillomavirus vaccination. Am J Prev Med 47:734-44

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