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.

Public Health Relevance

A web-based quality improvement intervention has been developed that demonstrably improves the quality of ADHD care and patient outcomes in community-based pediatric settings. The proposed research will investigate a nationwide dissemination of this intervention. The results of this study will serve both as a model and a roadmap for other technologically-based quality improvement efforts preparing for widespread dissemination.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Mental Health Services Research Committee (SERV)
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Pintello, Denise
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Cincinnati Children's Hospital Medical Center
United States
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