The myADHDportal.com Improvement Program: An Innovative Quality Improvement Intervention for Improving the Quality of ADHD Care Among Community-Based Pediatricians
Restricted accessResearch articleFirst published online March, 2013
The myADHDportal.com Improvement Program: An Innovative Quality Improvement Intervention for Improving the Quality of ADHD Care Among Community-Based Pediatricians
Although the American Academy of Pediatrics (AAP) has developed and disseminated clear evidence-based guidelines for attention-deficit/hyperactivity disorder (ADHD) care, community-based pediatricians often have difficulty implementing these guidelines. New strategies are needed to improve the quality of care received by children with ADHD and to improve utilization of the AAP consensus guidelines by pediatricians. An evidence-based quality improvement intervention has been developed that effectively improves the quality of ADHD care delivered by community-based pediatricians. In order to facilitate widespread dissemination of this intervention model, the entire intervention has been modified for online delivery. The intervention is called the myADHDportal.com Improvement Program. The full functionality of this online intervention is described, including the collection of online ADHD rating scales from parents and teachers, and online communication between parents, teachers, and physicians. In addition, the Web portal integrates several innovative quality improvement features, including an online wizard for mapping ADHD patient flow, an online report card for monitoring quality of care, and an online wizard for guiding practices through the Plan-Do-Study-Act (PDSA) cycle process. The combination of clinical utility and quality improvement tools facilitates delivery of quality ADHD care and reduces several of the obstacles to implementing AAP-recommended practice behaviors. Initial results with this intervention model are reviewed and goals for dissemination are described.
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References
1.
American Academy of Child & Adolescent Psychiatry. (2007). Practice parameters for the assessment and treatment of children and adolescents with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894–921.
2.
American Academy of Pediatrics. (2000). Clinical practice guideline: Diagnosis and evaluation of the child with attention deficit/hyperactivity disorder. Pediatrics, 105, 1158–1170.
3.
American Academy of Pediatrics. (2001). Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder. Pediatrics, 108, 1033–1044.
4.
American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128, 1007–1022.
5.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
6.
BussingR.ZimaB. T.GaryF. A., & GarvanC. W. (2003). Barriers to detection, help-seeking, and service use for children with ADHD symptoms. Journal of Behavioral Health Service Research, 30, 176–189.
7.
ChanE.HopkinsM. R.PerrinJ. M.HerreriasC., & HomerC. J. (2005). Diagnostic practices for attention deficit hyperactivity disorder: A national survey of primary care physicians. Ambulatory Pediatrics, 5, 201–208.
8.
EpsteinJ. N.LangbergJ. M.LichtensteinP. K.AltayeM.BrinkmanW. B.HouseK., & StarkL. J. (2010). Attention-deficit/hyperactivity disorder (ADHD) outcomes for children treated in community-based pediatric settings. Archives of Pediatrics and Adolescent Medicine, 164, 160–165.
9.
EpsteinJ. N.LangbergJ. M.LichtensteinP. K.KolbR.AltayeM., & SimonJ. O. (2011). Use of an internet portal to improve community-based pediatric ADHD care: A cluster randomized trial. Pediatrics, 128, e1201–e1208.
10.
EpsteinJ. N.LangbergJ. M.LichtensteinP. K.KolbR., & StarkL. J. (2010). Sustained improvement in pediatrician's ADHD practice behaviors in the context of a community-based quality improvement initiative. Children's Health Care, 39, 296–311.
11.
EpsteinJ. N.LangbergJ. M.LichtensteinP. K.MainwaringB. A.LuzaderC. P., & StarkL. J. (2008). A community-wide intervention to improve the ADHD assessment and treatment practices of community physicians. Pediatrics, 122, 19–27.
12.
EpsteinJ. N.RabinerD.JohnsonD. E.FitzGeraldD.ChrismanA.ErkanliA., . . .ConnersC. K. (2007). Improving attention-deficit/hyperactivity disorder treatment outcome through use of a collaborative consultation treatment service by community-based pediatricians: A cluster randomized trial. Archives of Pediatrics and Adolescent Medicine, 161, 835–840.
13.
FineS., & JewessonB. (1989). Active drug placebo trial of methylphenidate: A clinical service for children with an attention deficit disorder. Canadian Journal of Psychiatry, 34, 447–449.
14.
GardnerW.KelleherK. J.PajerK., & CampJ. V. (2004). Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study. Journal of Pediatrics, 145, 767–771.
15.
GuyattG. H.KellerJ. L.JaeschkeR.RosenbloomD.AdachiJ. D., & NewhouseM. T. (1990). The n-of-1 randomized controlled trial: Clinical usefulness. Our three-year experience. Annals of Internal Medicine, 112, 293–299.
16.
HoagwoodK.JensenP. S.FeilM.VitielloB., & BhataraV. (2000). Medication management of stimulants in pediatric practice settings: A national perspective. Developmental and Behavioral Pediatrics, 21, 322–331.
17.
JensenP.HinshawS.SwansonJ.GreenhillL.ConnersC.ArnoldL., . . .WigalT. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers. Journal of Developmental & Behavioral Pediatrics., 22, 60–73.
18.
LangbergJ. M.BrinkmanW. B.LichtensteinP. K., & EpsteinJ. N. (2009). Interventions to promote the evidence-based care of children with ADHD in primary-care settings. Expert Review of Neurotherapeutics, 9, 477–487.
19.
LarsonE. B.EllsworthA. J., & OasJ. (1994). Randomized clinical trials in single patients during a 2-year period. Journal of the American Medical Association, 270, 2708–2712.
20.
LeslieL. K.RappoP. D.AbelsonH. T.SewallS. R., & JenkinsR. R. (2000). Final report of the FOPE II pediatric generalists of the future workgroup. Pediatrics, 106, 1199–1223.
21.
LeslieL. K.StalloneK. A.WeckerlyJ.McDanielA. L., & MonnA. (2006). Implementing ADHD guidelines in primary care: Does one size fit all?Journal of Health Care for the Poor and Underserved, 17, 302–327.
22.
LeslieL. K.WeckerlyJ.PlemmonsD.LandsverkJ., & EastmanS. (2004). Implementing the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder Diagnostic Guidelines in primary care settings. Pediatrics, 114, 129–140.
23.
MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Archives of General Psychiatry, 56, 1073–1086.
24.
NiklesC. J.MitchellG. K.Del MarC. B.ClavarinoA., & McNairnN. (2006). An n-of-1 trial service in clinical practice: Testing the effectiveness of stimulants for Attention-Deficit/Hyperactivity Disorder. Pediatrics, 117, 2040–2046.
25.
OlsonB. G.RosenbaumP. F.DosaN. P., & RoizenN. J. (2005). Improving guideline adherence for the diagnosis of ADHD in an ambulatory pediatric setting. Ambulatory Pediatrics, 5, 138–142.
26.
PaceT. M.ChaneyJ. M.MullinsL. L., & OlsonR. A. (1995). Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting. Professional Psychology: Research and Practice, 26, 123–131.
27.
PelhamW. E. (1993). Pharmacotherapy of children with attention-deficit hyperactivity disorder. School Psychology Review, 22, 199–227.
28.
PelhamW. E.FabianoG. A., & MassettiG. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 34, 449–476.
29.
PolahaJ.CooperS. L.MeadowsT., & KratochvilC. J. (2005). The assessment of attention-deficit/hyperactivity disorder in rural primary care: The portability of the American Academy of Pediatrics guidelines to the “real world”. Pediatrics, 115, 120–126.
30.
RushtonJ. L.FantK. E., & ClarkS. J. (2004). Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics, 114, e23–e28.
31.
SchonwaldA.HuntingtonN.ChanE.RiskoW., & BridgemohanC. (2009). Routine developmental screening implemented in urban primary care settings: More evidence of feasibility and effectiveness. Pediatrics, 123, 660–668.
32.
SperoffT., & O'ConnorG. T. (2004). Study designs for PDSA quality improvement research. Quality Management in Healthcare, 13, 17–32.
33.
WolraichM. L.FeurerI. D.HannahJ. N.BaumgaertelA., & PinnockT. Y. (1998). Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM–IV. Journal of Abnormal Child Psychology, 26, 141–152.
34.
ZarinD. A.TanielianT. L.SuarezA. P., & MarcusS. C. (1998). Treatment of attention-deficit hyperactivity disorder by different physician specialties. Psychiatric Services, 49, 171.
35.
ZitoJ. M.SaferD. J.dosReisS.MagderL. S.GardnerJ. F., & ZarinD. A. (1999). Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Archives of Pediatrics and Adolescent Medicine, 153, 1257–1263.
