Evaluation of an Intervention for Improving Community-Based Pediatric ADHD Care

改善社区儿科多动症护理干预措施的评估

基本信息

批准号：
8473279
负责人：
JEFF N. EPSTEIN
金额：
$ 45.39万
依托单位：
CINCINNATI CHILDRENS HOSP MED CTR
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-12 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8473279
关键词：
Academic Detailing Academy Address American Area Attention deficit hyperactivity disorder Behavior Caring Child Child Care Childhood Client satisfaction Communities Control Groups Development Diagnosis Effectiveness Effectiveness of Interventions Evaluation Evidence based practice Family Goals Guidelines Internet Intervention Interview Linear Models Literature Measures Medical center Mental disorders Methodology Methods Modeling Outcome Parents Patients Pediatric Hospitals Pediatrics Pharmaceutical Preparations Physicians Primary Health Care Provider Public Health Publications Randomized Recommendation Relative (related person)Reporting Symptoms System Testing Training Treatment outcome Writing base cost cost effectiveness design effective therapy evidence base evidence based guidelines functional disability improved innovation intervention effect pediatrician post intervention primary care setting public health relevance randomized trial satisfaction teacher tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：多动症是儿童期最常见的心理健康障碍。大多数患有多动症的儿童在初级保健机构接受护理。虽然美国儿科学会 (AAP) 为儿科医生发布了基于证据的指南和建议，但大多数儿科医生很难遵守这些指南。鉴于观察到的基于证据的多动症护理的缺陷及其对儿童结局的可能影响，有必要制定和测试旨在改善初级保健机构中多动症护理的干预措施。辛辛那提儿童医院医疗中心开发了一种称为 ADHD 协作的干预模型，以全面解决这一问题。 ADHD 协作干预模型包括学术细节、质量改进方法和创新工具（例如门户网站），旨在促进和支持 AAP 指南的系统使用。该干预模型已用于培训大辛辛那提地区 55 个诊所的 200 多名医生。该干预措施似乎使参与的医生对基于证据的 ADHD 相关实践行为的使用增加了 2 至 4 倍。迄今为止，该干预措施已作为质量改进项目实施，几乎没有实验控制。拟议研究的主要目标是对 ADHD 协作干预进行实验控制的整群随机试验。 36 个儿科诊所将被随机分配接受 ADHD 协作干预或提供常规护理。大约 108 名医生和 648 名多动症患者将参与这项研究。将收集图表评论、家长访谈以及家长和教师评分量表。组间和组内分层线性模型分析将检查干预措施是否能显着改善儿科医生的实践行为、患者对 ADHD 护理的满意度以及超出典型 ADHD 护理的儿童结局。此外，ADHD 协作干预相对于典型护理的相对成本效益将通过使用成本和效果大小估计来计算增量成本效益比来确定。