Improving ADHD Behavioral Care Quality in Community-Based Pediatric Settings

提高社区儿科环境中的多动症行为护理质量

• 批准号: 9308840
• 负责人: JEFF N. EPSTEIN
• 金额: $ 39.72万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308840
• 关键词: Improving; ADHD; Behavioral; Care; Quality

Project Summary/Abstract Though the most effective treatment for children with Attention Deficit Hyperactivity Disorder (ADHD) consists of combined medication and behavioral strategies, the vast majority of children with ADHD are treated with medication only. While effective, medication primarily targets ADHD symptoms and typically has little to no impact on ADHD-related areas of functional impairment such as academic underachievement, impaired social relationships, and disrupted family functioning. One reason for the low rates of behavioral treatment is that primary care pediatricians, not mental health professionals, are responsible for treating the vast majority of children with ADHD. We have developed, tested, and are beginning to disseminate web-based software (www.myadhdportal.com) that has been shown in randomized clinical trials to improve the quality of ADHD medication care delivered by pediatricians. However, the current software functionality is limited entirely to medication management. The goal of the proposed study is to develop and test the integration of behavioral tools into the evidence-based myadhdportal.com software in order to improve access to behavioral treatment strategies, and ultimately improve outcomes for children with ADHD. The automated algorithms and decision rules we will develop for creating and monitoring the behavioral tools will ensure that behavioral treatments like daily report cards and token economies are delivered in a manner that is consistent with the evidence-base. Initially, we will design, build, and integrate behavioral tools into the myADHDportal.com software using an iterative stakeholder-centered design approach whereby feedback will be obtained from all stakeholders (i.e., parents, teacher, and pediatricians) before, during, and after development of these behavioral tools. Next, we will assess the acceptability of this software through qualitative methods such as usability studies and focus groups with users. Finally, we will conduct a cluster randomized controlled trial in community pediatric settings to test whether integration of the behavioral tools into the myADHDportal.com software (1) increases rates of behavioral treatment; (2) facilitates better integrity of behavioral interventions when implemented; (3) improves functional impairment in children with ADHD; and (4) generates higher satisfaction with ADHD care. By continuing to expand the functionality of the myADHDportal.com software, we are increasing patients' access to evidence-based care. This is especially critical for rural and underserved communities who have no or limited access to evidence-based mental health services. Moreover, by putting these behavioral tools in the hands of parents, teachers, and pediatricians, we are making it more likely that children will receive a high quality of care that includes both medication management and behavioral strategies, thereby improving the overall treatment outcomes of children with ADHD.

项目概要/摘要 尽管治疗注意力缺陷多动障碍 (ADHD) 儿童最有效的方法包括 通过药物和行为策略相结合，绝大多数患有多动症的儿童都接受了治疗 仅药物治疗。药物虽然有效，但主要针对多动症症状，通常几乎没有效果。 对 ADHD 相关功能障碍领域的影响，例如学业成绩不佳、社交能力受损 关系，并扰乱家庭功能。行为治疗率低的原因之一是 初级保健儿科医生，而不是心理健康专业人员，负责治疗绝大多数患者。 患有多动症的儿童。我们已经开发、测试并开始传播基于网络的软件 (www.myadhdportal.com) 已在随机临床试验中显示可提高 ADHD 的质量 由儿科医生提供的药物治疗。然而，当前的软件功能完全限于 用药管理。拟议研究的目标是开发和测试行为的整合 将工具纳入基于证据的 myadhdportal.com 软件，以改善获得行为治疗的机会 策略，并最终改善多动症儿童的治疗结果。自动化算法和决策 我们将为创建和监控行为工具而制定的规则将确保行为治疗，例如 每日报告卡和代币经济以与证据基础一致的方式提供。 最初，我们将使用以下方法设计、构建行为工具并将其集成到 myADHDportal.com 软件中： 以利益相关者为中心的迭代设计方法，将从所有利益相关者那里获得反馈（即 在开发这些行为工具之前、期间和之后。接下来，我们 将通过可用性研究和焦点等定性方法评估该软件的可接受性 与用户组。最后，我们将在社区儿科环境中进行整群随机对照试验 测试将行为工具集成到 myADHDportal.com 软件 (1) 中是否会提高 行为治疗； (2) 在实施时促进行为干预措施的完整性； (3)改善 多动症儿童的功能障碍； (4) 对多动症护理产生更高的满意度。经过 继续扩展 myADHDportal.com 软件的功能，我们正在增加患者的访问权限 循证护理。这对于没有或没有服务的农村和服务不足的社区尤其重要。 获得循证心理健康服务的机会有限。此外，通过将这些行为工具放入 在家长、老师和儿科医生的共同努力下，我们让孩子们更有可能获得高水平的教育 护理质量，包括药物管理和行为策略，从而提高 ADHD 儿童的总体治疗结果。