Nationwide dissemination of a web-based quality improvement intervention to improve the quality of ADHD care among community-based pediatricians

在全国范围内传播基于网络的质量改进干预措施，以提高社区儿科医生的多动症护理质量

• 批准号: 10301002
• 负责人: JEFF N. EPSTEIN
• 金额: $ 65.03万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301002
• 关键词: Academy; Address; Adoption; Advocate; Affect; Age; American; Attention deficit hyperactivity disorder; Behavior Therapy; Caring; Certification; Child; Childhood; Clinical Practice Guideline; Collaborations; Communities; Computer software; Consultations; Credentialing; Drug Industry; Effectiveness; Electronic Health Record; Entrepreneurship; Evidence based intervention; Family; Geography; Grant; Group Practice; Guidelines; Health; Health Professional; Health Services Accessibility; Healthcare; Information Dissemination; Intervention; Knowledge; Literature; Maintenance; Mental Health Services; Mental disorders; Methodology; Modeling; National Institute of Mental Health; Nurse Practitioners; Online Systems; Outcome Study; Parents; Patient-Focused Outcomes; Patients; Pediatrics; Pharmaceutical Preparations; Policy Maker; Primary Care Physician; Principal Investigator; Public Health; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Reporting; Research; Research Proposals; School-Age Population; Stimulant; System; Technology; Training; Treatment outcome; Voice; base; care delivery; care outcomes; cost; dissemination research; dissemination strategy; elementary school; evidence base; evidence based guidelines; health care delivery; implementation facilitation; improved; patient population; pediatrician; primary care setting; quality assurance; recruit; sociodemographic predictors; sociodemographics; success; teacher; technological innovation

ABSTRACT 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.

抽象的 大多数ADHD儿童在初级保健环境中获得护理。而美国学院 儿科（AAP）为儿科医生发布了基于证据的指南和建议，大多数 儿科医生很难遵守这些准则。带有儿科医生，父母和老师的意见 利益相关者，调查团队开发了一个基于网络的，技术辅助，质量改进 （QI）使用质量改进方法和技术创新的干预措施（Mehealth for 多动症）促进实施基于证据的多动症护理。使用这种干预会导致更高 小儿环境中多动症护理的质量。此外，使用这种干预措施的儿科医生的患者有 比接受典型的基于社区的多动症护理的治疗结果更好。与 AAP，我们已经通过ADHD软件进行了5季的Mehealth传播。在这项研究建议中， 调查团队将与AAP合作，在讲话后在全国范围内传播干预措施 在飞行员传播工作期间，最常见的三个最常见的收养障碍以及 为全国范围 传播。一个利益相关者咨询小组，代表来自儿科医生，患者/父母的领导者 倡导者，专业医疗保健提供系统，付款人，政策制定者，制药行业以及 技术企业家精神将就传播策略提供建议。调查团队将 确定，优先级，实施和不断评估推荐的传播策略（AIM＃1）。 此外，在将这种干预措施传播给全国58,726名儿科医生的背景下，我们将 确定哪些特定的传播策略最有效地使儿科医生与特定的儿科医生参与 社会人口统计学片段（Sub-aim＃1）。此外，使用重新传播阶段框架， 我们将描述和检查练习级，儿科医生水平和患者人口水平的社会人口统计学 a）触及，b）采用，c）实施和d）维护使用的预测因素（AIM＃2）。最后，输入 从我们的利益相关者咨询小组中，我们将确定并确定模型的财务可持续性模型 ADHD干预平台的MeHealth，该平台将允许维护平台并继续为 赠款结束后提供的无需给儿科医生提供。在赠款的最后一年，我们将采用混凝土 迈向试行和实施选定的财务可持续性模型的步骤（AIM＃3）。 意义：该提案的公共卫生意义是重要的。随着成功的传播 这种基于证据的干预措施有可能提高多动症护理质量和结果 全国数百万儿童。此外，这项研究的结果既将作为模型和 为其他基于技术的质量改进工作准备广泛传播的路线图。