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 大多数患有多动症的儿童在初级保健机构接受护理。虽然美国学院 儿科协会 (AAP) 向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指南。听取儿科医生、家长和老师的意见 调查小组开发了一个基于网络、技术辅助的质量改进系统 (QI) 使用质量改进方法和技术创新的干预措施（mehealth for ADHD）以促进实施基于证据的 ADHD 护理。使用这种干预措施会导致更高的 儿科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患者 比接受典型的社区多动症护理的治疗结果更好。与合作伙伴 AAP，我们已经在 5 个州试行了 ADHD 软件的 mehealth 传播。在这个研究计划中， 调查小组将与 AAP 合作，在解决问题后在全国范围内传播干预措施 试点传播工作期间最常报告的三个采用障碍 为全国范围调整软件的功能（即在线培训、计划-实施-学习-行动向导） 传播。代表儿科医生、患者/家长领导的利益相关者咨询小组 倡导者、专业医疗保健提供系统、付款人、政策制定者、制药行业和 技术创业将为团队提供传播策略方面的建议。调查组将 确定、优先考虑、实施并持续评估推荐的传播策略（目标#1）。 此外，在向全国 58,726 名儿科医生传播这一干预措施的背景下，我们将 确定哪些具体传播策略最有效地吸引来自特定领域的儿科医生 社会人口细分（子目标#1）。此外，使用 RE-AIM 传播阶段框架， 我们将描述和检查实践层面、儿科医生层面和患者群体层面的社会人口统计学 a) 覆盖范围、b) 采用、c) 实施和 d) 维持使用的预测因素（目标#2）。最后，输入 我们将根据我们的利益相关者咨询小组的意见，确定并优先考虑财务可持续发展的模式 mehealth for ADHD 干预平台将允许该平台得到维护并继续 补助金结束后免费向儿科医生提供。在赠款的最后一年，我们将采取具体措施 试点和实施选定的财务可持续性模型的步骤（目标#3）。 意义：该提案对公共卫生具有重大意义。随着传播的成功， 这种基于证据的干预措施有可能提高多动症护理的质量和治疗结果 全国数百万儿童。此外，本研究的结果既可以作为模型，也可以作为参考。 其他基于技术的质量改进工作的路线图，准备广泛传播。