Abstract
Background
Attention-deficit/hyperactivity disorder (ADHD) affects almost 2.4 million US children.
Because American Academy of Pediatrics guidelines for ADHD recommend use of standardized
diagnostic instruments, regular follow-up and the chronic care model, this pilot project
sought to implement and assess an electronic registry of patients with ADHD combined
with care coordination by a planned care team.
Methods
This quality improvement project was structured with 2 intervention and 2 control
clinics to facilitate evaluation of the use of a planned care system for management
of ADHD. Care teams included a pediatrician, nurse, medical assistant, and care coordinator
and tracked patients using an electronic registry with data drawn from the EMR. Clinical
work flows were pilot tested to facilitate use of the Vanderbilt scales and their
incorporation into the EMR at intervention sites. Outcome measures included 2 recommended
clinical follow-ups based on HEDIS measures as well as use of the Vanderbilt rating
scales. Initiation phase measure was for follow-up after initiating medication, while
the continuation phase measure was for subsequent follow-up during the first year
of treatment. Measures were monitored during the project year and then also in the
ensuing period of spread of the intervention to other sites.
Results
Although the modified HEDIS initiation phase measure for patients newly on medication
remained static at approximately 50% throughout the project period, the continuation
phase measure showed improvement from 35% at baseline to 45% at the end of the project
assessment year, a 29% increase. Follow-up for patients stable on medications also
remained unchanged during the project period, but during subsequent spreading of the
intervention to nonproject sites, follow-up of these patients improved to over 90%.
In adjusted analyses, patients with ADHD at intervention sites were over 2 times more
likely than patients at control sites to have had a Vanderbilt score documented in
their records.
Conclusions
The project achieved modest improvements in the diagnostic and treatment process for
patients with ADHD. The use of a planned care system and electronic patient registry
shows promise for improving the diagnosis and treatment process for patients with
ADHD.
Keywords
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Article Info
Publication History
Accepted:
December 8,
2014
Received:
August 12,
2014
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
