Evaluation of an Intervention for Improving Community-based Pediatric Attention-Deficit Hyperactivity Disorder (ADHD) Care
Condition: ADHD
Intervention: ADHD Collaborative
Intervention description: 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.
Phase: Phase 4
Study type: Interventional
Primary purpose: Health Services Research
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Enrollment: 577.0
Sex: All
Minimum age: 6 Years
Maximum age: 11 Years
Healthy volunteers: No

Summary:

      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-two pediatric practices will be randomly assigned to receive the ADHD Collaborative
      intervention or to provide usual care. Approximately 96 physicians and 576 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.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Practice must have a minimum of two pediatricians who agree to participate.

          -  Practice must have an electronic billing system.

          -  Practice must have internet access at office.

          -  Practice must not have an on-site mental health professional.

          -  Practice must have a member of practice staff willing to be trained in human subjects
             certification and willing to consent families.

          -  Children must be in Grade 1-5.

          -  Children must be newly diagnosed with ADHD.

        Exclusion Criteria:

        -