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Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial

Jeffery N Epstein1, Joshua M Langberg, Philip K Lichtenstein

  • 1Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA. jeff.epstein@cchmc.org

Pediatrics
|October 19, 2011
PubMed

Insights

A quality improvement program significantly enhanced pediatricians' adherence to attention-deficit/hyperactivity disorder (ADHD) guidelines. The intervention utilized an internet-based portal to improve ADHD care quality in community pediatric settings.

Area of Science:

  • Pediatric Healthcare Quality Improvement
  • Clinical Practice Guideline Adherence
  • Attention-Deficit/Hyperactivity Disorder (ADHD) Management

Background:

  • Pediatrician adherence to evidence-based Attention-Deficit/Hyperactivity Disorder (ADHD) practice guidelines can be suboptimal.
  • Improving the quality of ADHD care in community settings is a significant clinical challenge.

Purpose of the Study:

  • To evaluate the effectiveness of a quality improvement program designed to enhance pediatricians' adherence to established ADHD practice guidelines.
  • To assess the impact of an internet-based intervention on the quality of ADHD care provided by community-based pediatricians.

Main Methods:

  • A cluster-randomized trial involving 49 pediatricians across 8 practices was conducted.
  • Practices received training and access to an internet portal for ADHD patient assessment and treatment monitoring.
  • Medical charts were reviewed at baseline and 6 months to assess adherence to guidelines.

Main Results:

  • Pediatricians in the intervention group showed significantly higher rates of guideline-adherent practices compared to the control group.
  • Key improvements included increased collection of parent and teacher rating scales for ADHD assessment (Cohen's d = 0.69, 0.68).
  • Use of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (d = 0.85) and teacher rating scales for treatment monitoring (d = 1.01) also significantly improved.

Conclusions:

  • A widely disseminable, quality improvement intervention leveraging internet-based information technology effectively enhanced ADHD care quality in pediatric settings.
  • The findings support the use of such interventions to improve adherence to evidence-based guidelines for childhood disorders.
Abstract

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