Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial

Area of Science:

• Pediatric Primary Care
• Quality Improvement Science
• Clinical Decision Support

Background:

• Pediatric primary care providers (PCPs) face challenges in consistently using attention-deficit/hyperactivity disorder (ADHD) rating scales.
• Effective implementation of ADHD rating scales is crucial for accurate diagnosis and management in children.
• Quality improvement (QI) interventions aim to enhance evidence-based practices in pediatric healthcare settings.

Purpose of the Study:

• To assess the effectiveness of a distance-learning QI intervention designed to increase the utilization of ADHD rating scales by pediatric PCPs.
• To evaluate a multi-component intervention including web-based education, expert consultation, and performance feedback.

Main Methods:

• A cluster randomized trial design was employed, comparing an intervention group to a wait-list control group.
• The intervention involved a 3-part distance-learning program with MOC Part IV credit.
• An electronic health record-linked system was implemented for rating scale data collection; manual chart review was used for ascertainment.

Main Results:

• No significant difference in rating scale use was observed between the intervention and control arms.
• Clinicians in both arms showed increased use of parent and teacher rating scales post-intervention.
• Higher engagement with feedback calls or MOC credit correlated with increased parent rating scale use among intervention clinicians.

Conclusions:

• The tested distance-learning QI intervention did not significantly improve ADHD rating scale use in pediatric primary care.
• Future interventions should consider complementary strategies to support clinical workflows and enhance clinician engagement.
• Electronic systems for rating scale collection show promise in facilitating their use and improving ADHD management.