Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes

Abstract

Background: The quality of care for children with attention-deficit/hyperactivity disorder (ADHD) delivered in community-based pediatric settings is often poor. Interventions have been developed to improve community-based ADHD care but have not demonstrated that better care results in improved patient outcomes. The objective of this study was to determine whether an ADHD quality improvement (QI) intervention for community-based pediatric practices improves patient outcomes.

Methods: A cluster randomized controlled trial was conducted in which 50 community-based pediatric primary care practices (213 providers) were randomized either to receive a technology-assisted QI intervention or to a control condition. The intervention consisted of 4 training sessions, office flow modification, guided QI, and an ADHD Internet portal to assist with treatment monitoring. ADHD treatment processes and parent- and teacher-rated ADHD symptoms over the first year of treatment were collected for 577 patients.

Results: Intent-to-treat analyses examining outcomes of all children assessed for ADHD were not significant (b = -1.97, P = .08). However, among the 373 children prescribed ADHD medication, there was a significant intervention effect (b = -2.42, P = .04) indicating greater reductions in parent ratings of ADHD symptoms after treatment among patients treated by intervention physicians compared with patients treated at control practices. There were no group differences on teacher ratings of ADHD symptoms. ADHD treatment care around medication was significantly better at intervention practices compared with control practices.

Conclusions: A technology-assisted QI intervention improved some ADHD care quality and resulted in additional reductions in parent-rated ADHD symptoms among patients prescribed ADHD medications.

Trial registration: ClinicalTrials.gov NCT01143701.

Conflict of interest statement

Potential Conflicts of Interest: Dr. Epstein, along with his institution, own the intellectual property and licensing rights for the internet-based software used in this study.

Copyright © 2016 by the American Academy of Pediatrics.

Figures

FIGURE 1

CONSORT (Consolidated Standards of Reporting Trials) flow diagram. ITT, intention to treat.

FIGURE 2

Cox analyses examining time to key ADHD treatment care events across intervention and control groups. CI, confidence interval.

FIGURE 3

Cox analyses examining time to first office visit and first phone contact after starting medication across intervention and control groups. CI, confidence interval.

FIGURE 4

ADHD symptom reduction among patients treated by physicians randomly assigned to the intervention and control groups.