Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Pediatrics. 2011 Nov;128(5):e1201-8. doi: 10.1542/peds.2011-0872. Epub 2011 Oct 17.
To determine the effectiveness of a quality improvement program to improve pediatricians' adherence to existing, evidence-based, attention-deficit/hyperactivity disorder (ADHD) practice guidelines.
Forty-nine community-based pediatricians at 8 practices participated in a cluster-randomized trial. Practices were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid. The medical charts for a random sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months. All practices participated in 4 sessions of training, including didactic lectures and office flow modification workshops. Practices were then given access to an ADHD Internet portal that allowed parents, teachers, and pediatricians to input information (eg, rating scales) about patients, after which information was scored, interpreted, and formatted in a report style that was helpful for assessment and treatment of patients with ADHD. Physicians evaluated their practice behaviors quarterly and addressed underperforming areas.
Pediatricians in the intervention group, compared with those in the control group, demonstrated significantly higher rates of many American Academy of Pediatrics-recommended ADHD care practices, including collection of parent (Cohen's d = 0.69) and teacher (d = 0.68) rating scales for assessment of children with ADHD, use of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (d = 0.85), and use of teacher rating scales to monitor treatment responses (d = 1.01).
A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric settings.
确定一项质量改进计划在提高儿科医生对现有、基于证据的注意力缺陷/多动障碍（ADHD）实践指南的依从性方面的效果。
8 家实践机构的 49 名社区儿科医生参与了一项群组随机试验。根据儿科医生人数和接受医疗补助的患者比例，对实践进行了匹配。每位参与儿科医生的 ADHD 患者的医疗记录，在基线和 6 个月时进行了随机抽样检查。所有实践都参加了 4 次培训，包括专题讲座和办公流程修改研讨会。然后，为实践提供了一个 ADHD 互联网门户，允许家长、教师和儿科医生输入有关患者的信息（例如，评分量表），之后信息会被评分、解释，并以有助于评估和治疗 ADHD 患者的报告样式呈现。医生每季度评估他们的实践行为，并解决表现不佳的领域。
与对照组相比，干预组的儿科医生表现出更高比例的许多儿科学会推荐的 ADHD 护理实践，包括收集家长（Cohen's d = 0.69）和教师（d = 0.68）的评分量表来评估 ADHD 儿童、使用《精神障碍诊断与统计手册》第四版（d = 0.85）的标准，以及使用教师评分量表来监测治疗反应（d = 1.01）。
一种可以通过基于互联网的信息技术广泛传播的质量改进干预措施，显著提高了社区儿科环境中 ADHD 护理的质量。
