Epstein Jeffery N, Kelleher Kelly J, Baum Rebecca, Brinkman William B, Peugh James, Gardner William, Lichtenstein Phil, Langberg Joshua M
Cincinnati Children's Hospital Medical Center, Cincinnati.
Nationwide Children's Hospital, Columbus.
J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):483-490.e1. doi: 10.1016/j.jaac.2017.03.014. Epub 2017 Apr 5.
The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes.
Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care.
Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes.
The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components.
制定注意力缺陷多动障碍（ADHD）护理质量衡量标准是提高社区儿科对ADHD患儿护理质量的前提条件。遗憾的是，现有ADHD护理质量指标的证据基础薄弱。本研究的目的是确定ADHD护理的哪些组成部分最能预测患者的治疗结果。
确定了372名1至5年级未服用过药物的儿童的家长，这些儿童因ADHD相关问题前往社区儿科医生处就诊（N = 195），随后被开具了ADHD药物。家长在ADHD问题被提出时以及开始服用ADHD药物约12个月后完成了范德比尔特ADHD家长评定量表（VAPRS）。对每位患者的病历进行审查，以衡量ADHD护理的12个不同组成部分。
在所有儿童中，治疗第一年VAPRS总症状评分的平均下降为11.6（标准差10.1）。在ADHD护理的12个组成部分中，首次接触时间较短以及治疗第一年收集的教师评定较多，显著预测了患者总症状评分的更大下降。值得注意的是，预测ADHD症状减少更多的是接触的及时性，定义为门诊就诊、电话或电子邮件沟通。就数量或及时性而言，仅门诊就诊并不能预测患者的治疗结果。
使用ADHD药物可实现的ADHD症状减轻程度与ADHD护理的特定组成部分相关。未来ADHD优质护理指标的制定和修改应包括这些ADHD护理组成部分。
