Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry (AM Wenderlich, CD Baldwin, N Herendeen, and CM Rand), Rochester, NY.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (R Li), Rochester, NY.
Acad Pediatr. 2021 Sep-Oct;21(7):1253-1261. doi: 10.1016/j.acap.2021.04.004. Epub 2021 Apr 20.
Patients with a new diagnosis of attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication need regular follow-up. Guidelines recommend follow-up within 30 days of stimulant initiation or change but this goal is seldom achieved. This quality improvement (QI) study in an urban academic outpatient practice aimed to: 1) assess whether use of school-based telemedicine increases rates of follow-up within 30 days and decreases the number of days to follow-up for ADHD, and 2) compare rates of 30-day follow-up via in-person vs telemedicine visits.
We performed three Plan-Do-Study-Act cycles over a 12-month period: QI interventions included clinic wide education, paper prompts for clinicians, and creation of a database to track ADHD patients. We measured days from the index visit to the follow-up visit, and the mode of both visits (in-person or telemedicine). Data were collected for 6 months pre-intervention and 12 months post-intervention.
Follow-up within 30 days increased from 19% (of 191 visits) to 33% (of 661 visits) (P < .001). The time to follow-up decreased from 67 to 34 days (P < .001). Follow up visits by telemedicine were more also more likely to be within 30 days (62% vs. 32%, P < .001).
A QI intervention for ADHD care increased rates of follow-up within 30 days, particularly when telemedicine was used, and decreased the number of days to follow-up. This intervention could serve as a model to improve follow-up for ADHD in other settings.
新诊断为注意力缺陷/多动障碍（ADHD）并开处兴奋剂药物的患者需要定期随访。指南建议在开始或改变兴奋剂药物后的 30 天内进行随访，但这一目标很少能实现。这项在城市学术门诊实践中进行的质量改进（QI）研究旨在：1）评估基于学校的远程医疗是否会增加 30 天内的随访率并减少 ADHD 的随访天数，以及 2）比较面对面和远程医疗就诊的 30 天随访率。
我们在 12 个月的时间内进行了三个计划-执行-研究-行动循环：QI 干预措施包括对全体临床医生进行教育、为临床医生提供纸质提示、创建一个数据库以跟踪 ADHD 患者。我们测量了从索引就诊到随访就诊的天数，以及两次就诊的模式（面对面或远程医疗）。数据在干预前 6 个月和干预后 12 个月收集。
30 天内的随访率从 19%（191 次就诊）增加到 33%（661 次就诊）（P<0.001）。随访时间从 67 天减少到 34 天（P<0.001）。通过远程医疗进行的随访也更有可能在 30 天内进行（62%比 32%，P<0.001）。
ADHD 护理的 QI 干预措施提高了 30 天内的随访率，特别是在使用远程医疗时，并且减少了随访天数。这种干预措施可以作为在其他环境中改善 ADHD 随访的模式。
