Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK.
Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
BMC Health Serv Res. 2024 Oct 8;24(1):1201. doi: 10.1186/s12913-024-11693-7.
QbTest is a commercially available, computerised test of attention, impulsivity, and activity designed to assist with the diagnosis of attention deficit hyperactivity disorder (ADHD). Health Innovation East Midlands (formerly East Midlands AHSN), led the implementation of the QbTest on behalf of the 15 Health Innovation Networks across Child and Adolescent Mental Health services (CAMHS) and Paediatric sites in England between April 2020 and March 2023. We evaluate the impact of this programme on diagnostic assessment at participating sites.
A mixed-methods approach was used including: case-note data collected on 10-30 cases per site pre and post QbTest implementation; interviews with healthcare staff working with QbTest; and surveys to explore perspectives of healthcare staff and patients/carers. Case-note data was descriptively analysed to compare time to diagnosis (number of appointments and days) pre/post QbTest implementation. Survey data was analysed descriptively. Qualitative interview data was explored using thematic analysis.
Case-note data was provided by 20 sites across England. Comparison of mean values pre- and post-QbTest implementation identified a decrease of 0.37 (11.5%) in number of appointments to reach a diagnostic decision, a 55-day (12.5%) increase in days from initial referral to diagnosis, and a 12-day (10.3%) increase in days to reach a diagnostic decision. Exploratory analyses indicated greater benefit for Paediatric services over CAMHS, in terms of a decrease in days from referral to diagnosis and number of appointments to diagnosis. Interviews with healthcare staff (n=21) revealed that the QbTest was perceived to support a faster, more efficient diagnostic process. Survey data (n=65 healthcare staff, n=22 patients/carers) identified that the QbTest helped patients understand their symptoms and the diagnostic decision. Although some logistical issues (e.g., room requirements) and patient issues (e.g., sensory sensitivity) were identified, healthcare staff considered that QbTest was easily incorporated into the ADHD assessment pathway.
The national implementation of QbTest in ADHD clinics resulted in a small reduction in the number of clinical appointments needed to reach a diagnostic decision, with greatest benefit demonstrated in Paediatric sites. Data were impacted by COVID-19 therefore, further evaluation is warranted.
QbTest 是一种商业化的、计算机化的注意力、冲动和活动测试，旨在帮助诊断注意力缺陷多动障碍（ADHD）。健康创新东米德兰兹（前身为东米德兰兹 AHSN）代表英格兰儿童和青少年心理健康服务（CAMHS）和儿科的 15 个健康创新网络，于 2020 年 4 月至 2023 年 3 月期间实施了 QbTest。我们评估了该计划对参与站点诊断评估的影响。
采用混合方法，包括：每个站点收集 10-30 例病例的病例记录数据，在实施 QbTest 前后；与使用 QbTest 的医疗保健人员进行访谈；以及调查以探索医疗保健人员和患者/照顾者的观点。对病例记录数据进行描述性分析，以比较实施 QbTest 前后诊断时间（预约次数和天数）。对调查数据进行描述性分析。使用主题分析探索定性访谈数据。
英格兰 20 个站点提供了病例记录数据。比较实施 QbTest 前后的平均值，发现达到诊断决策的预约次数减少了 0.37（11.5%），从初次转诊到诊断的天数增加了 55 天（12.5%），达到诊断决策的天数增加了 12 天（10.3%）。探索性分析表明，儿科服务比 CAMHS 更能从 QbTest 中受益，表现在从转诊到诊断和预约到诊断的天数减少。与医疗保健人员（n=21）的访谈表明，QbTest 被认为可以支持更快、更有效的诊断过程。调查数据（n=65 名医疗保健人员，n=22 名患者/照顾者）表明，QbTest 帮助患者了解他们的症状和诊断决策。尽管发现了一些后勤问题（例如，房间要求）和患者问题（例如，感觉敏感），但医疗保健人员认为 QbTest 很容易纳入 ADHD 评估途径。
在 ADHD 诊所中全国范围内实施 QbTest 导致达到诊断决策所需的临床预约次数略有减少，儿科站点受益最大。由于 COVID-19 的影响，数据受到了影响，因此需要进一步评估。
