Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 19-27 (doi:10.1542/peds.2007-2704)
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ARTICLE

Community-wide Intervention to Improve the Attention-Deficit/Hyperactivity Disorder Assessment and Treatment Practices of Community Physicians

Jeffery N. Epstein, PhDa,b, Joshua M. Langberg, PhDa,b, Philip K. Lichtenstein, MDa,b, Beth A. Mainwaring, BAb, Carolyn P. Luzader, MSb and Lori J. Stark, PhDa,b

a University of Cincinnati College of Medicine, Cincinnati, Ohio
b Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

OBJECTIVES. The goals were to implement and to test a quality-improvement intervention aimed at improving community-based primary care providers’ adherence to the American Academy of Pediatrics, evidence-based diagnostic and treatment guidelines for attention-deficit/hyperactivity disorder.

METHODS. Nineteen practices (with 84 primary care providers) from a large urban community were trained by using quality-improvement methods with some academic detailing. Pretraining and posttraining adherence to evidence-based practices was assessed through review of patient charts.

RESULTS. Preintervention rates of guideline usage were uniformly low. After the intervention, primary care providers showed substantial improvement in their use of the guidelines for the assessment and treatment of elementary school-aged patients with newly diagnosed attention-deficit/hyperactivity disorder. Use of parent and teacher assessment rating scales increased from levels of 52% to 55% to levels of nearly 100%. Systematic monitoring of responses to medication improved from a baseline level of 9% to 40%.

CONCLUSIONS. Quality-improvement interventions such as the one used in this study seem quite effective in improving primary care providers’ practices at offices that express interest in improving the quality of care for attention-deficit/hyperactivity disorder. The design of the intervention, problems associated with improving and sustaining treatment monitoring, and issues related to generalizability of the intervention model are discussed.

Key Words: attention-deficit/hyperactivity disorder • pediatricians • American Academy of Pediatrics guidelines • quality improvement

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • PCP—primary care provider • AAP—American Academy of Pediatrics • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Accepted Nov 2, 2007.