Electronic health record decision support improves the care of children with ADHD
Research Activities, April 2011, No. 368
Children with attention-deficit/hyperactivity disorder (ADHD) must be managed properly if they are to succeed in school, in their relationships, and in life. Critical to optimal care of these children is the role of the pediatrician. Although consensus guidelines exist on the diagnosis and treatment of ADHD, provider adherence to the guidelines is suboptimal. Offering decision support as part of the electronic health record (EHR) can improve the quality of care for these children, concludes a new study. This includes getting children in for a visit with their pediatrician to assess ADHD symptoms and review treatment effectiveness.
The study involved 79 pediatricians caring for 412 children with ADHD from 12 primary care practices in Massachusetts. Prior to the study, all were using the same EHR without decision support. Various sites were then selected to receive the decision-support intervention. Features included reminders to the pediatrician to assess children's ADHD symptoms every 3 to 6 months. There was also a visit note template with prompts to assess and record symptoms, treatment effectiveness, and adverse effects. Half of the children in the study received this intervention.
A higher proportion of children in the intervention group had a visit during which ADHD was assessed (71 percent) than children in the control group (54 percent). Pediatricians in the intervention group were more likely to document and discuss ADHD symptoms and treatment during well-child visits than those in the control group (78 vs. 63 percent). At 32 percent of patient visits scheduled specifically for ADHD assessment in the intervention group, pediatricians used the ADHD template.
The researchers found that this use was associated with better documentation of symptoms as well as treatment effectiveness and adverse effects. Satisfaction rates on managing ADHD were also higher among physicians in the intervention group who had access to the decision-support templates and tools. The study was supported in part by the Agency for Healthcare Research and Quality (HS15002).
See "Electronic health record decision support and quality of care for children with ADHD," by John Patrick T. Co, M.D., M.P.H., Sarah A. Johnson, B.A., Eric G. Poon, M.D., M.P.H., and others in Pediatrics 126(2), pp. 239-246, 2010.