Improving Care for Children With Attention Deficit Hyperactivity Disorder: Assessing the Impact of Self-Assessment and Targeted Training on Practice Performance

Homer, Charles J.; Horvitz, Lisa; Heinrich, Patricia; Forbes, Peter; Lesneski, Cheryll; Phillips, Jim

doi:10.1367/A03-116R.1

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Volume 4, Issue 5 , Pages 436-441, September 2004

Improving Care for Children With Attention Deficit Hyperactivity Disorder: Assessing the Impact of Self-Assessment and Targeted Training on Practice Performance

Charles J. Homer, MD, MPH
- Address correspondence to Charles J. Homer, National Initiative for Children's Healthcare Quality, 375 Longwood Ave, 3rd Floor, Boston, MA 02215
Lisa Horvitz, SM
- From the National Initiative for Children's Healthcare Quality, (Dr Homer, Ms Horvitz, Ms Heinrich) Boston, Mass; Children's Hospital, (Dr Homer, Mr Forbes), Boston, Mass; the Harvard Medical School (Dr Homer), Boston, Mass; and the NC Center for Children's Healthcare Improvement, University of North Carolina (Ms Lesneski, Dr Phillips), Chapel Hill, NC
Patricia Heinrich, RN, BSN
- From the National Initiative for Children's Healthcare Quality, (Dr Homer, Ms Horvitz, Ms Heinrich) Boston, Mass; Children's Hospital, (Dr Homer, Mr Forbes), Boston, Mass; the Harvard Medical School (Dr Homer), Boston, Mass; and the NC Center for Children's Healthcare Improvement, University of North Carolina (Ms Lesneski, Dr Phillips), Chapel Hill, NC
Peter Forbes, MA
- From the National Initiative for Children's Healthcare Quality, (Dr Homer, Ms Horvitz, Ms Heinrich) Boston, Mass; Children's Hospital, (Dr Homer, Mr Forbes), Boston, Mass; the Harvard Medical School (Dr Homer), Boston, Mass; and the NC Center for Children's Healthcare Improvement, University of North Carolina (Ms Lesneski, Dr Phillips), Chapel Hill, NC
Cheryll Lesneski, MA
- From the National Initiative for Children's Healthcare Quality, (Dr Homer, Ms Horvitz, Ms Heinrich) Boston, Mass; Children's Hospital, (Dr Homer, Mr Forbes), Boston, Mass; the Harvard Medical School (Dr Homer), Boston, Mass; and the NC Center for Children's Healthcare Improvement, University of North Carolina (Ms Lesneski, Dr Phillips), Chapel Hill, NC
Jim Phillips, DrPH
- From the National Initiative for Children's Healthcare Quality, (Dr Homer, Ms Horvitz, Ms Heinrich) Boston, Mass; Children's Hospital, (Dr Homer, Mr Forbes), Boston, Mass; the Harvard Medical School (Dr Homer), Boston, Mass; and the NC Center for Children's Healthcare Improvement, University of North Carolina (Ms Lesneski, Dr Phillips), Chapel Hill, NC

Received 28 July 2003; accepted 27 May 2004.

Objectives.—Major gaps exist between usual clinical practice and evidence-based recommendations for care. Many interventions to improve care are costly and time intensive. This study sought to determine whether a clinician's self-assessment of their practice performance for the diagnosis and management of children with attention deficit hyperactivity disorder (ADHD) followed by attendance at a 2-day conference focused on system change would result in improvement in care.

Methods.—Design: Quasi-experimental—before and after with external controls. Participants: Clinician attendees compared with convenience sample of nonattendees. Outcomes: Consistency with 10 specific recommendations from the American Academy of Pediatrics Guidelines concerning ADHD. Analysis: Logistic regression, with use of generalized estimating equations to account for clustering of subjects within clinician practices.

Results.—Widespread deficiencies in care were present prior to the intervention. Practice improved significantly more among conference attendees in 2 of the 10 performance measures (evaluation for coexisting conditions and offering treatment options), with positive trends in most of the other indicators.

Conclusions.—Practice assessment and system-based training may be a cost-effective strategy to improve practice performance.

KEY WORDS: attention deficit-hyperactivity disorder , children's behavioral health , chronic conditions , guidelines , quality improvement