Improving care for children with attention deficit hyperactivity disorder: assessing the impact of self-assessment and targeted training on practice performance

Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association
Charles J HomerJim Phillips

Abstract

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. Quasi-experimental-before and after with external controls. Clinician attendees compared with convenience sample of nonattendees. Consistency with 10 specific recommendations from the American Academy of Pediatrics Guidelines concerning ADHD. Logistic regression, with use of generalized estimating equations to account for clustering of subjects within clinician practices. 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. Practice assessment and system-based training may be a cost-effective strategy to improve practice performance.

Citations

Feb 12, 2011·Patient Preference and Adherence·William B Brinkman, Jeffery N Epstein
Oct 3, 2006·The Journal of Pediatrics·Rachel C VreemanStephen M Downs
Aug 21, 2008·The Journal of Continuing Education in the Health Professions·Suzanne LazorickCarole M Lannon
Jun 12, 2009·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Kristin M RankinCharles Onufer
Aug 2, 2014·Clinical Pediatrics·Lucy McGoronDanielle Marks
Apr 7, 2009·Expert Review of Neurotherapeutics·Joshua M LangbergJeffery N Epstein
Aug 18, 2017·Journal of Developmental and Behavioral Pediatrics : JDBP·Alexander G FiksThomas J Power
Jul 27, 2012·Journal of Evidence-based Social Work·Melanie A BarwickIan Manion

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