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



METHODS
Quasi-experimental-before and after with external controls.


METHODS
Clinician attendees compared with convenience sample of nonattendees.


RESULTS
Consistency with 10 specific recommendations from the American Academy of Pediatrics Guidelines concerning ADHD.


METHODS
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.
Homer
Charles J
CJ
National Initiative for Children's Healthcare Quality, Boston, MA 02215, USA. chomer@nichq.org
Horvitz
Lisa
L
Heinrich
Patricia
P
Forbes
Peter
P
Lesneski
Cheryll
C
Phillips
Jim
J
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking / Q000592:standards; D008499:Medical Records / Q000592:standards*; D010372:Pediatrics / Q000193:education* / Q000592:standards; D012655:Self-Evaluation Programs