title: Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. jeff.epstein@cchmc.org
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Langberg
authors.forename: Philip K
authors.initials: PK
authors.lastname: Lichtenstein
authors.forename: Beth A
authors.initials: BA
authors.lastname: Mainwaring
authors.forename: Carolyn P
authors.initials: CP
authors.lastname: Luzader
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Stark
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care; D019037:Urban Health Services / Q000592:standards