title: Use of a computerized decision aid for ADHD diagnosis: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if implementing attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment guidelines in a clinical decision support system would result in better care, including higher rates of adherence to clinical care guidelines.
  
  
  METHODS
  We conducted a cluster randomized controlled trial in which we compared diagnosis and management of ADHD in 6- to 12-year-olds after implementation of a computer decision support system in 4 practices.
  
  
  RESULTS
  Eighty-four charts were reviewed. In the control group, the use of structured diagnostic assessments dropped from 50% in the baseline period to 38% in the intervention period. In the intervention group, however, it rose from 60% to 81%. This difference was statistically significant, even after controlling for age, gender, and race (odds ratio of structured diagnostic assessment in intervention group versus control group = 8.0, 95% confidence interval 1.6-40.6). Significant differences were also seen in the number of ADHD core symptoms noted at the time of diagnosis. Our study was not powered to detect changes in care and management, but the percent of patients who had documented medication adjustments, mental health referrals, and visits to mental health specialists were higher in the intervention group than the control.
  
  
  CONCLUSIONS
  The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. Future work will examine how to further develop the ADHD module and add support for other chronic conditions.
authors: Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA. aaecarro@iupui.edu
authors: Aaron E
authors: AE
authors: Carroll
authors: Nerissa S
authors: NS
authors: Bauer
authors: Tamara M
authors: TM
authors: Dugan
authors: Vibha
authors: V
authors: Anand
authors: Chandan
authors: C
authors: Saha
authors: Stephen M
authors: SM
authors: Downs
mesh_terms: D000465:Algorithms; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D002648:Child; D016001:Confidence Intervals; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007196:Indiana; D008297:Male; D008403:Mass Screening
keywords: ADHD; CHICA; computer decision support system; screening
references: Pediatrics. 2004 Jul;114(1):129-40
references: 15231919
references: JAMA. 1998 Apr 8;279(14):1100-7
references: 9546570
references: N Engl J Med. 2007 Oct 11;357(15):1515-23
references: 17928599
references: Pediatrics. 2011 Nov;128(5):1007-22
references: 22003063
references: Pediatrics. 2009 Jul;124(1):e37-43
references: 19564267
references: AMIA Annu Symp Proc. 2006;:214-8
references: 17238334
references: J Pediatr Psychol. 2003 Dec;28(8):559-67
references: 14602846
references: Health Aff (Millwood). 2005 Sep-Oct;24(5):1214-20
references: 16162565
references: Arch Dis Child. 2001 May;84(5):404-9
references: 11316683
references: AMIA Annu Symp Proc. 2008 Nov 06;:166-70
references: 18998823
references: Ment Retard Dev Disabil Res Rev. 2002;8(3):162-70
references: 12216060
references: J Am Med Inform Assoc. 2013 Mar-Apr;20(2):311-6
references: 22744960
references: J Pediatr. 2006 Oct;149(4):568-71
references: 17011336
references: Arch Pediatr Adolesc Med. 2010 Feb;164(2):160-5
references: 20124145
references: Ambul Pediatr. 2005 Jul-Aug;5(4):201-8
references: 16026184
references: Pediatrics. 2012 May;129(5):e1275-81
references: 22508925
references: JAMA. 1999 Oct 20;282(15):1458-65
references: 10535437
references: Pediatrics. 2001 Oct;108(4):1033-44
references: 11581465
references: Ambul Pediatr. 2005 May-Jun;5(3):138-42
references: 15913406
references: J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921
references: 17581453
references: Stud Health Technol Inform. 2004;107(Pt 1):187-91
references: 15360800
references: Pediatrics. 2004 Jul;114(1):e23-8
references: 15231969
references: AMIA Annu Symp Proc. 2005;:51-5
references: 16779000
references: Pediatrics. 2000 May;105(5):1158-70
references: 10836893