title: A planned care approach and patient registry to improve adherence to clinical guidelines for the diagnosis and management of attention-deficit/hyperactivity disorder.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) affects almost 2.4 million US children. Because American Academy of Pediatrics guidelines for ADHD recommend use of standardized diagnostic instruments, regular follow-up and the chronic care model, this pilot project sought to implement and assess an electronic registry of patients with ADHD combined with care coordination by a planned care team.
  
  
  METHODS
  This quality improvement project was structured with 2 intervention and 2 control clinics to facilitate evaluation of the use of a planned care system for management of ADHD. Care teams included a pediatrician, nurse, medical assistant, and care coordinator and tracked patients using an electronic registry with data drawn from the EMR. Clinical work flows were pilot tested to facilitate use of the Vanderbilt scales and their incorporation into the EMR at intervention sites. Outcome measures included 2 recommended clinical follow-ups based on HEDIS measures as well as use of the Vanderbilt rating scales. Initiation phase measure was for follow-up after initiating medication, while the continuation phase measure was for subsequent follow-up during the first year of treatment. Measures were monitored during the project year and then also in the ensuing period of spread of the intervention to other sites.
  
  
  RESULTS
  Although the modified HEDIS initiation phase measure for patients newly on medication remained static at approximately 50% throughout the project period, the continuation phase measure showed improvement from 35% at baseline to 45% at the end of the project assessment year, a 29% increase. Follow-up for patients stable on medications also remained unchanged during the project period, but during subsequent spreading of the intervention to nonproject sites, follow-up of these patients improved to over 90%. In adjusted analyses, patients with ADHD at intervention sites were over 2 times more likely than patients at control sites to have had a Vanderbilt score documented in their records.
  
  
  CONCLUSIONS
  The project achieved modest improvements in the diagnostic and treatment process for patients with ADHD. The use of a planned care system and electronic patient registry shows promise for improving the diagnosis and treatment process for patients with ADHD.
authors.affiliation: Department of Pediatrics, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass. Electronic address: pgeltman@challiance.org.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Geltman
authors.affiliation: Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Fried
authors.affiliation: Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Arsenault
authors.affiliation: Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Knowles
authors.affiliation: Department of Pediatrics, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
authors.forename: David A
authors.initials: DA
authors.lastname: Link
authors.affiliation: Division of Child Psychiatry, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Goldstein
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.affiliation: Allegheny County Health Department and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hacker
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D010372:Pediatrics; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D058996:Quality Improvement; D012042:Registries
chemical_list: D000697:Central Nervous System Stimulants
keywords: ADHD; planned care; primary care; quality improvement; registry