title: Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes.
abstract: The quality of care for children with attention-deficit/hyperactivity disorder (ADHD) delivered in community-based pediatric settings is often poor. Interventions have been developed to improve community-based ADHD care but have not demonstrated that better care results in improved patient outcomes. The objective of this study was to determine whether an ADHD quality improvement (QI) intervention for community-based pediatric practices improves patient outcomes.
  
  
  
  A cluster randomized controlled trial was conducted in which 50 community-based pediatric primary care practices (213 providers) were randomized either to receive a technology-assisted QI intervention or to a control condition. The intervention consisted of 4 training sessions, office flow modification, guided QI, and an ADHD Internet portal to assist with treatment monitoring. ADHD treatment processes and parent- and teacher-rated ADHD symptoms over the first year of treatment were collected for 577 patients.
  
  
  
  Intent-to-treat analyses examining outcomes of all children assessed for ADHD were not significant (b = -1.97, P = .08). However, among the 373 children prescribed ADHD medication, there was a significant intervention effect (b = -2.42, P = .04) indicating greater reductions in parent ratings of ADHD symptoms after treatment among patients treated by intervention physicians compared with patients treated at control practices. There were no group differences on teacher ratings of ADHD symptoms. ADHD treatment care around medication was significantly better at intervention practices compared with control practices.
  
  
  
  A technology-assisted QI intervention improved some ADHD care quality and resulted in additional reductions in parent-rated ADHD symptoms among patients prescribed ADHD medications.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; jeff.epstein@cchmc.org.
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio;
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Baum
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: James
authors.initials: J
authors.lastname: Peugh
authors.affiliation: Department of Epidemiology, University of Ottawa, and Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario;
authors.forename: William
authors.initials: W
authors.lastname: Gardner
authors.affiliation: The Children's Home of Cincinnati, Cincinnati, Ohio; and.
authors.forename: Phil
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Langberg
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D020407:Internet; D008297:Male; D015233:Models, Statistical; D009820:Ohio; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010290:Parents; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*; D000070777:School Teachers; D016896:Treatment Outcome