A Tool for Supporting and Monitoring Decision Making in ADHD

DESCRIPTION (provided by applicant): This proposal is to complete and validate a new web-based tool to assist in the screening, diagnosis and management of mental health disorders (focusing here on ADHD), quality improvement (QI) documentation and efficient large scale research. CHADIS is a screening, assessment and decision support system delivering tools online for care of health, development, and mental health conditions including ADHD. CHADIS provides online questionnaires for parents, teens and teachers to complete prior to a visit. These are automatically scored to yield conclusions on a worksheet linked to electronic chapters of clinician guidance and myriad resources for families which become handouts. Clinical data is shared securely among professionals, also forming a deidentified research database. This proposal is to adapt CHADIS tools to optimize use for ADHD care, QI and research. Proper care of ADHD (Attention Deficit Hyperactivity Disorder), a common treatable mental health condition, calls for accurate diagnosis, assessment for comorbidity and multiple observer input. Among CHADIS' tools is a comprehensive previsit parent questionnaire (CHADIS-DSM) for assessing child mental health problems based on the logic of both DSM-IV and DSM-PC and producing provisional DSM diagnoses. While pilot data on CHADIS DSM is encouraging, additional validation focusing on ADHD and its comorbidities is needed. This project also proposes creating case-specific templates (CST) within CHADIS to receive the responses from all previsit parent, teen or teacher questionnaires to provide specific guidance to clinicians. CSTs will provide the clinician with evidence-based prompts, e.g. symptoms to explore, suggested wording for questions, menus of observations from which to select, and related text to help further confirm, refute or change the presumptive conclusions from parent/teen data. CST use will document evidence of diagnostic criteria, diagnose more accurately, improve care, and compile a research database. This study will validate CHADIS-DSM for ADHD and its comorbidities and assess the impact of CSTs on accuracy of diagnoses. 1100 4-12 year olds presenting for care in 2 existing CHADIS practice networks will be screened. Those 300 seeking care for behavior problems, and all positive among 800 coming for well visits plus a random sample of those negative will complete comparison and gold standard criterion measures. Pediatricians are required to conduct a QI effort in use of evidence based practices in order tomaintain professional certification through the American Board of Pediatrics (ABP). ABP approved QI programs require chart audits for documentation of approved care, difficult for practices to implement. Another product of this proposal is making CHADIS the first system for pediatric care that collects both patient data and clinician responses thus providing automated documentation of care for QI accreditation. PUBLIC HEALTH RELEVANCE: Attention Deficit Hyperactivity Disorder (ADHD), a disorder affecting 4-12% of children, is mainly diagnosed and managed by primary care physicians yet evidence based guidelines and optimized outcomes are generally not achieved. The American Board of Pediatrics is striving to improve all pediatric care by requiring Quality Improvement (QI) activities but the recertification process is onerous. This proposal is to complete and validate additions to CHADIS, an innovative web-based system for healthcare that delivers previsit questionnaires online and presents results to theclinician linked to decision support and helpful resource listings, in order to overcome obstacles to implementation of QI, in this case for ADHD, by guiding and documenting clinicians' responses to parent input, to increase evidence-based care and to create a tool facilitating large scale research projects.