Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral
disorder in children. Prevalence rates in the United States range from 2% to 18% depending
on diagnostic criteria and population studied. Primary care physicians, especially
pediatricians, have historically played a large role in the diagnosis and treatment of ADHD.
Despite the existence of authoritative guidelines to assist primary care physicians, ample
evidence demonstrates that they continue to diagnose and treat this disorder suboptimally.
This is due, in part, to a lack of training and cumbersome delivery system designs. Modern
computer decision support strategies offer the best hope of equipping general practitioners
to deal with the mental health epidemic of ADHD.
The investigators have developed a novel decision support system for implementing clinical
guidelines in pediatric practice. CHICA (Child Health Improvement through Computer
Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a
dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing
electronic medical record systems. The result is a system that both delivers "just-in-time"
patient-relevant guidelines to physicians during the clinical encounter, and accurately
captures structured data from all who interact with it. Preliminary work with CHICA has
demonstrated the feasibility of using the system to implement and evaluate clinical
guidelines. The investigators propose to expand CHICA to include ADHD diagnosis and
treatment guidelines. The investigators hypothesize that implementation of the ADHD
guidelines will result in better outcomes, including higher rates of adherence to
recommendations and improved patient functioning.
The specific research aims of this proposal are:
Aim 1: Expand and modify an existing computer-based decision support system (CHICA) to
include ADHD treatment and diagnosis guideline rules as well as the capability to fax data
directly into the medical record.
Aim 2: Evaluate the effect of the CHICA system on the processes of ADHD care in pediatric
practices, including adherence to guidelines for ADHD treatment and diagnosis.
- Child between age 5 and 12 years seen in one of our clinics