1. Intervention primary care practices using an enhanced computer system had a higher percentage of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) when compared to control practices.
2. At the time of ADHD diagnosis, intervention practices documented more symptoms characteristic of ADHD than control practices.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Although ADHD is the most commonly diagnosed pediatric behavior disorder, physician diagnosis can be difficult as other conditions can present in a similar manner. Researchers in the current study hypothesized that physicians would adhere more strictly to clinical diagnostic guidelines with computer guidance. A previously tested computer automation system, CHICA, was implemented in primary care practices with intervention groups using an “enhanced” system, CHICA ADHD, and control practices using the “traditional” system. The CHICA ADHD system provided physicians with immediate ADHD guidelines and treatment recommendations individualized to the patient, while the traditional CHICA system did not. Practices randomized to use the CHICA ADHD system had a higher percentage of patients diagnosed with ADHD according to established guidelines when compared to the control group. Intervention groups noted significantly more characteristic symptoms of ADHD at the time of diagnosis. This study may be limited by its lack of generalizability, but it displayed the capacity to effectively improve ADHD diagnosis with the aid of a computer support system with the potential to improve physician quality of care.
In-Depth [cluster randomized controlled trial study]: Researchers randomized four primary care practices with two intervention practices using the CHICA ADHD system and two control practices using the traditional CHICA system. The CHICA ADHD system is an enhanced computer support system which offers guidelines for ADHD diagnosis and management. Control clinics using the traditional CHICA system did not have built-in computer assistance for diagnosis or treatment. The primary outcome was the percentage of pediatric patients, ages 5-12 years old, diagnosed with ADHD as defined by a structured diagnostic assessment. At the conclusion of the study period, 42 charts of ADHD-diagnosed patients were randomly chosen from each group for analysis. Intervention practices were significantly more likely to diagnose according to guidelines (OR = 8.0, CI 1.6-40.6), and had a 31% increase in patients diagnosed in this manner. Over the same time period, diagnosis by structured assessment among patients of control practices decreased by 12%. Intervention practices also recorded more symptoms characteristic of ADHD at the time of diagnosis (p < .05).
By Brandon Childs and Leah H. Carr
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