from the AAP Department of Community and Chapter Affairs and Quality Improvement
Chapters Views & News
A pilot project to improve the care of children with attention-deficit/hyperactivity
disorder (ADHD) led to a reduction in symptoms as well as increased confidence among
pediatricians in diagnosing and managing the disorder.
The Chapter Quality Network (CQN) led the project from December 2015 through January
2017 to improve the quality of care processes and outcomes by implementing the Academy’s
clinical practice guideline on ADHD. Pediatricians, practices and chapters from Arkansas,
Georgia, New York Chapters 1 and 2, Ohio and Texas used quality improvement (QI) methods
to test evidence-based care processes and embed them into their workflows. They also
participated in monthly calls to share best practices and review data, and attended
four learning sessions.
At the end of the project, children with ADHD experienced a 12% reduction in symptoms,
as measured by parent and teacher assessment. Furthermore, 70% of providers reported
increased confidence in diagnosing ADHD and 83% reported increased confidence in managing
and treating ADHD.
“With this grant, pediatricians have become comfortable evaluating, diagnosing, treating
and providing ongoing care for the child and families with ADHD,” said Joseph J. Abularrage,
M.D., M.P.H., M.Phil., FAAP, project physician leader from New York Chapter 2. “That’s
been a big positive for the children, the families, the pediatricians and the neurologists
in New York City who, in general, were actually happy to shift ADHD patients away
Chapter and national project leaders helped practices develop reliable systems to
ensure they receive parent and teacher assessments of child symptoms throughout diagnosis,
medication titration and follow-up care, which is a core tenant of the AAP ADHD guideline.
The national and chapter teams also provided education on medication management, diagnosis
of comorbidities and evidence-based behavior therapy, which is the first-line treatment
for preschoolers and recommended for all other ages, in addition to medication. The
practices were encouraged to connect with behavior therapy providers in their communities
and were given tools to encourage collaboration with parents and schools, such as
school-home report cards and an online message center.
Results showed the percentage of children whose parent and teacher returned an assessment
within 30 days of medication initiation increased from 58% at baseline to 83% at the
end of the project. Furthermore, 71% of providers reported an increase in return of
parent assessments, and 66% reported an increase in return of teacher assessments.
In addition, 72% of participants reported developing a better understanding of evidence-based
therapy, and 45% reported finding new behavior therapy providers as a result of the
Unique approach: parent engagement
National and chapter leaders also engaged parent advisers in project design and development
of tools to help providers guide parents as they work to manage their child’s condition
and set them up for school success. The parents also shared personal stories to educate
providers on how to support them throughout the diagnosis and treatment process.
“Parents play a huge role in treating their children for any condition but particularly
for ADHD, and it can be a tough journey for a family,” said Dr. Abularrage. “Incorporating
the parents’ perspective into this project helped pediatricians get a better picture
of what parents need, the things we can do and say to support them when they’re trying
to make sure their child is happy and healthy.”
“There is a huge disconnect between the physician, parent and the school, but with
(this) QI project that gap was bridged,” added Donna Williams, parent adviser for
New York Chapter 1. “Educating physicians on the parent perspective also gives them
more insight on cultural competency. No two children are alike and being in a country
where we are surrounded by many cultures and practices, it behooves physicians to
be as well-rounded as possible. This makes it easy for parents to relate to them and
trust that their expertise is appropriate for the help that they are seeking.”
CQN will embark on a second phase of the ADHD project, which will be open to chapters
and health care organizations. The request for proposal will be released this spring.
Both phases of the project are funded by an independent grant from Pfizer Inc.
CQN projects address immunizations, judicious use of antibiotics
The Chapter Quality Network (CQN) U.S. Immunizations project launched in October 2016
to help practices improve immunization rates in children 19-35 months of age. Chapters
in Georgia, New Jersey, Oklahoma, California Chapters 2 and 4, and New York Chapter
2 are working with practices to address missed opportunities and improve recall systems.
The project is funded by an independent grant from Pfizer Inc.
Additionally, the Virginia Chapter is beginning a CQN pilot project on the judicious
use of antibiotics with a focus on acute otitis media and upper respiratory infections.
The project, funded by the Centers for Disease Control and Prevention, also aims to
improve communication with parents and caregivers regarding antibiotic prescribing.
For the first time, CQN is working with Anthem Inc.’s affiliated health plans to provide
incentives to participating pediatricians.
For more information about the Chapter Quality Network or other chapter quality improvement
activities contact Suzanne Emmer at 847-434-4077 or firstname.lastname@example.org.