Practices network to improve care for children with ADHD
from the AAP Department of Community and Chapter Affairs and Quality Improvement
Chapters Views & News
Community-based pediatricians often struggle to treat children with attention-deficit/hyperactivity
disorder (ADHD) based on AAP guidelines. Recent studies suggest that quality improvement
(QI) strategies could improve adherence to the guidelines.
Five organizations were awarded independent grants from Pfizer Inc. and formed a learning
network to test innovative strategies for improving the quality of ADHD care. Participants
came from a variety of organizations and academic institutions, and delivered care
to more than 11,000 patients. All were committed to building and strengthening their
systems of care for children with ADHD and their families.
Following are highlights of each program.
The Child Health and Development Institute (CHDI) of Connecticut used its successful
academic detailing (educational outreach) program called Educating Practices in the
Community to train providers at 10 pediatric primary care sites to implement the AAP
CHDI partnered with the Practice Quality Improvement program at Connecticut Children’s
Medical Center Office for Community Child Health to develop and implement a QI activity
that engages practices in plan-do-study-act cycles to improve care. It also partnered
with the CT Family Support Network, a statewide organization serving families of children
with special health care needs, to incorporate the family experience into training
and provide technical support to participants.
Maine Quality Counts and the AAP Maine Chapter recruited primary care practice teams
to participate in a year-long learning collaborative to improve screening, diagnosis
and treatment of ADHD, especially for children in foster care.
Practices had access to parenting classes or online parenting resources to increase
adherence to behavior therapy recommendations. The project also piloted a program
in which school nurses helped ensure teacher evaluations for students with ADHD were
completed and returned promptly.
“The ADHD project was a tremendous opportunity to connect Maine practice sites with
the work at the national AAP and projects in other states,” said Amy L. Belisle, M.D.,
M.B.A., FAAP, director of child health quality improvement at Maine Quality Counts.
“This project helped jump-start work in the state on ADHD, bring together clinicians
and specialists, and help practices implement the best practices around ADHD. In Maine,
we were also able to connect practices more closely with school and parent organizations
to help build relationships to improve ADHD care for patients and families.”
The Pennsylvania State University College of Medicine team built on previous work
to create a family-centered chronic care model to improve adherence to AAP recommendations
on ADHD treatment and management. The model includes three novel components: 1) telehealth
visits to reduce burden on families, 2) systematic assessment of parental factors
that influence treatment uptake and 3) an engagement intervention that incorporates
motivational interviewing to generate discussions with families about the child’s
The Penn State model integrated multiple disciplines (pediatrics, psychology, QI)
to ensure all aspects of ADHD treatment were addressed.
Rush University Medical Center(RUMC)worked to increase access to systematic, high-quality ADHD care for children and adolescents
in Chicago. The diverse population has an ADHD prevalence well below the accepted
national prevalence, which may be due to under-diagnosis.
The intervention included 1) implementation of a diagnostic evaluation and management
protocol, 2) creation of templates to assist with visit documentation, 3) education
for clinicians regarding the guideline, 4) development of dedicated behavior therapy
services, and 5) dedicated consultative services by a developmental-behavioral pediatrician.
RUMC’s partnership with the AAP Illinois Chapter has resulted in the launch of an
ADHD practice-based learning collaborative.
Tulane School of Medicine engaged five residency clinics and two federally qualified
health centers in New Orleans to increase adherence to the guidelines in high-need
children ages 4-11.
Project leaders developed electronic and print educational resources for participants.
They also offered 1) clinical consultation with specialists and priority access to
behavior therapy, and 2) systems consultation regarding practice process improvements.
Project leaders have aligned their work with various state initiatives and the Louisiana
Department of Health.
Organizations participating in the five programs developed and implemented their
own QI strategies, and the AAP formed a learning network where participants shared
successes and barriers with each other. An in-person session and monthly webinars
focused on topics such as communicating with families, billing and coding, transitioning
adolescents to self-management and incorporating school nurses into the care team.