Sustained Improvement in Pediatricians' ADHD Practice Behaviors in the Context of a Community-Based Quality Improvement Initiative

Abstract

The long-term sustainability of a quality improvement project was examined. The ADHD Collaborative was designed to assist community-based pediatricians in adhering to the American Academy of Pediatrics evidence-based assessment and treatment guidelines for attention deficit hyperactivity disorder (ADHD). Patient chart reviews were completed out to 2 years post training for 14 practices (N = 38 pediatricians), who received the ADHD Collaborative intervention to assess whether improvements made immediately post training were sustained. Pediatricians maintained significant improvements in their use of evidence-based assessment and treatment practices for a period of 2 years. The majority of the improvements occurred quickly, within 6 months of training. Pediatricians focused most of their continuous quality improvement (CQI) efforts on improving follow-up care for their patients with ADHD. Systematic monitoring and follow up of ADHD patients who were prescribed medication improved considerably from pre-training (10%) to 6 months (49%), and pediatricians continued to make gradual improvements in follow-up care (62% at the 2-year follow up). Systematic intervention efforts with a focus on CQI are effective at improving and sustaining quality of ADHD care. More work is needed to determine how to disseminate, support, and deliver this and similar intervention models to the many physicians who may benefit.