Use of a computerized decision aid for ADHD diagnosis: a randomized controlled trial

• Published in: Pediatrics (Evanston) Vol. 132; no. 3; pp. e623 - e629
• Main Authors: Carroll, Aaron E, Bauer, Nerissa S, Dugan, Tamara M, Anand, Vibha, Saha, Chandan, Downs, Stephen M
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-09-2013
• Subjects: Algorithms; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - psychology; Attention Deficit Disorder with Hyperactivity - therapy; Attention deficit hyperactivity disorder; Child; Children & youth; Clinical trials; Confidence Intervals; Decision support software; Decision support systems; Decision Support Systems, Clinical; Diagnosis; Female; Guideline Adherence; Hospitals, University; Humans; Indiana; Male; Mass Screening; Medical diagnosis; Medical protocols; Medical treatment; Pediatrics; Quality of care; Indiana; ADHD; screening; CHICA; computer decision support system
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2013-0933

To determine if implementing attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment guidelines in a clinical decision support system would result in better care, including higher rates of adherence to clinical care guidelines.
We conducted a cluster randomized controlled trial in which we compared diagnosis and management of ADHD in 6- to 12-year-olds after implementation of a computer decision support system in 4 practices.
Eighty-four charts were reviewed. In the control group, the use of structured diagnostic assessments dropped from 50% in the baseline period to 38% in the intervention period. In the intervention group, however, it rose from 60% to 81%. This difference was statistically significant, even after controlling for age, gender, and race (odds ratio of structured diagnostic assessment in intervention group versus control group = 8.0, 95% confidence interval 1.6-40.6). Significant differences were also seen in the number of ADHD core symptoms noted at the time of diagnosis. Our study was not powered to detect changes in care and management, but the percent of patients who had documented medication adjustments, mental health referrals, and visits to mental health specialists were higher in the intervention group than the control.
The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. Future work will examine how to further develop the ADHD module and add support for other chronic conditions.