108 - Enhancing ADHD Follow-Up Care: Evaluating the Impact of a Web-Based Monitoring System

Publication Number: 1100.108

Sarah Weas, Boston Children's Hospital, Boston, MA, United States; Eugenia Chan, Boston Children's Hospital, Boston, MA, United States; William Barbaresi, Harvard Medical School; Boston Children's Hospital, Boston, MA, United States

Background: Attention-deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children. Over the past two decades, practice guidelines have emphasized the importance of collecting parent and teacher rating scales to guide ADHD treatment. Various health information technologies (HITs) have been developed to facilitate this process, but their effectiveness and uptake remains underexplored.

Objective: To evaluate the impact of a novel HIT focused on adherence to practice guidelines for ADHD follow-up care as reflected by documentation in clinical notes of parent and teacher Vanderbilt rating scales. The study was conducted in a large academic specialty clinic.

Design/Methods: A retrospective review of clinical notes was conducted for three time periods: before HIT implementation (15 months), during implementation (12 months), and 27 months post implementation phase. Data were extracted with the assistance of a text-query tool to find documentation of parent and/or teacher Vanderbilt rating scales. An analysis of variance (ANOVA) was performed to assess differences in documentation rates across the three time periods. Post-hoc analyses utilized the Tukey-Kramer method, with statistical significance set at p < 0.05.

Results: Clinical notes from 5,821 ADHD follow-up visits were reviewed. Significant differences were noted when comparing before versus post implementation phases for both parent (28% to 40%, p< 0.001) and teacher (18 to 28%, p< 0.001) Vanderbilt Scales. There were no significant differences noted when comparing rates before versus during implementation and during versus after implementation.

Conclusion(s): With the HIT implementation, there was a significant increase in the collection of both parents and teacher Vanderbilt rating scales. However, despite the considerable cost in time and money to implement the HIT, over 50% of visits still had no documented rating scales. Despite practice guidelines and efforts to implement consistent clinical standards, follow-up care for children with ADHD continues to lack consistent and standardized approaches. New, clinician-friendly systems are needed to capture precise, clinically meaningful, structured information to provide evidence-based treatments for children with ADHD.

Percent of ADHD Rating Scale Documentation in Follow-Up Notes