Electronic health record decision support and quality of care for children with ADHD

Abstract

Objectives: The objective of this study was to assess the effect of electronic health record (EHR) decision support on physician management and documentation of care for children with attention-deficit/hyperactivity disorder (ADHD).

Methods: This study involved 79 general pediatricians in 12 pediatric primary care practices that use the same EHR who were caring for 412 children who were aged 5 to 18 years and had a previous diagnosis of ADHD. We conducted a cluster randomized trial of EHR-based decision support that included (1) clinician reminders to assess ADHD symptoms every 3 to 6 months and (2) an ADHD note template with structured fields for symptoms, treatment effectiveness, and adverse effects. The main outcome measures were (1) proportion of children with visits during the 6-month study period in which ADHD was assessed and (2) quality of documentation of ADHD assessment. Generalized estimating equations were used to control for the clustering by providers.

Results: Children at intervention sites were more likely to have had a visit during the study period in which their ADHD was assessed. The ADHD template was used at 32% of visits at which patients were scheduled specifically for ADHD assessment, and its use was associated with improved documentation of symptoms, treatment effectiveness, and treatment adverse effects.

Conclusions: EHR-based decision support improved the likelihood that children with ADHD had visits for as well as care related to managing this condition. Better understanding of how to optimize provider use of the decision support and templates could promote additional improvements in care.

Trial registration: ClinicalTrials.gov NCT00134823.