Past Programs

2002 NICHQ CCHI ADHD Collaborative

Building and Strengthening Capacity to Promote and Maintain High Quality Care For Medicaid Beneficiaries Breakthrough Series Collaborative on Improving Care for Children with Attention Deficit Hyperactivity Disorder was a project of the partnership between the Center for Health Care Quality at Cincinnati Children's Hospital Medical Center and the National Initiative for Children's Healthcare Quality (NICHQ) and the North Carolina Division of Medial Assistance (DMA).

This project intended to develop, measure, promote and disseminate positive changes to improve care in primary care practices that serve Medicaid recipients. This report will discuss the Breakthrough Series Collaborative on Improving Care for Children with Attention Deficit Hyperactivity Disorder (ADHD), realizing that the same methodology could be used for any other disease specific or preventive condition.

Framework

The content and process of this collaborative were framed in the context of implementing a system of care for children with chronic conditions. Wagner and colleagues developed the model we used. (Wagner, 1996)

This framework provided a systematic approach to chronic care based on extensive review of the literature on health care systems that work for persons with chronic conditions and expert panel review. Specific topics included a broad overview of the framework, as well as individual breakout sessions on each of the components of the model:

Self-Management Support
Community Partnerships
Delivery System Design
Decision Support
Healthcare Information
Clinical Information Systems
Teams were taught a general approach to making changes and improvements in their health care systems.

Participating sites in this collaborative were selected from across the country based on their potential for making breakthrough improvements in care and their potential to serve as sources of spread across larger entities -- such as professional societies, managed care organizations and primary care practice networks, North Carolina State Medicaid program, and others. Special emphasis was provided to sites that met these criteria and also served indigent and minority communities.

Eleven practice teams received scholarship funding and NC Division of Medical Assistance sponsored North Carolina teams. Primary care practice teams were multidisciplinary and represented physicians, nurses, administrative / front desk office staff, and support staff (medical records, information systems / data, etc.)

Results

All four of the processes measures improved by 30% or more during the nine months of the collaborative. The process measures that showed the most improvement when analyzing aggregated measures on the run charts are:

Percent of patients with the benefits and risks of treatment options explained
Percent of patients with a written care plan in chart.

Both outcome measures improved during the collaborative. The percent of patients who maintained acceptable symptoms score or improved that score by 25% or more increased by 31 percentage points from January (n=6 sites) to September (n=4 sites). A greater percentage of patients improved their functioning or maintained acceptable functioning, increasing from 15% of patients from 6 sites in January to 56% of patients from 4 sites in September. Although these results are limited by the variability in sites submitting data each month during this project, overall there is a positive trend in improving processes and outcomes.

The dramatic success of the teams in improving care for children with ADHD demonstrated that pediatric providers could improve systems of care and the outcomes that children with this condition experience. By implementing the AAP Guidelines using the Care Model for Child Health framework the symptoms and function of participating children improved. Primary care clinicians, their office teams and their community school and mental health providers were able to work together as partners with children and families. Family satisfaction and provider satisfaction improved as a result of a more comprehensive and organized approach to the care of these children.

The collaborative served to test and refine practical measures of processes and outcomes that practices and systems could use to track improvement, and develop exemplar models of care that could facilitate dissemination by demonstrating the feasibility of improvement.