Communication to Improve Shared Decision-Making in ADHD (ADHD-Link)

Children's Hospital of Philadelphia (CHOP)

Status: Completed

Conditions: Attention-Deficit/Hyperactivity Disorder

Treatments: Other: ADHD Portal; Behavioral: Care Manager CM)

Study type: Interventional

Funder types: Other

Identifiers

NCT02716324

15-012456

Details and patient eligibility

About

The purpose of this study was to explore whether using an online patient portal plus a Care Manager is more effective than using an online portal alone in managing care for children with ADHD. Doctors at The Children's Hospital of Philadelphia currently use the online patient portal to help gather information from parents and teachers on ADHD symptoms, treatment, and medication side effects. The Care Manager is a person who meets with participants during the study to discuss their child's ADHD care. The Care Manager communicates with the child's doctor and teacher to communicate a parent's goals and preferences for their child's ADHD care.

Full description

Fragmentation in health care and poor communication across systems adversely impact engagement and adherence to treatment by children with ADHD and their families. Fragmentation of services for ADHD impairs communication and collaboration between families and primary care providers, mental health providers, and educators, and leads to suboptimal outcomes for children. Prior studies have documented that little communication and coordination exist among providers across different systems despite calls for better system integration.

Fragmentation in communication between providers has the potential to impair shared decision-making. To promote shared decision-making, we developed an electronic health record (EHR)-linked portal to collect information from parents, teachers and clinicians on children's ADHD symptoms and treatment-related preferences and goals. This has become standard of care at our institution. We also developed and pilot tested a ADHD Care Manager intervention which will be employed in this comparative effectiveness study.

303 participants were recruited from 11 primary care pediatric practices. Participants were randomly assigned to either the EHR portal alone, or the EHR portal plus a Care Manager. For those assigned to the EHR portal plus Care Manager, the Care Manager met with families at the beginning of the study to confirm their treatment preferences and goals, provide additional education on ADHD treatment, and distribute handouts on common concerns among ADHD patients and families. The Care Manager contacted families every 3 months or more frequently if needed by phone, email, or in-person to assess treatment use, identify new concerns, and assist families with problem-solving. The Care Manager also communicated with primary care clinicians, mental health providers, and teachers to clarify family treatment preferences and goals and address emerging treatment issues. Participants completed surveys that assessed ADHD symptoms, goal attainment, patient-reported outcomes, patient and family engagement, and treatment initiation and adherence.

Enrollment: 303 patients

Sex: All

Ages: 5 to 12 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Aged 5 through12 years old
• Receiving Attention-Deficit/Hyperactivity Disorder (ADHD) treatment from participating practices
• ADHD or Attention Deficit Disorder (ADD) diagnosis code, International Classification of Diseases (ICD) code ICD-10-CM F90.9 or F90.0, listed in the problem list or recorded at an ambulatory visit in the past year.
• Parental/guardian permission (informed consent) and if appropriate, child assent.

Exclusion criteria

• Autism spectrum disorder, ICD-10-CM F84.0
• Conduct disorder, ICD-10-CM F91.1
• Psychosis, ICD-10-CM F29
• Bipolar disorder, ICD-10-CM F31.9
• Suicide attempt, ICD-10-CM T14.91, or suicide ideation, ICD-10-CM R45.85
• Children and/or their parents/caregivers non-English speaking

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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303 participants in 2 patient groups

ADHD Portal

Active Comparator group

Description:

In this arm, the ADHD Portal was used alone as an electronic communication tool.The ADHD portal is considered standard of care at our institution for communicating information between clinicians, teachers, and parents.

Treatment:

Other: ADHD Portal

ADHD Portal plus Care Manager (CM)

Experimental group

Description:

In this arm, the ADHD Portal was combined with the CM. Clinicians, teachers, and parents used the ADHD Portal as standard of care. In addition, clinicians, teachers, parents, and any external mental health providers interacted with a CM, who had access to information contained in the ADHD Portal.

Treatment:

Behavioral: Care Manager CM)

Other: ADHD Portal