Implementation of a Family-Centric Chronic Care Model for Pediatric and Adolescent ADHD in a General Pediatrics Setting

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly occurring behavioral health disorders with annual costs approaching 80 billion dollars. Most ADHD treatment is delivered in primary care (PC) settings. It has been well established that ADHD is best treated using a chronic care model dispensed in a family-centric fashion. Yet, it has proved challenging to implement evidenced-based ADHD guidelines in routine clinical practice. Creation of ADHD care teams that redesign practice flow for the management of ADHD has improved the quality of care but gaps still exist. Nationwide and in our own system, three of the biggest hurdles have been, implementation of behavioral therapy, systematic follow-up of treatment effects and improving persistence with effective treatments. Over the past year, we conducted a local needs assessment to understand barriers to family centric ADHD care. Based on these results integrating input from families, providers and staff, we propose to create a Family Centric Chronic Care Model for ADHD (FCCM). FCCCM integrates established components of a multidisciplinary care team and standardized treatment measures with the innovative components of electronic visits, systematic assessment of parental factors influencing treatment uptake and a brief, primary care-based engagement intervention. We will employ the IHI Model for Improvement and rapid Plan-Do-Study-Act cycles to implement the interventions described above in the context of a multidisciplinary, Quality Improvement infrastructure that is well established in our General Pediatrics practice.  The primary outcome will be our capacity to meet AAP metrics for appropriate treatment, medication titration and medication maintenance.