Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Clinical Decision Support System, PROVIDER/PRACTICE, Public Insurance (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS

Intervention Description: To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices.

Intervention Results: Significant increase in percentage of children screened with a standardized screening tool at target visits (85% vs 24.4%, P<.001)

Conclusion: Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age.

Study Design: RCT

Setting: Four primary care pediatric clinics in the Eskenazi Medical Group in Indianapolis, Indiana

Population of Focus: Children younger than 66 months

Data Source: Child medical record

Sample Size: Medical records - Intervention (n=180) - Control (n=180)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Clinical Decision Support System,

Intervention Description: We examined primary care providers' (PCPs') management of attention-deficit/hyperactivity disorder (ADHD) during and following families' participation in two arms of the Children's ADHD Telemental Health Treatment Study. We hypothesized that more intensive treatment during the trial would show an "after-effect" with more assertive PCPs' management during short term follow-up. Methods: We conducted a pragmatic follow-up of PCPs' management of children with ADHD who had been randomized to two service delivery models. In the Direct Service Model, psychiatrists provided six sessions over 22 weeks of pharmacotherapy followed by behavior training. In the Consultation Model, psychiatrists provided a single-session consultation and made treatment recommendations to PCPs who implemented these recommendations at their discretion for 22 weeks. At the end of the trial, referring PCPs for both service delivery models resumed ADHD treatment for 10 weeks. We performed intent-to-treat analysis using all 223 original participants.

Intervention Results: Participants in the Direct Service Model had more ADHD visits than those in the Consultation Model across the full 32 weeks (mean = 7.05 visits vs. 3.36 visits; adjusted rate ratio = 2.1 [1.85-2.38]; p < 0.0001). During follow-up, participants in the DSM were more likely to be taking ADHD-related medications (82% vs. 61%; adjusted odds ratio = 2.44 [1.24-4.81], p = 0.01). At 32 weeks, participants in the Direct Service Model had higher stimulant dosages (adjusted difference = 5.64 [0.12-11.15] mg; p = 0.046).

Conclusion: These results from a pragmatic follow-up of a randomized trial suggest an "after-effect" for brief intensive treatment in the Direct Service Model on the short term follow-up management of ADHD in primary care.

Study Design: Randomized controlled trial

Setting: Primary care settings in seven communities.

Population of Focus: Children referred by primary care providers (PCPs) in seven communities who met the criteria for ADHD

Sample Size: 223 boys and girls who were referred to the trial by 88 primary care providers (PCPs) in seven communities

Age Range: Children ages 5.5 to 12 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Feedback Using the Plan-Do-Study-Act-Tool, Clinical Decision Support System,

Intervention Description: This study aimed to determine whether youth access behavioral health (BH) care earlier (i.e., when problems are less severe) when receiving services in colocated pediatric primary care clinics. Six primary care clinics in the Midwest with a colocated BH provider participated in this study. Data on number of sessions attended/not attended with the BH provider, BH symptom severity as measured by the Child Behavior Checklist, parent report of length of presenting problem, and improvement ratings were collected and compared for on-site referrals and off-site referrals. Descriptive, independent sample t tests and regression analyses compared those referred from on-site physicians versus off-site referral sources.

Intervention Results: Results demonstrated that youth receiving BH services at their primary care physician's office accessed services when problems were less severe and had been impacting their functioning for a shorter duration.

Conclusion: This study is among the first to explore whether youth receiving BH services in primary care are accessing those services earlier than those who are referred from outside sources, resulting in improved patient outcomes.

Study Design: Medical record reviews

Setting: Six colocated primary care clinics in the Midwest region of the United States

Population of Focus: Pediatric patients who initiated behavioral health treatment in six colocated primary care clinics in the Midwest

Sample Size: 617 children

Age Range: Children ages 1 to 19 years old