A Quality Improvement Initiative to Improve ADHD Follow-up rates Using School-based Telemedicine

Acad Pediatr. 2021 Apr 13:S1876-2859(21)00218-7. doi: 10.1016/j.acap.2021.04.004. Online ahead of print.


OBJECTIVE: Patients with a new diagnosis of attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication need regular follow-up. Guidelines recommend follow-up within 30 days of stimulant initiation or change but this goal is seldom achieved. This quality improvement (QI) study in an urban academic outpatient practice aimed to: 1) assess whether use of school-based telemedicine increases rates of follow-up within 30 days and decreases the number of days to follow-up for ADHD, and 2) compare rates of 30-day follow-up via in-person vs telemedicine visits.

METHODS: We performed three Plan-Do-Study-Act cycles over a 12-month period: QI interventions included clinic wide education, paper prompts for clinicians, and creation of a database to track ADHD patients. We measured days from the index visit to the follow-up visit, and the mode of both visits (in-person or telemedicine). Data were collected for 6 months pre-intervention and 12 months post-intervention.

RESULTS: Follow-up within 30 days increased from 19% (of 191 visits) to 33% (of 661 visits) (p<0.001). The time to follow-up decreased from 67 to 34 days (p<0.001). Follow up visits by telemedicine were more also more likely to be within 30 days (62% vs. 32%, p<0.001).

DISCUSSION: A QI intervention for ADHD care increased rates of follow-up within 30 days, particularly when telemedicine was used, and decreased the number of days to follow-up. This intervention could serve as a model to improve follow-up for ADHD in other settings.

PMID:33862289 | DOI:10.1016/j.acap.2021.04.004