Playing by the Rules : Integrated Care's Impact on Quality of ADHD Management

1. Session F1b October 17th, 2014 Playing by the Rules: Integrated Care'sImpact on Quality of ADHD Management Tawnya Meadows, Ph.D., BCBA-D Shelley J. Hosterman, Ph.D Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

2. Faculty Disclosure • We have not had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Identify simple data collection procedures to measure outcomes on standards of care outcomes. • Compare ADHD outcomes in three domains between Integrated versus comparison sites. • Identify procedures implemented to impact standards of care adherence. • Discuss other pediatric standards of care in which behavioral health care can impact patient experience and outcomes.

4. Bibliography / Reference • American Academy of Pediatrics [AAP], 2000, 2001, 2011 • Epstein, J. N., Langberg, J. M., Lichtenstein, P., Kolb, R., & Stark, L. (2010). Sustained Improvement in Pediatricians' ADHD Practice Behaviors in the Context of a Community-Based Quality Improvement Initiative. Children’s Health Care. Association for the Care of Children's Health, 39: 296-311. • Sheldrick, R. C., Leslie, L. K., Rodday, A. M., Parsons, S. K., Saunders, T. S., & Wong, J. B. (2012). Variations in Physician Attitudes Regarding ADHD and Their Association With Prescribing Practices. Journal of Attention Disorder. DOI: 10.1177/1087054712461689. • Wolraich, M. L. (2012). The new attention deficit hyperactivity disorder clinical practice guidelines published by the American Academy of Pediatrics. Journal of developmental and behavioral pediatrics, 33(1):76-7. • Fothergill, K.E., Gadomski, A., Solomon, B.S., Olson, A.L., Gaffney, C.A., dosReis, S., & Wissow, L.S. (2013). Assessing the Impact of a Web-Based Comprehensive Somatic and Mental Health Screening Tool in Pediatric Primary Care. Academic Pediatrics, 13 (4), 340–347.

5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

6. Introduction

7. Assessment and treatment of ADHD • Greatly consumes PCP’s clinical attention and resources • 15% of pediatric PC practice consists of BX disorders (ADHD most frequent). • 75% of ADHD patients are seen in PC, but only 2% see BH specialists • One-third to half of pediatric BH referrals are for ADHD • At 3-10% of school-aged children, ADHD is the most common childhood BH diagnosis • PCPs complete 1-2 new ADHD evaluations/month & most spend 15-45 minutes at at least 2 visits to reach diagnosis5

8. AAP Guidelines • Initiate evaluation when a child presents with ADHD-like symptoms • Document that child meets DSM-IV criteria • Obtain evidence from parents regarding core symptoms across settings, age of onset, duration of symptoms, and degree of impairment • Retrieve information from teachers or school personnel • Assess for coexisting conditions |

9. Multiple Barriers • Less than 25% of physicians are familiar with & implement AAP guidelines in their practice • Lack of training • Limited time • Difficult to coordinate information with school/teachers |

10. Possible Solution: PCBH • Behavioral health specialists located within a pediatrician’s office can assist with meeting practice guidelines. • High customer satisfaction • Low dropout rates • Increased cost effectiveness • Support adherence to standards of care • Assist in monitoring of treatment & providing behavioral support |

11. Methods

12. Methods: • Physician surveys: • 6-17 IPC & 24-54 control PCPs • Reported on use of screening tools & comfort in diagnosing ADHD • Chart Review: • Key variables in PCP & IPC BH provider documentation within EHR • Onset, diagnosis, medication, use of rating scales, family hx, comprehensive physical & neurological exam, use of BH services |

13. Intervention • REACH training • Psychologists on site • Increased availability of rating forms • Change of ADHD template |

14. Results

15. Survey Results: Screening Instrument Use • PCPs in IPC clinics report significantly higher use of BH screening instruments compared to PCPs in control clinics (p< .01)

16. Survey Results: PCP Comfort Diagnosing • IPC PCPs report increased comfort in dx (*p< .01) |

17. Survey Results: Comfort in Managing • IPC PCPs reported increased comfort in managing ADHD at year one (p< .01) |

18. Survey Results: PCP Knowledge • IPC PCPs reported increased knowledge of common psychotropic medications and treatment post integration(p< .01) |

19. Chart Review: Demographics |

20. Chart Review: Assessment Adherence |

21. Chart Review: PCP Treatment Adherence |

22. | • Conclusions/Implications

23. Implications • All providers were not equal in documentation of standards of care.

24. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!