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Appl Clin Inform 2018; 09(04): 892-904
DOI: 10.1055/s-0038-1676087
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application

Jeremy J. Michel
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Stephanie Mayne
3   Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4   PolicyLab: Center to Bridge Research, Practice, and Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Robert W. Grundmeier
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
James P. Guevara
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
4   PolicyLab: Center to Bridge Research, Practice, and Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Nathan J. Blum
6   Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Thomas J. Power
7   Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Emily Coffin
8   The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Jeffrey M. Miller
2   Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Alexander G. Fiks
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
3   Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding This work was funded through the Patient Centered Outcomes Research Institute (CDR-1408–20669).
Further Information

Publication History

04 September 2018

20 October 2018

Publication Date:
19 December 2018 (online)

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Abstract

Background Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Our institution developed an email-based software to collect ADHD information from parents and teachers, which delivered data directly to the clinician within the electronic health record (EHR).

Objective We sought to adapt our institution's existing EHR-linked system for ADHD symptom monitoring to support communication between parents and teachers and then to assess child characteristics associated with sharing of ADHD information.

Methods We updated our software to support automated sharing of ADHD information between parents and teachers. Sharing was optional for parents but obligatory for teachers. We conducted a retrospective cohort study involving 590 patients at 31 primary care sites to evaluate a system for sharing of ADHD-specific health information between parents and teachers. We used multivariable logistic regression to estimate associations between child characteristics and parental sharing. We further investigated the association between child characteristics and viewing of survey results delivered through the electronic communication system.

Results Most parents (64%) elected to share survey results with teachers at the first opportunity and the vast majority (80%) elected to share all possible information. Parents who elected to share usually continue sharing at subsequent opportunities (89%). Younger child age and performance impairments were associated with increased likelihood of sharing. However, parents viewed only 16% of teacher submitted surveys and teachers only viewed 30% of surveys shared by parents.

Conclusion This study demonstrates that electronic systems to capture ADHD information from parents and teachers can be adapted to support communication between them, and that parents are amenable to sharing ADHD information with teachers. However, strategies are needed to encourage viewing of shared information.

Keywords

attention-deficit/hyperactivity disorder - information dissemination - surveys and questionnaires - communications - other clinical informatics applications

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the CHOP's Institutional Review Board.


 

  • References

  • 1 Sharma A, Couture J. A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother 2014; 48 (02) 209-225
    CrossrefPubMedGoogle Scholar
  • 2 Wolraich M, Brown L, Brown RT. , et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128 (05) 1007-1022
    CrossrefPubMedGoogle Scholar
  • 3 Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014; 43 (02) 434-442
    CrossrefPubMedGoogle Scholar
  • 4 Wolraich ML, Feurer ID, Hannah JN, Baumgaertel A, Pinnock TY. Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV. J Abnorm Child Psychol 1998; 26 (02) 141-152
    CrossrefPubMedGoogle Scholar
  • 5 Murray E, Charles C, Gafni A. Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice. Patient Educ Couns 2006; 62 (02) 205-211
    CrossrefPubMedGoogle Scholar
  • 6 Fiks AG, Mayne S, Debartolo E, Power TJ, Guevara JP. Parental preferences and goals regarding ADHD treatment. Pediatrics 2013; 132 (04) 692-702
    CrossrefPubMedGoogle Scholar
  • 7 Brinkman WB, Hartl Majcher J, Poling LM. , et al. Shared decision-making to improve attention-deficit hyperactivity disorder care. Patient Educ Couns 2013; 93 (01) 95-101
    CrossrefPubMedGoogle Scholar
  • 8 Lyon AR, Whitaker K, French WP, Richardson LP, Wasse JK, McCauley E. Collaborative care in schools: enhancing integration and impact in youth mental health. Adv Sch Ment Health Promot 2016; 9 (3-4): 148-168
    PubMedGoogle Scholar
  • 9 Hoagwood K, Kelleher KJ, Feil M, Comer DM. Treatment services for children with ADHD: a national perspective. J Am Acad Child Adolesc Psychiatry 2000; 39 (02) 198-206
    CrossrefPubMedGoogle Scholar
  • 10 Zwi M, Jones H, Thorgaard C, York A, Dennis JA. Parent training interventions for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2011; (12) CD003018
    PubMedGoogle Scholar
  • 11 DuPaul GJ, Gormley MJ, Laracy SD. School-based interventions for elementary school students with ADHD. Child Adolesc Psychiatr Clin N Am 2014; 23 (04) 687-697
    CrossrefPubMedGoogle Scholar
  • 12 Lange AM, Daley D, Frydenberg M, Rask CU, Sonuga-Barke E, Thomsen PH. The effectiveness of parent training as a treatment for preschool attention-deficit/hyperactivity disorder: study protocol for a randomized controlled, multicenter trial of the New Forest Parenting Program in Everyday Clinical Practice. JMIR Res Protoc 2016; 5 (02) e51
    CrossrefPubMedGoogle Scholar
  • 13 Wagner EH. The role of patient care teams in chronic disease management. BMJ 2000; 320 (7234): 569-572
    CrossrefPubMedGoogle Scholar
  • 14 Bilgrami Z, McLaughlin L, Milanaik R, Adesman A. Health implications of new-age technologies: a systematic review. Minerva Pediatr 2017; 69 (04) 348-367
    PubMedGoogle Scholar
  • 15 Guevara JP, Feudtner C, Romer D. , et al. Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder. Pediatrics 2005; 116 (04) e512-e517
    CrossrefPubMedGoogle Scholar
  • 16 Wolraich ML, Bickman L, Lambert EW, Simmons T, Doffing MA. Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD. J Atten Disord 2005; 9 (01) 354-368
    CrossrefPubMedGoogle Scholar
  • 17 Power TJ, Blum NJ, Guevara JP, Jones HA, Leslie LK. Coordinating mental health care across primary care and schools: ADHD as a case example. Adv Sch Ment Health Promot 2013; 6 (01) 68-80
    PubMedGoogle Scholar
  • 18 Reinke WM, Stormont M, Herman KC, Puri R, Goel N. Supporting children's mental health in schools: teacher perceptions of needs, roles, and barriers. Sch Psychol Q 2011; 26 (01) 1-13
    CrossrefPubMedGoogle Scholar
  • 19 Heuer B, Williams S. Collaboration between PNPs and school nurses: meeting the complex medical and academic needs of the child with ADHD. J Pediatr Health Care 2016; 30 (01) 88-93
    CrossrefPubMedGoogle Scholar
  • 20 Corkum P, Bessey M, McGonnell M, Dorbeck A. Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2015; 7 (01) 49-74
    CrossrefPubMedGoogle Scholar
  • 21 Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 2003; 28 (08) 559-567
    CrossrefPubMedGoogle Scholar
  • 22 Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics 2016; 137 (03) e20152749
    CrossrefPubMedGoogle Scholar
  • 23 Brinkman WB, Epstein JN. Promoting productive interactions between parents and physicians in the treatment of children with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2011; 11 (04) 579-588
    CrossrefPubMedGoogle Scholar
  • 24 Hart CN, Kelleher KJ, Drotar D, Scholle SH. Parent-provider communication and parental satisfaction with care of children with psychosocial problems. Patient Educ Couns 2007; 68 (02) 179-185
    CrossrefPubMedGoogle Scholar
  • 25 Patel A, Medhekar R, Ochoa-Perez M. , et al. Care provision and prescribing practices of physicians treating children and adolescents with ADHD. Psychiatr Serv 2017; 68 (07) 681-688
    CrossrefPubMedGoogle Scholar
  • 26 Power TJ, Michel J, Mayne S. , et al. Coordinating systems of care using health information technology: development of the ADHD care assistant. Adv Sch Ment Health Promot 2016; 9 (3-4): 201-218
    PubMedGoogle Scholar
  • 27 Fiks AG, Grundmeier RW, Biggs LM, Localio AR, Alessandrini EA. Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics 2007; 120 (04) 707-714
    CrossrefPubMedGoogle Scholar
  • 28 Fiks AG, Zhang P, Localio AR. , et al. Adoption of electronic medical record-based decision support for otitis media in children. Health Serv Res 2015; 50 (02) 489-513
    CrossrefPubMedGoogle Scholar
  • 29 Tham E, Swietlik M, Deakyne S. , et al; Pediatric Emergency Care Applied Research Network (PECARN). Clinical decision support for a multicenter trial of pediatric head trauma: development, implementation, and lessons learned. Appl Clin Inform 2016; 7 (02) 534-542
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Michel J, Utidjian LH, Karavite D. , et al. Rapid adjustment of clinical decision support in response to updated recommendations for palivizumab eligibility. Appl Clin Inform 2017; 8 (02) 581-592
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Fiks AG, Mayne S, Karavite DJ, DeBartolo E, Grundmeier RW. A shared e-decision support portal for pediatric asthma. J Ambul Care Manage 2014; 37 (02) 120-126
    CrossrefPubMedGoogle Scholar
  • 32 Fiks AG, Mayne SL, Karavite DJ. , et al. Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics 2015; 135 (04) e965-e973
    CrossrefPubMedGoogle Scholar
  • 33 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Simon JO. The myADHDportal.com Improvement Program: an innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol 2013; 1 (01) 55-67
    PubMedGoogle Scholar
  • 34 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics 2011; 128 (05) e1201-e1208
    CrossrefPubMedGoogle Scholar
  • 35 Epstein JN, Kelleher KJ, Baum R. , et al. Impact of a web-portal intervention on community ADHD care and outcomes. Pediatrics 2016; 138 (02) e20154240
    CrossrefPubMedGoogle Scholar
  • 36 Baum RA, Epstein JN, Kelleher K. Healthcare reform, quality, and technology: ADHD as a case study. Curr Psychiatry Rep 2013; 15 (07) 369
    CrossrefPubMedGoogle Scholar
  • 37 Fiks AG, Mayne SL, Michel JJ. , et al. Distance-learning, ADHD quality improvement in primary care: a cluster-randomized trial. J Dev Behav Pediatr 2017; 38 (08) 573-583
    CrossrefPubMedGoogle Scholar
  • 38 Fiks AG, Mayne S, Hughes CC. , et al. Development of an instrument to measure parents' preferences and goals for the treatment of attention deficit-hyperactivity disorder. Acad Pediatr 2012; 12 (05) 445-455
    CrossrefPubMedGoogle Scholar
  • 39 Cisco Registered Envelope Service. San Jose, CA: Cisco Systems, INC.; 2017
  • 40 Schatz NK, Fabiano GA, Cunningham CE. , et al. Systematic review of patients' and parents' preferences for ADHD treatment options and processes of care. Patient 2015; 8 (06) 483-497
    CrossrefPubMedGoogle Scholar
  • 41 Eiraldi RB, Mazzuca LB, Clarke AT, Power TJ. Service utilization among ethnic minority children with ADHD: a model of help-seeking behavior. Adm Policy Ment Health 2006; 33 (05) 607-622
    CrossrefPubMedGoogle Scholar
  • 42 Bussing R, Zima BT, Gary FA, Garvan CW. Barriers to detection, help-seeking, and service use for children with ADHD symptoms. J Behav Health Serv Res 2003; 30 (02) 176-189
    CrossrefPubMedGoogle Scholar
  • 43 Child Trends. Parental involvement in schools; 2013. Available at: https://www.childtrends.org/?indicators=parental-involvement-in-schools . Accessed November 29, 2018
    PubMed
  • 44 Hill N, Taylor L. Parental school involvement and children's academic achievement: pragmatics and issues. Curr Dir Psychol Sci 2004; 13 (04) 161-164
    CrossrefPubMedGoogle Scholar
  • 45 Gardner B, Phillips LA, Judah G. Habitual instigation and habitual execution: definition, measurement, and effects on behaviour frequency. Br J Health Psychol 2016; 21 (03) 613-630
    CrossrefPubMedGoogle Scholar
  • 46 Schomaker J, Meeter M. Short- and long-lasting consequences of novelty, deviance and surprise on brain and cognition. Neurosci Biobehav Rev 2015; 55: 268-279
    CrossrefPubMedGoogle Scholar
  • 47 Kwahk K-Y, Ahn H, Ryu YU. Understanding mandatory IS use behavior: how outcome expectations affect conative IS use. Int J Inf Manage 2018; 38 (01) 64-76
    CrossrefPubMedGoogle Scholar
  • 48 Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010; 10 (01) 113
    CrossrefPubMedGoogle Scholar
  • 49 Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems?. Med J Aust 2007; 187 (7, Suppl): S35-S39
    PubMedGoogle Scholar
  • 50 Tao D, Xie L, Wang T, Wang T. A meta-analysis of the use of electronic reminders for patient adherence to medication in chronic disease care. J Telemed Telecare 2015; 21 (01) 3-13
    CrossrefPubMedGoogle Scholar
  • 51 Coleman MT, Pasternak RH. Effective strategies for behavior change. Prim Care 2012; 39 (02) 281-305
    CrossrefPubMedGoogle Scholar