PCORI-Funded Project Will Assess ADHD Portal


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With the support of a recent $2.1 million award from the Patient-Centered Outcomes Research Institute (PCORI), The Children’s Hospital of Philadelphia’s James Guevara, MD, MPH, will study the comparative effectiveness of an electronic portal vis-à-vis in-person communication for attention-deficit/hyperactivity disorder (ADHD). Set to be conducted in 15 primary care facilities across Children’s Hospital’s care network, the study will inform ongoing efforts to further involve families’ preferences and goals in ADHD care.

Established by 2010’s Affordable Care Act, PCORI funds comparative effectiveness research, with an eye toward improving “the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers make informed health decisions,” per the PCORI website.

Through September 2014, the Institute has awarded $671 million to support 360 projects in 39 states, according to its 2014 financial report. Dr. Guevara’s award is one of more than 125 — including another to Richard Aplenc, MD, PhD — awarded so far in 2015.

In addition to acting as an attending physician at Children’s Hospital, Dr. Guevara is also an associate professor of Pediatrics and Epidemiology at the University of Pennsylvania’s Perelman School of Medicine, and a founding member of PolicyLab, one of CHOP Research’s Centers of Emphasis. Much of Dr. Guevara’s work has been focused on “improving the delivery of healthcare in primary care settings, reducing health disparities, and translating research findings into practice and policy,” per PolicyLab’s site.

One area of this work has focused on assessing how shared decision-making (SDM) — in which families and clinicians make choices together — can improve outcomes for ADHD patients. A co-investigator on the PCORI project, Alexander G. Fiks, MD, MSCE, has been developing the electronic ADHD portal that will be used to facilitate electronic communication.

As part of this investigation, in 2013 Drs. Guevara, Fiks, and colleagues published a study in Pediatrics that examined parental preferences in ADHD treatment. They found parents’ preferences were associated with treatment initiation. Moreover, the results “suggest that assessing parents’ preferences and goals … is useful for clinicians in understanding which treatment, if any, parents are likely to initiate for their children,” the authors write.

Supported by this new three-year award from PCORI, with his current study Dr. Guevara plans to assess the effectiveness of the ADHD portal versus the ADHD portal in combination with a care manager in communicating patients’ and families’ treatment goals. The researchers hope to enroll roughly 300 children between the ages of 5 to 12 years, who will be randomized to one of the two groups. Parents will complete ADHD outcome measures at 0, 3, 6, and 9 months.

Dr. Guevara and colleagues also plan on using feedback to improve the study. The will ask various stakeholders — including clinicians, as well as parents and teachers of children with ADHD — to advise the research team on study questions, the investigation’s design, and how the results are disseminated.

“Findings from this study,” Dr. Guevara notes, “will inform the use of communication strategies to share family preferences and goals among parents, teachers, and clinicians of children with ADHD.”

To read more about PolicyLab’s work on communications strategies and provider-patient relationships, see the Center’s website.

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