Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers.
To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation. Retrospective cohort study of electronic health records from all office visits of patients aged...
| Published in: | Academic Pediatrics Vol. 20; no. 3; pp. 384 - 391 |
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| Main Authors: | , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Elsevier B.V.
Apr2020
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142386720&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 142386720 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18762859 8NBK jtl: Academic Pediatrics issn: 18762859 maglogo: N pubinfo: dt: Apr2020 vid: 20 iid: 3 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 142386720 142386720 142386720 10.1016/j.acap.2019.11.016 142386720 ppf: 384 ppct: 7 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers. aug: au: Bannett, Yair Feldman, Heidi M. Bentley, Jason P. Ansel, David A. Wang, C. Jason Huffman, Lynne C. affil: Division of Developmental-Behavioral Pediatrics (Y Bannett, HM Feldman, DA Ansel, and LC Huffman), Stanford University School of Medicine, Stanford, Calif sug: subj: Physicians, Family Attention Deficit Hyperactivity Disorder Prevention and Control Disease Management Pediatricians Practice Patterns Evaluation Human Child, Preschool Child Adolescence California Health Services Research Retrospective Design Prospective Studies Record Review Regression Odds Ratio Confidence Intervals Descriptive Statistics Child, Preschool: 2-5 years Child: 6-12 years Adolescent: 13-18 years ab: To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation. Retrospective cohort study of electronic health records from all office visits of patients aged 4 to 17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary health care network in California. Outcomes per clinician: 1) percent patients seen for ADHD management; (2) percent ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation. Of 40,323 patients in the cohort, 2039 (5.1%) carried an ADHD diagnosis, of which 1142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0% to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (ie, sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high-percent full-time equivalent (odds ratio 1.17; 95% confidence interval 1.07–1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0% to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R = 0.10). Objective electronic health records measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, percent of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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