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Diseases. 2019 Feb 7;7(1). pii: E20. doi: 10.3390/diseases7010020.

Timely Interventions for Children with ADHD through Web-Based Monitoring Algorithms.

Author information

1
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. julia.oppenheimer@umassmed.edu.
2
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. william.femi@gmail.com.
3
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. annalee.antonetty@childrens.harvard.edu.
4
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. madeline.chiujdea@childrens.harvard.edu.
5
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. sgarcia7@pride.hofstra.edu.
6
Division of Developmental Medicine, Boston Children's Hospital, Boston, MA 02115, USA. sarah.weas@childrens.harvard.edu.
7
Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA. tobias.loddenkemper@childrens.harvard.edu.
8
Harvard Medical School, Boston, MA 02115, USA. tobias.loddenkemper@childrens.harvard.edu.
9
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA. eric.fleegler@childrens.harvard.edu.
10
Harvard Medical School, Boston, MA 02115, USA. eric.fleegler@childrens.harvard.edu.
11
Division of Developmental Medicine, Boston Children's Hospital, Boston, MA 02115, USA. eugenia.chan@childrens.harvard.edu.
12
Harvard Medical School, Boston, MA 02115, USA. eugenia.chan@childrens.harvard.edu.

Abstract

The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians' alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts. A total of 146 out of 1738 parent reports (8%) triggered alerts for 98 patients. One hundred and eleven alerts (76%) required immediate clinician review. Nurses successfully contacted parents for 68 (61%) of actionable alerts; 46% (31/68) led to a change in care plan prior to the next scheduled appointment. Compared to patients without alerts, patients with alerts demonstrated worsened ADHD severity (β = 5.8, 95% CI: 3.5⁻8.1 [p < 0.001] within 90 days prior to an alert. The trigger algorithm facilitated timely changes in the care plan in between face-to-face visits.

KEYWORDS:

ADHD; Vanderbilt rating scale; alerts; algorithm; care plan; parent reports; trigger

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