Healthcare Reform, Quality, and Technology: ADHD as a Case Study

Abstract

The concepts of healthcare reform and population health are shifting the emphasis from traditional, volume-based care to a model in which value, or quality, predominates. High quality care will be increasingly rewarded, with financial consequences for poor performance. This shift will be accelerated by the use of healthcare technology, a rapidly growing industry with tools ranging from electronic health records to smart phones and web portals. In this article we highlight pertinent legislative reforms followed by a review of technologies that may play a role in the implementation of these reforms. Pediatric Attention Deficit Hyperactivity Disorder is used as an example given the large number of proposed tools for this condition. While the evidence base is weak for some technologies, research regarding web portals is better developed and will be presented as an example of a technology that may allow practitioners and organizations to improve healthcare quality in several dimensions.

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

“…If telehealth is to be integrated into mainstream mental health practice for families of children with ADHD, interventions with demonstrated efficacy when conducted in person will need to be replicated using telehealth technologies (Baum, Epstein, & Kelleher, 2013). …”

Comparison of Performance on ADHD Quality of Care Indicators: Practitioner Self-Report Versus Chart Review

“…Electronic Health Records (EHRs) hold promise but pose particular difficulties with regard to obtaining teacher information, as most EHRs are unable to effectively process information from external sources. Moreover, extracting data from EHRs has proven to be difficult in practice, as it can still be time-intensive and is “dependent on the resources of the organization to pull and analyze the data” (Baum, Epstein, & Kelleher, 2013, p. 371). Finally, quality measures calculated from data extracted from EHRs by computers often correlate poorly with measures calculated from data extracted by human chart reviewers (Gardner et al, 2014).…”

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

“…Various programmes to improve quality of healthcare for this vulnerable group have taken place in many countries around the world (Baum et al . ; Salvador‐Carulla et al . ).…”

“…This increased the complexity of care, as we observed lengthy hospital stay, excessive use of diagnostic intervention and high likelihood of being transferred in PwNDD at the end of acute care for ADEs. Various programmes to improve quality of healthcare for this vulnerable group have taken place in many countries around the world (Baum et al 2013;Salvador-Carulla et al 2015). However, most of these programmes encourage PwNDD to use mainstream healthcare services with little effort to tailor service provisions to meet their complex needs (Schrevel 2015;Hepsi & Pike 2016).…”