Kamala Gipson-McElroy, DNP, MSN, CPNP-PC

Abstract:

Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral condition in children. Current guidelines recommend that Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) criteria be used prior to diagnosis of ADHD. However, many providers are still using DSM-IV with the potential for inaccurate diagnosis. The use of a standardized electronic health record (EHR) template for ADHD that will serve as a reminder for providers to use DSM-V criteria. The objective of the project was to compare utilization of the DSM-V EHR evaluation tool with current documentation practice for screening ADHD. The project examined consistencies in ADHD screening documentation and conducted comparisons between different providers: physician (MD), advanced practice registered nurse (APRN), and physician assistant (PA) in relationship to screening for ADHD.

Methods. Pre- and post-intervention design was used to evaluate documentation practices. Ten providers were given education on DSM-V criteria and instructions for screening template use. Providers’ documentation practices were collected at 3 months before DSM-V EHR template implementation (October 1- December 31, 2019) and 2 months after (January 16 – March 1, 2019). Demographic and clinical data of children both pre- and post-implementation were also collected from the EHR. Provider demographics were obtained from a pre-implementation survey. Descriptive statistics and Chi-square were used to characterize variable distributions and t-tests evaluated group comparisons between provider groups.

Results. Provider (5 MDs and 5APRN/PAs) documentation practices were screened for children pre (n=57) and post (n=55) implementation. Children had a mean age of 9 ± 3.7, predominantly males (75%), Hispanic (85%), and all children were covered by public insurance (100%). Some children (20-30%) required referral in both groups for further evaluation by a child psychiatrist. There was no statistical differences pre- and post-intervention related to DSM-V template use in ADHD screening. However, there were statistical differences between provider type with the APRN/PAs screening more frequently using the DSM-V template (n=4) than MDs (n= 0) (p=.009).

Conclusion. Providers did not consistently use the DSM-V EHR template to screen children for ADHD. Future studies are needed to evaluate barriers to using the template, including practice preferences, openness to change, and other factors that may affect use of the EHR template.

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