A Quality Improvement Initiative to Improve ADHD Follow-up rates Using School-based Telemedicine.

A Quality Improvement Initiative to Improve Attention-Deficit/Hyperactivity Disorder Follow-up rates Using School-based Telemedicine.

Wenderlich AM, Li R, Baldwin CD, Contento N, Herendeen N, Rand CM.

 Acad Pediatr. 2021 Apr 13:S1876-2859(21)00218-7.
doi: 10.1016/j.acap.2021.04.004.

Commentary* by Dr. Margaret Weiss: Telehealth has meant almost no no-shows, patients don’t have to take off work, commute or pay for parking, kids don’t have to miss school (they can be engaged on their school laptop email and they just leave class for a few minutes). All this has led to a significant increase in access to care.



Objective: Patients with a new diagnosis of attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication need regular follow-up. Guidelines recommend follow-up within 30 days of stimulant initiation or change but this goal is seldom achieved. This quality improvement (QI) study in an urban academic outpatient practice aimed to: 1) assess whether use of school-based telemedicine increases rates of follow-up within 30 days and decreases the number of days to follow-up for ADHD, and 2) compare rates of 30-day follow-up via in-person vs telemedicine visits.

Methods: We performed three Plan-Do-Study-Act cycles over a 12-month period: QI interventions included clinic wide education, paper prompts for clinicians, and creation of a database to track ADHD patients. We measured days from the index visit to the follow-up visit, and the mode of both visits (in-person or telemedicine). Data were collected for 6 months pre-intervention and 12 months post-intervention.

Results: Follow-up within 30 days increased from 19% (of 191 visits) to 33% (of 661 visits) (p<0.001). The time to follow-up decreased from 67 to 34 days (p<0.001). Follow up visits by telemedicine were more also more likely to be within 30 days (62% vs. 32%, p<0.001).

Discussion: A QI intervention for ADHD care increased rates of follow-up within 30 days, particularly when telemedicine was used, and decreased the number of days to follow-up. This intervention could serve as a model to improve follow-up for ADHD in other settings.


* Abstracts are selected for their clinical relevance by Dr. Margaret Weiss, Director of Clinical Research, Child Psychiatry, Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion.  It is not approved or necessarily representative of the CADDRA board.


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