Improving Diagnosis and Management of ADHD Team Lead Call #3 Diane Liu, MD Assistant Professor, Pediatrics Co-Director, UPIQ

Welcome Practice Teams! Families First Pediatrics Intermountain Moroni Clinic Mountain West Pediatrics Ogden Clinic Southwest Children’s Clinic South Jordan Health Clinic Utah Valley Pediatrics- Provo North University Pediatrics Clinic Wasatch Pediatrics – Draper Please note the number next to your practice as the label for the graphs to follow. In the future the graphs will be labeled by your practice’s name

Agenda Mute responsibly . Project update: review practice aggregate February data Please submit your data – QI coaches available for support

Percentage of encounters for initial diagnosis and follow-up for ADHD where there is documentation of the screening tool in 2 settings documented in the chart

Discussion Ideas for receipt of completed Vanderbilt tools from teachers Informed consent for the school from the parent Release of information for the practice from the parent Challenges or barriers Unknown school personnel Communication between practice and school teacher directly vs. via parents Current processes

Percentage of encounters for Initial Diagnosis where there is documentation of DSM-V criteria and Co-Existing Conditions

Percentage of encounters for Initial Diagnosis and ADHD follow-up where there is documentation of medication follow-up within the recommended time of 30-45 days for new Rx and 6 months for maintenance Rx

Optional Measures: Follow-up documentation and ADHD Registry

ADD/ADHD (DSM V Criteria): (SOUTH JORDAN’S xfile FOR INITIAL DX) (available on QITS)   A. Inattention Questions (6 or more x 6 months if under 17 yrs. of age. 5 or more x 6 months if over 17 yrs.): -Fails to give close attention to details or makes careless mistakes?:  *** -Difficulty sustaining attention in tasks or play activities?:  *** -Does not listen when spoken to directly?:  *** -Does not follow through on instructions or fails to finish schoolwork/work duties?:  *** -Has difficulties organizing tasks or activities?:  *** -Avoids tasks that require sustained mental effort (ex. homework)?:  *** -Frequently loses things?:  *** -Is easily distracted by external stimuli?:  *** -Is forgetful in daily activities?:  *** B. Hyperactivity Questions (6 or more x 6 months if under 17 yrs. of age.  5 of more x 6 months if over 17 yrs.): -Fidgets with hands or feet, or squirms in seat?:  *** -Often leaves seat in classroom or in other situations in which remaining seated is expected?:  *** -Often runs or climbs excessively or inappropriately (feelings of restlessness in adults)?:  *** -Often has difficulty playing or engaging in leisure activities quietly?:  *** -Is often on the go as if driven by a motor?:   *** -Often talks excessively (impulsivity)?:  *** -Often blurts out answers before questions have been completed?:  *** -Often has difficulty awaiting turn?:  *** -Often interrupts or intrudes on others (butts into conversations or games)?:  *** C. Symptoms before the age of twelve?:  *** D. Impairment in 2 or more settings? (work, school, home, etc.):  *** E. Clinically significant impairment in social, academic or occupational functioning?:  ***

ADD/ADHD Follow-Up: (SOUTH JORDAN’S xfile FOR PEDS FOLLOW-UP) available on QI TS History of Present Illness: -ADD or ADHD?: *** -Conduct at school acceptable? *** -Conduct at home acceptable? *** -Peer relations acceptable? *** -Ability to concentrate acceptable? *** -Current medication for ADD/ADHD: *** -Daily medication schedule: *** -Specific concerns: *** -How are grades at school? *** Targeted Review of Systems: -Insomnia? *** -Loss of appetite? *** -Palpitations? *** -Weight loss? *** -Headache or vision changes? ***

Discussion Successes? Challenges? Feedback from parents or patients?

Reminders Next ADHD Webinar is Tuesday, April 19th 12:15pm Malinda Horton, CPNP, Primary Children’s Hospital Integrative Medicine Clinic Complementary Medicine Highlights March Data due by April 15th