CClinicalTrials.gg
CompletedNCT02716324ADHD-LinkUpdated Nov 25, 2019Results posted

Communication to Improve Shared Decision-Making in ADHD

An interventional study of Care Manager CM) and ADHD Portal in Attention-Deficit/Hyperactivity Disorder, sponsored by Children's Hospital of Philadelphia. Completed at 1 site in United States. Open to participants aged 5 Years to 12 Years. Per ClinicalTrials.gov, last updated 2019-11-25.

Sponsored by Children's Hospital of Philadelphia · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
303
Allocation
Randomized
Ages
5 Years to 12 Years
Sex
All
01

Study summary

The purpose of this study was to explore whether using an online patient portal plus a Care Manager is more effective than using an online portal alone in managing care for children with ADHD. Doctors at The Children's Hospital of Philadelphia currently use the online patient portal to help gather information from parents and teachers on ADHD symptoms, treatment, and medication side effects. The Care Manager is a person who meets with participants during the study to discuss their child's ADHD care. The Care Manager communicates with the child's doctor and teacher to communicate a parent's goals and preferences for their child's ADHD care.

Read the detailed description

Fragmentation in health care and poor communication across systems adversely impact engagement and adherence to treatment by children with ADHD and their families. Fragmentation of services for ADHD impairs communication and collaboration between families and primary care providers, mental health providers, and educators, and leads to suboptimal outcomes for children. Prior studies have documented that little communication and coordination exist among providers across different systems despite calls for better system integration.

Fragmentation in communication between providers has the potential to impair shared decision-making. To promote shared decision-making, we developed an electronic health record (EHR)-linked portal to collect information from parents, teachers and clinicians on children's ADHD symptoms and treatment-related preferences and goals. This has become standard of care at our institution. We also developed and pilot tested a ADHD Care Manager intervention which will be employed in this comparative effectiveness study.

303 participants were recruited from 11 primary care pediatric practices. Participants were randomly assigned to either the EHR portal alone, or the EHR portal plus a Care Manager. For those assigned to the EHR portal plus Care Manager, the Care Manager met with families at the beginning of the study to confirm their treatment preferences and goals, provide additional education on ADHD treatment, and distribute handouts on common concerns among ADHD patients and families. The Care Manager contacted families every 3 months or more frequently if needed by phone, email, or in-person to assess treatment use, identify new concerns, and assist families with problem-solving. The Care Manager also communicated with primary care clinicians, mental health providers, and teachers to clarify family treatment preferences and goals and address emerging treatment issues. Participants completed surveys that assessed ADHD symptoms, goal attainment, patient-reported outcomes, patient and family engagement, and treatment initiation and adherence.

02

Conditions studied

  • Attention-Deficit/Hyperactivity Disorder

Keywords

  • Attention-Deficit/Hyperactivity Disorder
  • Shared-Decision Making
  • Care Manager
  • Children
  • Parents
  • Teachers
03

In context

Hyperkinesis

729 studies on the registry are indexed under Hyperkinesis; 25 are open to participants now.

This study's enrollment of 303 is above the median of 80 across 583 interventional studies indexed under Hyperkinesis.

Browse Hyperkinesis studies →

Lead sponsor

Children's Hospital of Philadelphia is the lead sponsor of 480 studies on the registry; 85 are open to participants now.

Of its 28 completed or terminated interventional studies of FDA-regulated products, 22 (79%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
5 Years to 12 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Aged 5 through12 years old
  • Receiving Attention-Deficit/Hyperactivity Disorder (ADHD) treatment from participating practices
  • ADHD or Attention Deficit Disorder (ADD) diagnosis code, International Classification of Diseases (ICD) code ICD-10-CM F90.9 or F90.0, listed in the problem list or recorded at an ambulatory visit in the past year.
  • Parental/guardian permission (informed consent) and if appropriate, child assent.

Exclusion criteria

Exclusion Criteria:

  • Autism spectrum disorder, ICD-10-CM F84.0
  • Conduct disorder, ICD-10-CM F91.1
  • Psychosis, ICD-10-CM F29
  • Bipolar disorder, ICD-10-CM F31.9
  • Suicide attempt, ICD-10-CM T14.91, or suicide ideation, ICD-10-CM R45.85
  • Children and/or their parents/caregivers non-English speaking
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
303 participants (actual)

Study arms

  • Active comparator
    ADHD Portal

    In this arm, the ADHD Portal was used alone as an electronic communication tool.The ADHD portal is considered standard of care at our institution for communicating information between clinicians, teachers, and parents.

    Other: ADHD Portal

  • Experimental
    ADHD Portal plus Care Manager (CM)

    In this arm, the ADHD Portal was combined with the CM. Clinicians, teachers, and parents used the ADHD Portal as standard of care. In addition, clinicians, teachers, parents, and any external mental health providers interacted with a CM, who had access to information contained in the ADHD Portal.

    Behavioral: Care Manager CM) · Other: ADHD Portal

Interventions

  • BehavioralCare Manager CM)

    The CM was an individual responsible for communicating and coordinating ADHD care. The CM established rapport with families and communicated with them every 3 months or more frequently if needed to assess treatment use, identify new concerns, and help problem-solve. The CM also communicated with the patient's ADHD care team (pediatrician, teacher, mental health providers) to clarify family goals, communicate information, and coordinate treatment.

  • OtherADHD Portal

    The ADHD portal was a web-based platform that permits access to parts of the hospital's electronic health record. The portal permits (1) capture and sharing of patient and family treatment preferences and goals, (2) monitoring of ADHD symptoms, treatment receipt, and side effects, and (3) assessing goal attainment. The system prompts for completion of periodic check-in surveys (bi-weekly to 3 months) with parents and teachers. Within the portal, preferences and goals for ADHD treatment were measured using the ADHD Preference Goal Instrument (PGI) (Fiks et al., 2012). Parents were encouraged to consult with their children when completing the tool.

06

What researchers measure

Primary outcomes

  1. Change in Vanderbilt Parent Rating Scales (VPRS)

    The VPRS is a public domain tool that consists of forms completed by the child's parent and includes 18 items corresponding to the DSM-5 ADHD symptom criteria, 8 performance items, and 12 items assessing side effects. The VPRS items are scaled on a 4-point Likert rating ("never" to "very often"), and the scales used in this study were restricted to the 18 ADHD symptom items. Total scores were used to measure ADHD Symptoms. Higher scores indicated worse outcome. VPRS were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value. The VPRS measures ADHD symptoms and is scaled on a 4-point Likert rating ("never" to "very often"). The scale includes 18 ADHD symptom items with total scores ranges from 0-54.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

Secondary outcomes

  1. Mean Goal Attainment Scale (GAS) Score by Timepoint

    The GAS is a 5-point likert scale that assesses the degree to which parents' goals (obtained from the ADHD Preferences and Goals Instrument) are attained from none to completely. The GAS response categories are ordered from 0 ("no change") to 6 ("goal completely met"). Higher scores indicate greater goal attainment. The GAS was measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  2. Treatment Initiation and Use of Services

    Using responses from the Services Assessment for Children and Adolescents (SACA), a well-validated client-reported tool and provides information on any mental health services use, ambulatory services use, and inpatient service use, we determined (yes/no) whether participants ever received educational services, mental health services, or medications for ADHD. Parents reported whether their children used services ever or within the last nine months. Treatment initiation was measured by use of services ever. Categorizations include any service use, ambulatory service use (any community mental health or outpatient clinic, private professional, or in-home provider), and overnight stay (psychiatric or medical unit, residential treatment center, group home, or foster home). The time range of 9-12 given for Visit 4 reflects the time range counted as a single value.

    Time frame: 9-12 months (Visit 4)

  3. Treatment Adherence and Use of Services

    Using responses from the Services Assessment for Children and Adolescents (SACA), a well-validated client-reported tool and provides information on any mental health services use, ambulatory services use, and inpatient service use, we determined (yes/no) whether participants ever received educational services, mental health services, or medications for ADHD. Parents reported whether their children used services ever or within the last nine months. Treatment adherence was measured by use of services in the past nine months. Categorizations include any service use, ambulatory service use (any community mental health or outpatient clinic, private professional, or in-home provider), and overnight stay (psychiatric or medical unit, residential treatment center, group home, or foster home). The time range of 9-12 given for Visit 4 reflects the time range counted as a single value.

    Time frame: 9-12 months (Visit 4)

  4. School Performance

    School Performance is a 5-item domain (minimum score=1, maximum score=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the School Performance domain is 5 and the maximum total score is 25 (total scores are not shown below). Values in the table below are reported as mean scores at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. School performance PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  5. Student Engagement

    Student Engagement is a 4-item domain (minimum score=1, maximum score=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the Student Engagement domain is 4 and the maximum total score is 20 (total scores are not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Student Engagement PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  6. Teacher Connectedness

    Teacher Connectedness is a 9-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the Teacher Connectedness domain is 9 and the maximum total score is 45 (total scores not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Teacher Connectedness PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  7. Peer Relationships

    Peer Relationships is a 6-item domain (minimum=1, maximum=5, on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and a 7-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score is 6 and the maximum total score is 30 on the Child PROs. The minimum total score for the Peer Relationships domain is 7 and the maximum total score is 35 on the Parent PROs. Total scores not shown below. Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Higher scores indicate better outcomes. Peer Relationships PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  8. Family Relationships

    Family Relationships is a 6-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the 30-item Child- (age 8-12) Patient Reported Outcomes Measures of relationships with other family members over the past 4 weeks. The minimum total score for the Family Relationships domain is 6 and the maximum total score is 30 (total scores not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Child-reported PRO measures were averaged for each domain for each time point. Higher scores indicate better outcomes. Family Relationships PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)

  9. Engagement Measure Scores

    The Engagement Measure is a 28-item parent self-report measure comprised of four domains: Access (5-items, total score range 5-25), Patient Family Centered Care or PFCC (6-items, total score range 6-30), Communication (3-items, total score range 3-15), and Understanding (5-items, total score range 5-25). Total scores are not reported below. Scores for each individual item and therefore the mean for each domain (means reported in the table below) ranged from 1-5 with higher scores indicating greater engagement. The time range given for Visit 4 reflects the time range counted as a single value.

    Time frame: Visit 4 (9-12 months)

07

Results

Posted Sep 27, 2019
Limitations and caveats
Study was conducted within a single integrated health care system in the Philadelphia metropolitan area and results may not be generalizable to other health systems or geographic areas.

Participant flow

From 3/2016-7/2017, primary care clinicians at participating pediatric practices nominated eligible patients for recruitment. Eligible patients were contacted by phone and then underwent in-person informed consent. Participants were stratified by practice, age group (5-7 or 8-12 years old), and sex and randomized 1:1 to the two study arms.

Participant flow — Overall Study
MilestoneADHD PortalADHD Portal Plus Care Manager
Started149154
Completed130143
Not completed1911

Outcome measures

PrimaryChange in Vanderbilt Parent Rating Scales (VPRS)

The VPRS is a public domain tool that consists of forms completed by the child's parent and includes 18 items corresponding to the DSM-5 ADHD symptom criteria, 8 performance items, and 12 items assessing side effects. The VPRS items are scaled on a 4-point Likert rating ("never" to "very often"), and the scales used in this study were restricted to the 18 ADHD symptom items. Total scores were used to measure ADHD Symptoms. Higher scores indicated worse outcome. VPRS were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value. The VPRS measures ADHD symptoms and is scaled on a 4-point Likert rating ("never" to "very often"). The scale includes 18 ADHD symptom items with total scores ranges from 0-54.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · score on a scale
Change in Vanderbilt Parent Rating Scales (VPRS)
score on a scaleADHD PortalADHD Portal Plus Care Manager
Visit 132.6 ± 11.831.3 ± 10.8
Visit 228.7 ± 12.229.0 ± 11.4
Visit 328.1 ± 12.126.3 ± 11.6
Visit 427.2 ± 12.125.7 ± 11.1
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · GLS random-effects model · p = .871 · Beta coefficient: 0.001 · 95% CI -0.010 to 0.012
SecondaryMean Goal Attainment Scale (GAS) Score by Timepoint

The GAS is a 5-point likert scale that assesses the degree to which parents' goals (obtained from the ADHD Preferences and Goals Instrument) are attained from none to completely. The GAS response categories are ordered from 0 ("no change") to 6 ("goal completely met"). Higher scores indicate greater goal attainment. The GAS was measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Units on a scale
Mean Goal Attainment Scale (GAS) Score by Timepoint
Units on a scaleADHD PortalADHD Portal Plus Care Manager
Visit 22.92 ± 1.822.67 ± 1.68
Visit 32.93 ± 1.893.01 ± 1.68
Visit 43.03 ± 1.662.86 ± 1.75
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.499 · Beta coefficient: 0.001 · 95% CI -0.002 to 0.004
SecondaryTreatment Initiation and Use of Services

Using responses from the Services Assessment for Children and Adolescents (SACA), a well-validated client-reported tool and provides information on any mental health services use, ambulatory services use, and inpatient service use, we determined (yes/no) whether participants ever received educational services, mental health services, or medications for ADHD. Parents reported whether their children used services ever or within the last nine months. Treatment initiation was measured by use of services ever. Categorizations include any service use, ambulatory service use (any community mental health or outpatient clinic, private professional, or in-home provider), and overnight stay (psychiatric or medical unit, residential treatment center, group home, or foster home). The time range of 9-12 given for Visit 4 reflects the time range counted as a single value.

Time frame:
9-12 months (Visit 4)
Reported as:
Count of participants · Participants
Treatment Initiation and Use of Services
ParticipantsADHD PortalADHD Portal Plus Care Manager
Use of any services (Ever) : Yes — Yes7988
Use of any services (Ever) : Yes — No4049
Use of ambulatory services (Ever) : Yes — Yes7787
Use of ambulatory services (Ever) : Yes — No4249
Overnight Stay for Services (Ever) : Yes — Yes56
Overnight Stay for Services (Ever) : Yes — No92118
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 0.718
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 0.903
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 0.915
SecondaryTreatment Adherence and Use of Services

Using responses from the Services Assessment for Children and Adolescents (SACA), a well-validated client-reported tool and provides information on any mental health services use, ambulatory services use, and inpatient service use, we determined (yes/no) whether participants ever received educational services, mental health services, or medications for ADHD. Parents reported whether their children used services ever or within the last nine months. Treatment adherence was measured by use of services in the past nine months. Categorizations include any service use, ambulatory service use (any community mental health or outpatient clinic, private professional, or in-home provider), and overnight stay (psychiatric or medical unit, residential treatment center, group home, or foster home). The time range of 9-12 given for Visit 4 reflects the time range counted as a single value.

Time frame:
9-12 months (Visit 4)
Reported as:
Count of participants · Participants
Treatment Adherence and Use of Services
ParticipantsADHD PortalADHD Portal Plus Care Manager
Use of any service (Past 9 months) — Yes4851
Use of any service (Past 9 months) — No1929
Use of ambulatory services (Past 9 months) — Yes4750
Use of ambulatory services (Past 9 months) — No1829
Overnight Stay for Services (Ever) — Yes12
Overnight Stay for Services (Ever) — No34
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 0.310
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 0.251
  • ADHD Portal vs ADHD Portal Plus Care Manager · Chi-squared · p = 1.00
SecondarySchool Performance

School Performance is a 5-item domain (minimum score=1, maximum score=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the School Performance domain is 5 and the maximum total score is 25 (total scores are not shown below). Values in the table below are reported as mean scores at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. School performance PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Score on a scale
School Performance
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Parent PROS : Visit 12.82 ± 1.002.77 ± 0.80
Parent PROS : Visit 23.00 ± 1.012.91 ± 0.80
Parent PROS : Visit 33.03 ± 0.893.04 ± 0.92
Parent PROS : Visit 43.08 ± 0.963.03 ± 0.90
Child PROS : Visit 13.53 ± 0.773.42 ± 0.79
Child PROS : Visit 23.22 ± 0.933.30 ± 0.81
Child PROS : Visit 33.29 ± 0.853.27 ± 0.77
Child PROS : Visit 43.23 ± 0.833.41 ± 0.86
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.662 · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.075 · Beta coefficient: 0.001 · 95% CI 0.000 to 0.002
SecondaryStudent Engagement

Student Engagement is a 4-item domain (minimum score=1, maximum score=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the Student Engagement domain is 4 and the maximum total score is 20 (total scores are not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Student Engagement PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Score on a scale
Student Engagement
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Parent PROS : Visit 12.98 ± 0.792.93 ± 0.80
Parent PROS : Visit 23.18 ± 0.853.08 ± 0.80
Parent PROS : Visit 33.18 ± 0.783.09 ± 0.70
Parent PROS : Visit 43.24 ± 0.823.13 ± 0.80
Child PROS : Visit 13.11 ± 0.823.04 ± 0.80
Child PROS : Visit 23.09 ± 0.093.06 ± 0.73
Child PROS : Visit 33.15 ± 0.943.01 ± 0.78
Child PROS : Visit 43.08 ± 0.832.95 ± 0.79
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.707 · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.735 · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
SecondaryTeacher Connectedness

Teacher Connectedness is a 9-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score for the Teacher Connectedness domain is 9 and the maximum total score is 45 (total scores not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Higher scores indicate better outcomes. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Teacher Connectedness PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Score on a scale
Teacher Connectedness
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Child PROS : Visit 13.81 ± 0.803.75 ± 0.76
Child PROS : Visit 23.85 ± 0.763.82 ± 0.77
Child PROS : Visit 33.86 ± 0.863.77 ± 0.83
Child PROS : Visit 43.75 ± 0.873.72 ± 0.84
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.735 (Random effects models regressed Child Patient Reported Outcomes Teacher Connectedness Scores on intervention status, time (days), intervention by time, season, and clustered by doctor's office. The threshold for statistical significance was p\<0.05.) · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
SecondaryPeer Relationships

Peer Relationships is a 6-item domain (minimum=1, maximum=5, on a 5 point Likert scale) of the of 30-item Child- (age 8-12) and a 7-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the 17-item Parent Patient Reported Outcomes Scores (PROS). The minimum total score is 6 and the maximum total score is 30 on the Child PROs. The minimum total score for the Peer Relationships domain is 7 and the maximum total score is 35 on the Parent PROs. Total scores not shown below. Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Parent-reported PRO and child-reported PRO measures were averaged for each domain for each time point. Higher scores indicate better outcomes. Peer Relationships PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Score on a scale
Peer Relationships
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Parent PROS : Visit 13.56 ± 0.823.54 ± 0.74
Parent PROS : Visit 23.63 ± 0.753.56 ± 0.75
Parent PROS : Visit 33.61 ± 0.793.63 ± 0.74
Parent PROS : Visit 43.72 ± 0.803.66 ± 0.72
Child PROS : Visit 14.03 ± 0.744.07 ± 0.71
Child PROS : Visit 23.79 ± 0.753.93 ± 0.84
Child PROS : Visit 33.84 ± 0.743.99 ± 0.72
Child PROS : Visit 43.91 ± 0.833.94 ± 0.79
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.873 (Random effects models regressed Parent Patient Reported Outcomes Peer Relationships Scores on intervention status, time (days), intervention by time, season, and clustered by doctor's office. The threshold for statistical significance was p\<0.05.) · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.888 (Random effects models regressed Child Patient Reported Outcomes Peer Relationships Scores on intervention status, time (days), intervention by time, season, and clustered by doctor's office. The threshold for statistical significance was p\<0.05.) · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
SecondaryFamily Relationships

Family Relationships is a 6-item domain (minimum=1, maximum=5 on a 5 point Likert scale) of the 30-item Child- (age 8-12) Patient Reported Outcomes Measures of relationships with other family members over the past 4 weeks. The minimum total score for the Family Relationships domain is 6 and the maximum total score is 30 (total scores not shown below). Values in the table below are reported as means at each time point and therefore fall between the minimum score of 1 and maximum score of 5. Child-reported PRO measures were averaged for each domain for each time point. Higher scores indicate better outcomes. Family Relationships PRO scores were measured at baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4). The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Baseline (Visit 1), 3 months (Visit 2), 6 months (Visit 3), and 9-12 months (Visit 4)
Reported as:
Mean · Score on a scale
Family Relationships
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Child PROS : Visit 13.81 ± 0.773.82 ± 0.68
Child PROS : Visit 23.83 ± 0.693.80 ± 0.65
Child PROS : Visit 33.96 ± 0.673.72 ± 0.72
Child PROS : Visit 43.81 ± 0.773.79 ± 076
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.679 (Random effects models regressed Child Patient Reported Outcomes Family Relationships Scores on intervention status, time (days), intervention by time, season, and clustered by doctor's office. The threshold for statistical significance was p\<0.05.) · Beta coefficient: 0.000 · 95% CI -0.001 to 0.001
SecondaryEngagement Measure Scores

The Engagement Measure is a 28-item parent self-report measure comprised of four domains: Access (5-items, total score range 5-25), Patient Family Centered Care or PFCC (6-items, total score range 6-30), Communication (3-items, total score range 3-15), and Understanding (5-items, total score range 5-25). Total scores are not reported below. Scores for each individual item and therefore the mean for each domain (means reported in the table below) ranged from 1-5 with higher scores indicating greater engagement. The time range given for Visit 4 reflects the time range counted as a single value.

Time frame:
Visit 4 (9-12 months)
Reported as:
Mean · Score on a scale
Engagement Measure Scores
Score on a scaleADHD PortalADHD Portal Plus Care Manager
Access3.43 ± 0.73.52 ± 0.6
PFCC3.45 ± 0.73.44 ± 0.7
Communication2.50 ± 1.12.64 ± 1.0
Understanding2.89 ± 0.83.02 ± 0.8
Statistical analysis
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.495 · Beta coefficient: 0.074 · 95% CI -0.164 to 0.311
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.885 · Beta coefficient: -0.013 · 95% CI -0.217 to 0.191
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.527 · Beta coefficient: 0.073 · 95% CI -0.182 to 0.328
  • ADHD Portal vs ADHD Portal Plus Care Manager · Random effects model · p = 0.285 · Beta coefficient: 0.136 · 95% CI -0.138 to 0.410

Adverse events

Collected over 9-12 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
ADHD Portal0/149 (0%)0/149 (0%)0/149 (0%)
ADHD Portal Plus Care Manager0/154 (0%)0/154 (0%)0/154 (0%)

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)ADHD PortalADHD Portal Plus Care ManagerTotal
<=18 years149154303
Between 18 and 65 years000
>=65 years000
Sex: Female, Male
Sex: Female, Male(Participants)ADHD PortalADHD Portal Plus Care ManagerTotal
Female474794
Male102106208
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)ADHD PortalADHD Portal Plus Care ManagerTotal
Race/Ethnicity — White5862120
Race/Ethnicity — Black/African American6970139
Race/Ethnicity — Hispanic7815
Race/Ethnicity — Other151328
Region of Enrollment
Region of Enrollment(participants)ADHD PortalADHD Portal Plus Care ManagerTotal
United States149154303
Baseline Vanderbilt Parent Rating Scale Scores
Baseline Vanderbilt Parent Rating Scale Scores(Vanderbilt Parent Rating Scale Score)ADHD PortalADHD Portal Plus Care ManagerTotal
Mean32.6 ± 11.831.3 ± 10.831.9 ± 11.3
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Study locations

1 site
  • The Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania 19104, United States
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References and documents

Publications

  • Guevara JP, Rothbard A, Shera D, Zhao H, Forrest CB, Kelleher K, Schwarz D. Correlates of behavioral care management strategies used by primary care pediatric providers. Ambul Pediatr. 2007 Mar-Apr;7(2):160-6. doi: 10.1016/j.ambp.2006.12.006. PubMed 17368411 ↗
  • Forrest CB, Glade GB, Baker AE, Bocian AB, Kang M, Starfield B. The pediatric primary-specialty care interface: how pediatricians refer children and adolescents to specialty care. Arch Pediatr Adolesc Med. 1999 Jul;153(7):705-14. doi: 10.1001/archpedi.153.7.705. PubMed 10401803 ↗
  • Homonoff EE, Maltz PF. Developing and maintaining a coordinated system of community-based services to children. Community Ment Health J. 1991 Oct;27(5):347-58. doi: 10.1007/BF00752385. PubMed 1934995 ↗
  • Guevara JP, Feudtner C, Romer D, Power T, Eiraldi R, Nihtianova S, Rosales A, Ohene-Frempong J, Schwarz DF. Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder. Pediatrics. 2005 Oct;116(4):e512-7. doi: 10.1542/peds.2005-0243. PubMed 16199679 ↗
  • Wolraich ML, Bickman L, Lambert EW, Simmons T, Doffing MA. Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD. J Atten Disord. 2005 Aug;9(1):354-68. doi: 10.1177/1087054705278834. PubMed 16371681 ↗
  • Guevara JP, Power TJ, Bevans K, Snitzer L, Leavy S, Stewart D, Broomfield C, Shah S, Grundmeier R, Michel JJ, Berkowitz S, Blum NJ, Bryan M, Griffis H, Fiks AG. Improving Care Management in Attention-Deficit/Hyperactivity Disorder: An RCT. Pediatrics. 2021 Aug;148(2):e2020031518. doi: 10.1542/peds.2020-031518. Epub 2021 Jul 19. PubMed 34281997 ↗

Study documents

  • Study protocol · Apr 17, 2018
  • Statistical analysis plan · Jun 28, 2019

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — A complete, cleaned, and de-identified dataset will be made available to the Patient-Centered Outcomes Research Institute (PCORI) and other investigators after all analyses have been conducted and within nine months of the end of the final year of funding. To obtain this data set, other investigators may contact the study PI who will provide a data sharing agreement. The data sharing agreement will permit the data set to be shared once an Institutional Review Board (IRB) protocol has been approved at the investigators' home institution and the investigators have signed a pledge to not attempt to identify individual study subjects. The data set will be made available electronically or via a secure file transfer protocol (FTP) site.

Supporting information: Study protocol

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Nov 25, 2019, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT02716324
Lead sponsor
Children's Hospital of Philadelphia
Collaborators
Patient-Centered Outcomes Research Institute
Responsible party
Sponsor
First posted
Mar 23, 2016
Start date
Mar 10, 2016
Primary completion
May 9, 2018
Completion
Oct 14, 2018
Results posted
Sep 27, 2019
Last update
Nov 25, 2019

Study contacts

James Guevara, MD MPH
principal investigator · Children's Hospital of Philadelphia

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Nov 2019. You cannot join it, but the record below documents what was studied.

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