Quality-improvement interventions such as the one used in this study seem quite effective in improving primary care providers' practices at offices that express interest in improving the quality of care for attention-deficit/hyperactivity disorder. The design of the intervention, problems associated with improving and sustaining treatment monitoring, and issues related to generalizability of the intervention model are discussed.

WHAT'S KNOWN ON THIS SUBJECT:Although evidence-based guidelines for pediatric attention-deficit/hyperactivity disorder (ADHD) care exist, adherence to the guidelines in communitybased settings has been problematic. Effective interventions that improve the quality of pediatricians' ADHD care and are ready for widespread dissemination do not currently exist. WHAT THIS STUDY ADDS:By using a cluster-randomized trial design, results of this study provide evidence that a quality improvement intervention that is conducive to widespread dissemination improves the ADHD assessment and treatment behaviors of community-based pediatricians.abstract OBJECTIVE: To determine the effectiveness of a quality improvement program to improve pediatricians' adherence to existing, evidencebased, attention-deficit/hyperactivity disorder (ADHD) practice guidelines. METHODS: Forty-nine community-based pediatricians at 8 practices participated in a cluster-randomized trial. Practices were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid. The medical charts for a random sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months. All practices participated in 4 sessions of training, including didactic lectures and office flow modification workshops. Practices were then given access to an ADHD Internet portal that allowed parents, teachers, and pediatricians to input information (eg, rating scales) about patients, after which information was scored, interpreted, and formatted in a report style that was helpful for assessment and treatment of patients with ADHD. Physicians evaluated their practice behaviors quarterly and addressed underperforming areas. RESULTS: Pediatricians in the intervention group, compared with those in the control group, demonstrated significantly higher rates of many American Academy of Pediatrics-recommended ADHD care practices, including collection of parent (Cohen's d ϭ 0.69) and teacher (d ϭ 0.68) rating scales for assessment of children with ADHD, use of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (d ϭ 0.85), and use of teacher rating scales to monitor treatment responses (d ϭ 1.01). CONCLUSION: A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric settings.

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