Consider how you will establish practicewide procedures for high-quality ADHD care that include:

• Adequate time for ADHD-related visits.
• Efficient office flow for ADHD care.
• Clear roles and responsibilities.
• Processes to ensure that all ADHD activities are consistent with the AAP 2019 ADHD Guideline and accompanying documents, occur on a timely basis, and are documented, including:
  • ADHD evaluation
  • Rating scales distributed, returned, and scored (from 2 or more settings, eg, home and school, for the school-aged child)
  • Basis of the diagnosis established (DSM-5 criteria met and type of presentation)
  • Identified patient as CYSHCN
  • Ongoing assessment/treatment of comorbid conditions
  • Ongoing education
  • Ongoing review of target goals
  • Treatment recommendations including, as appropriate: evidence-based behavioral/training interventions, medication, school services/classroom interventions
  • Written care plan with actionable items to manage ADHD symptoms
  • Close monitoring of patient’s response to treatment and adjustments as needed
  • Anticipatory guidance
  • Transition of adolescents toward self-management and adult health care
  • Care coordination
  • Billing and payment
• Determine how you will incorporate new ADHD procedures into your office flow. The workflow should identify by whom, how, when, and where each component of care will take place. In some situations, the workflow may delineate a handoff from a staff member responsible for gathering information (ie, rating scale results) to the physician equipped to assess results and initiate/maintain/adjust treatment.
• Establish your office’s confidentiality practices to ensure patient privacy and information discussed during visits and follow-up care.
• Identify educational materials to offer to patients and families.
• Identify/develop relationships with specialists/providers in order to match referrals to patients’ needs.
• Establish billing and payment procedures for ADHD services.

PDSA Cycle: Start by testing a process to address one or more of the procedures listed above.

Plan

• Plan the process: What is the workflow? Who is involved? What materials (eg, rating scales, brochures) are needed and where will they be stored?

Do

• Pilot the process you have laid out.

Study

• Gather feedback from staff. What worked? What did not work?
• Use the information gathered to help refine and improve your process.

Act

• If needed, redesign your process and test again.
• Implement changes that resulted in success.

Use successive PDSA cycles to refine and improve your process. The value of the PDSA cycle is the continuous search for improvement.

• Once a process is working well, standardize improvements and begin to use them regularly.
• Consider formalizing the process as an office policy/procedure document.
• Choose a different process or procedure and use PDSA cycles to test and refine as above.