The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial / Laura WYATT ; Christopher PARTLETT ; Colleen EWART ; Anupam BHARDWAJ ; Bernadka DUBICKA ; Tamsin MARSHALL ; Julia GLEDHILL ; Alexandra LANG ; Kirsty SPRANGE ; Louise THOMSON ; Sebastian MOODY ; Grace HOLT ; Helen BOULD ; Clare UPTON ; Matthew KEANE ; Edward COX ; Marilyn JAMES ; Alan A. MONTGOMERY in Journal of Child Psychology and Psychiatry, 66-6 (June 2025)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 66-6 (June 2025) . - p.805-820 Titre : The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial Type de document : texte imprimé Auteurs : Laura WYATT, Auteur ; Christopher PARTLETT, Auteur ; Colleen EWART, Auteur ; Anupam BHARDWAJ, Auteur ; Bernadka DUBICKA, Auteur ; Tamsin MARSHALL, Auteur ; Julia GLEDHILL, Auteur ; Alexandra LANG, Auteur ; Kirsty SPRANGE, Auteur ; Louise THOMSON, Auteur ; Sebastian MOODY, Auteur ; Grace HOLT, Auteur ; Helen BOULD, Auteur ; Clare UPTON, Auteur ; Matthew KEANE, Auteur ; Edward COX, Auteur ; Marilyn JAMES, Auteur ; Alan A. MONTGOMERY, Auteur Article en page(s) : p.805-820 Langues : Anglais (eng) Mots-clés : RCT  standardised diagnostic assessment  diagnosis  emotional disorders  health economic evaluation  STADIA  Child and Adolescent Mental Health Services (CAMHS) Index. décimale : PER Périodiques Résumé : Background Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness. Methods We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5 17 year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18 months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation. Trial registration: ISRCTN15748675. Results In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups. Conclusions As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes. En ligne : https://doi.org/10.1111/jcpp.14090 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=556 [article] The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial [texte imprimé] / Laura WYATT, Auteur ; Christopher PARTLETT, Auteur ; Colleen EWART, Auteur ; Anupam BHARDWAJ, Auteur ; Bernadka DUBICKA, Auteur ; Tamsin MARSHALL, Auteur ; Julia GLEDHILL, Auteur ; Alexandra LANG, Auteur ; Kirsty SPRANGE, Auteur ; Louise THOMSON, Auteur ; Sebastian MOODY, Auteur ; Grace HOLT, Auteur ; Helen BOULD, Auteur ; Clare UPTON, Auteur ; Matthew KEANE, Auteur ; Edward COX, Auteur ; Marilyn JAMES, Auteur ; Alan A. MONTGOMERY, Auteur . - p.805-820. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 66-6 (June 2025) . - p.805-820 Mots-clés : RCT  standardised diagnostic assessment  diagnosis  emotional disorders  health economic evaluation  STADIA  Child and Adolescent Mental Health Services (CAMHS) Index. décimale : PER Périodiques Résumé : Background Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness. Methods We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5 17 year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18 months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation. Trial registration: ISRCTN15748675. Results In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups. Conclusions As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes. En ligne : https://doi.org/10.1111/jcpp.14090 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=556

The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial / Chris HOLLIS in Journal of Child Psychology and Psychiatry, 59-12 (December 2018)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 59-12 (December 2018) . - p.1298-1308 Titre : The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial Type de document : texte imprimé Auteurs : Chris HOLLIS, Auteur ; Charlotte L. HALL, Auteur ; Boliang GUO, Auteur ; Marilyn JAMES, Auteur ; Janet BOADU, Auteur ; Madeleine J. GROOM, Auteur ; Nikki BROWN, Auteur ; Catherine KAYLOR-HUGHES, Auteur ; Maria MOLDAVSKY, Auteur ; Althea Z. VALENTINE, Auteur ; Gemma M. WALKER, Auteur ; David DALEY, Auteur ; Kapil SAYAL, Auteur ; Richard MORRISS, Auteur Article en page(s) : p.1298-1308 Langues : Anglais (eng) Mots-clés : QbTest  assessment  attention deficit hyperactivity disorder  continuous performance test Index. décimale : PER Périodiques Résumé : BACKGROUND: Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS: Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS: One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS: QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy. En ligne : http://dx.doi.org/10.1111/jcpp.12921 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=371 [article] The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial [texte imprimé] / Chris HOLLIS, Auteur ; Charlotte L. HALL, Auteur ; Boliang GUO, Auteur ; Marilyn JAMES, Auteur ; Janet BOADU, Auteur ; Madeleine J. GROOM, Auteur ; Nikki BROWN, Auteur ; Catherine KAYLOR-HUGHES, Auteur ; Maria MOLDAVSKY, Auteur ; Althea Z. VALENTINE, Auteur ; Gemma M. WALKER, Auteur ; David DALEY, Auteur ; Kapil SAYAL, Auteur ; Richard MORRISS, Auteur . - p.1298-1308. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 59-12 (December 2018) . - p.1298-1308 Mots-clés : QbTest  assessment  attention deficit hyperactivity disorder  continuous performance test Index. décimale : PER Périodiques Résumé : BACKGROUND: Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS: Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS: One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS: QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy. En ligne : http://dx.doi.org/10.1111/jcpp.12921 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=371

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