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The concepts of healthcare reform and population health are shifting the emphasis from traditional, volume-based care to a model in which value, or quality, predominates. High quality care will be increasingly rewarded, with financial consequences for poor performance. This shift will be accelerated by the use of healthcare technology, a rapidly growing industry with tools ranging from electronic health records to smart phones and web portals. In this article we highlight pertinent legislative reforms followed by a review of technologies that may play a role in the implementation of these reforms. Pediatric Attention Deficit Hyperactivity Disorder is used as an example given the large number of proposed tools for this condition. While the evidence base is weak for some technologies, research regarding web portals is better developed and will be presented as an example of a technology that may allow practitioners and organizations to improve healthcare quality in several dimensions.

AbstractThis study investigated the role of externalizing behavior as a mediator of the relation between social self‐control and peer liking among children with attention‐deficit/hyperactivity disorder‐combined type (ADHD‐CT). A model was proposed whereby externalizing behavior would fully statistically account for the direct relation of social self‐control to peer liking. One hundred seventy‐two children ages 7.0–9.9 years with ADHD‐CT were rated by their teachers regarding their social self‐control and by their parents and teachers regarding their rates of externalizing behavior. Same‐sex classmates provided ratings of overall liking. Structural equation modeling was used to assess the proposed model. Results supported the proposed model of externalizing behavior as fully statistically accounting for the relation of social self‐control to peer liking. This study demonstrated the crucial role that externalizing behaviors play in the social impairment commonly seen among children with ADHD‐CT.

Objective Examine patterns and predictors of skill learning during multisession Enhanced FOrward Concentration and Attention Learning (FOCAL+) training. Background FOCAL+ teaches teens to reduce the duration of off-road glances using real-time error learning. In a randomized controlled trial, teens with ADHD received five sessions of FOCAL+ training and demonstrated significant reductions in extended glances (>2-s) away from the roadway (i.e., long-glances) and a 40% reduced risk of a crash/near-crash event. Teens' improvement in limiting long-glances as assessed after each FOCAL+ training session has not been examined. Method Licensed teen (ages 16–19) drivers with ADHD ( n = 152) were randomly assigned to five sessions of either FOCAL+ or modified standard driver training. Teens completed driving simulation assessments at baseline, after each training session, and 1 month and 6 months posttraining. Naturalistic driving was monitored for one year. Results FOCAL+ training produced a 53% maximal reduction in long-glances during postsession simulated driving. The number of sessions needed to achieve maximum performance varied across participants. However, after five FOCAL+ training sessions, number of long-glances was comparable irrespective of when teens achieved their maximum performance. The magnitude of reduction in long-glances predicted levels of long-glances during simulated driving at 1 month and 6 months posttraining but not naturalistic driving outcomes. FOCAL+ training provided the most benefit during training to teens who were younger and had less driving experience. Conclusion FOCAL+ training significantly reduces long-glances beginning at the 1st training session. Application Providing five FOCAL+ training sessions early on during teen driving may maximize benefit.

The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Any views expressed are those of the author(s) and not necessarily those of the funders.