"I can honestly say that this innovation has revolutionised my clinical practice. The feedback from clinicians, parents and schools so far has all been extremely positive. We are already planning how we can extend into other areas.”
Dr Julie Clarke, Consultant Paediatrician at United Lincolnshire Hospitals
Overview

Winner of the 2018 HSJ Award for Innovation in Mental Health, this innovative programme is being rolled out from April 2020 across the AHSN Network. Pioneered in the East Midlands it supports more effective diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) for children 6 to 18 years old.

The innovation has been mainstreamed within three NHS trusts in the East Midlands – by early 2020 it has spread to 20% of trusts across England and via the support of the AHSN Network will be spread even further.

The East Midlands demonstrator utilised QbTest, a digital objective assessment tool. It is the only CE marked and European Medicines Agency (EMA) registered intervention that simultaneously measures attention, impulsivity and motor activity. These are core indicator symptoms of ADHD and accurate measurement supports a timely clinical diagnosis.

The East Midlands AHSN worked with international medical technology company Qbtech Ltd to roll out QbTest at seven sites in three NHS trusts and provided funding for the 12-month demonstrator. The project tested out two different models in CAMHS (Child and Adult Mental Health Services) and paediatric services. The evaluation of the demonstrator (January 2017 to December 2017) showed impressive results, including:

  • Time from assessment to diagnosis reduced by 153 days
  • The number of appointments to make a diagnosis was reduced by one appointment for two trusts
  • 85% of patients found the QbTest results helpful
  • 94% of clinicians reported greater understanding of patients’ symptoms.

Full details of the demonstrator findings are outlined below (Impacts and Outcomes).

Based on these results the intervention was mainstreamed, with the three trusts committed to funding beyond 2018 (United Lincolnshire Hospitals NHS Trust, Derbyshire Healthcare NHS Foundation Trust and Leicestershire Partnership NHS Trust).

“The support of the East Midlands AHSN and the skilled clinicians who have been fundamental to this project have allowed us to demonstrate the impact and value of QbTest, both for patients and the NHS. We are delighted that our technology will continue to be used across these sites. We believe that the independent evaluation from the East Midlands AHSN showing cost savings and reduced waits for diagnosis will compel many other trusts and CCGs to adopt QbTest to benefit their patients.”

Tony Doyle, Managing Director, Qbtech

Challenge/problem identified

ADHD is a treatable, common neurodevelopmental disorder affecting 5% of school-aged children worldwide[1].  It is characterised by a persistent pattern of inattention and/or hyperactivity and impulsivity.

Current diagnosis techniques are highly subjective based on clinical interpretation, service user and parent feedback, and this can delay effective diagnosis and time to treatment. There is no simple test to determine whether a child has ADHD. The process for diagnosing ADHD can include multiple steps and is based on clinical judgement informed by subjective reports from parents, teachers and observation of the patient.  As such, children in the UK wait 18 months (average)[2] to obtain an accurate diagnosis, significantly more than the European average of 11 months. Assessment for diagnosing ADHD is estimated to cost the NHS £23 million a year and the total cost for patients over their lifetime is estimated at more than £102,000 (this includes assessment, treatment, management, education and social support costs).

“We know it’s important for families to get advice and support as quickly as possible when a child is thought to have ADHD. Having a computerised tool like QbTest is contributing to effective medications management and helping to reduce the time to diagnosis, which in turn alleviates families’ uncertainty.”

Donna Whitemore, Team Manager of the Neurodevelopmental Service, Derbyshire Healthcare NHS Foundation Trust

[1] Faraone, Sergeant, Gilberg & Biederman (2003)

[2] Fridman, M., Banaschewski, T., Sikirica, V., Quintero, J., & Chen, K. S. (2017). Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: Data from the caregiver Perspective on Pediatric ADHD survey. Neuropsychiatric Disease and Treatment, 13, 947–958.

Actions taken

The East Midlands demonstrator (up to October 2020) supported spread to 40 NHS trusts across 78 sites.

The AHSNs involvement has been key to evaluating the innovation, by:

  • Funding the demonstrator project
  • Piloting and evaluating different approaches to using the technology
  • Developing a robust business case to support rapid adoption and spread
  • Understanding the NHS market to support highly targeted engagement with trusts
  • Developing a coordinated approach to adoption and spread within and beyond the East Midlands (from 2018).

The East Midlands demonstrator focused on deploying the QbTest diagnostic tool within Community Paediatric Mental Health services in Derbyshire, Leicestershire, Lincolnshire and CAMHS in Derbyshire, funded by the AHSN for one year from January 2017.

QbTest monitors an individual’s ‘push button’ responses to a target appearing on a computer screen.  Whilst simultaneously tracking their head movement using an infra-red camera. Output data is captured in a visual report which is available immediately following test completion and compares the result against an age and gender matched normative control group.

Each of the three trust areas deployed the QbTest differently, in response to the needs of their service and available resources. In all cases it was used to support the diagnostic process for children referred for assessment of possible ADHD.

Two trusts redesigned their discrete ADHD assessment pathways, placing QbTest at the beginning of the patient journey. The remaining trust implemented it into an existing neurodevelopmental patient pathway, using QbTest to support the assessment of ADHD in complex cases.

“I was reassured that all of the results and assessments confirmed ADHD. It was nice to see this QbTest and I kept a copy to show my family to help them understand too.”

Service user

Impacts / outcomes
  • All three trusts involved in the demonstrator saw an in-year return on investment (ROI) of between £14,300 and £93,900 (the differences between the trusts relates to different pathway changes implemented and variation in tariff costs). The costs of QbTest per trust is approximately £12,000 +VAT per year depending on patient volumes.
  • Staff surveys show clinicians felt the QbTest supported both diagnostic decision-making as well as communicating decisions to patients and families – 94% said they were better able to understand their patients’ symptoms of ADHD.
  • 1,231 patients were assessed using QbTest during 2017, exceeding the target and ensuring best use of resources during implementation and effective capture of robust benchmarking data.
  • Reduction in clinical time required to rule in or rule out ADHD in children over a 12-month period ranged from a 20% to 33% (based on time released per child, multiplied by the number of children seen in the one-year period of the study).
  • Average number of days to reach a decision before the implementation of QbTest ranged between 161 to 453 days. With QbTest this reduced to a range of 15 to 252 days (153 days median across the three trusts.
  • Number of appointments required to reach a diagnostic decision before the implementation of QbTest ranged from three to eight across the trusts. Following the implementation, there was a reduction of one consultant appointment per child to reach a diagnosis and release of an average between 0.24 and 1.04 total number of appointments on the pathway. In two trusts diagnosis was reached at the first contact with the paediatrician in the majority of cases.
  • 90 patient and family experience questionnaires were distributed by clinic staff and 43% responded with 85% of these reporting that QbTest reports had helped them to better understand their symptoms.
  • Sustainability has been achieved, with all three demonstrator trusts mainstreaming funding for QbTest from 2018 based on positive outcomes and evaluation. All have signed contracts with Qbtech for the ongoing provision of QbTest.
  • EMAHSN and Qbtech Ltd were named as winners of the 2018 HSJ Award for Innovation in Mental Health for a mental health innovation that is leading the way in delivering better services and evidence of financial savings alongside improved patient experience.

 

“The QbTest provides an up-to-date platform to test and observe young people and gain meaningful data, which can be easily interpreted to support the diagnostic process. It helps to reduce clinical observation time, supporting an overall reduction in time for the diagnostic process. The QbTest also supports ongoing monitoring and efficacy of the use of medications, which is a huge help.”

Fran Guerra, Neurodevelopmental Nurse Specialist, Leicestershire Partnership NHS Trust

Plans for the future

Sustainability has been achieved with all three demonstrator trusts mainstreaming funding from 2018 based on positive outcomes and evaluation.

Based on the outstanding impacts from the East Midlands demonstrator, this project has been developed into a new programme called ‘Focus ADHD’, which is being rolled out nationally across AHSNs in a phased approach from April 2020.

Start and end dates

The 12-month East Midlands demonstrator ran from January 2017 to December 2017 and adoption as an AHSN network national spread programme commenced from April 2020.

Find out  more

Dara Coppel, Head of Innovation Programme Delivery, East Midlands AHSN
E: dara.coppel@nottingham.ac.uk

Tony Doyle, Managing Director, Qbtech Ltd
T: +44 (0)208 996 5148
M: +44 (0)7771 937 845
W: www.qbtech.com

Media enquiries:

Chris Taylor, Associate Director of Communications & Engagement, East Midlands AHSN
E: chris.taylor@nottingham.ac.uk