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New HEDIS 2006 Measure: Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD)

Medication

New HEDIS 2006 Measure: Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD)

Medication

Sally Turbyville, Senior Health Care Analyst, Quality Measurement

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ImportanceImportance

• Attention-deficit/hyperactivity disorder is one of the more common chronic conditions of childhood.

• Children with ADHD may experience significant functional problems such as school difficulties, academic underachievement, troublesome relationships with family members and peers, and behavioral problems.

• Pharmacologic treatment with psychostimulants is the most widely studied treatment for ADHD.

• The long-term care management for a child with ADHD requires an ongoing partnership among clinicians, parents and the child.

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PurposePurpose

• Develop a health plan level measure to assess timely follow-up care for children prescribed ADHD medications

• Determine accuracy of administrative data to identify population and follow-up care

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Data SourceData Source

• Health plan administrative data– Member demographics and enrollment– Pharmacy claims– Ambulatory claims or encounters

• Six health plans participated– 6 commercial– 3 Medicaid

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Study DesignStudy Design

• Cross-sectional health plan data

– 5288 children identified– 867 medical record charts reviewed for validation

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Timely Follow-UpTimely Follow-Up

• AAP Clinical Practice Guideline1

– “Once the child [ages 6 – 12 years] is stable, an office visit every 3 to 6 months allows for assessment of learning and behavior.”

• AACAP Practice Parameter 2

– “Once the child with ADHD is stabilized on stimulant medication, visits may be scheduled once a month.”

• Expert input

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Method of MeasurementMethod of Measurement

Follow-up during start of treatment (Initiation Phase)

• Denominator– Children between the ages of 6 and 12 years– Starting a new treatment of ADHD-specific

medication. A new treatment requires no evidence of ADHD medication during the previous 120 days (4 months) of the dispensing date.

• Numerator– One visit within 30 days after the dispensing event

with practitioner who has prescribing authority.

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Method of MeasurementMethod of Measurement

Follow-up during continued treatment (Continuation and Maintenance Phase)

• Denominator– Children who remain on ADHD medication for 9

months after starting a new treatment.

• Numerator– Two additional visits within 9 months after the

“initiation” phase ends event with any practitioner. One of these two may be telephonic.

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Health Plan DenominatorHealth Plan Denominator

• Prevalence of enrolled 6 – 12 year olds – commercial: 16.3 per 1,000 members– Medicaid: 22.6 per 1,000 members

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Defining the DenominatorDefining the Denominator

• Requiring a diagnosis of ADHD significantly reduces denominator size: – Denominator size dropped by 42%.

• ADHD diagnosis confirmed in medical record or administrative data– 96.8% of the children identified had a

diagnosis of ADHD

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Defining the NumeratorDefining the Numerator

Follow-Up Rates-Requiring ADHD Diagnosis

43 40

1914

2317

45 42

0

10

20

30

40

50

Initiation InitiationDx

C&M C&M Dx

Rat

e

Commercial Medicaid

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Timely Follow-UpTimely Follow-Up

% Mean % Range

Initiation

Commercial 42.8 31.3 – 49.5

Medicaid 45.0 33.3 – 46.7

Continuation & Maintenance

Commercial 40.0 24.8 – 48.3

Medicaid 42.1 31.4 – 43.7

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ConclusionsConclusions

• Pharmacy claims data reliably identifies children with ADHD who are taking ADHD medication

• Children are not receiving timely follow-up care after a starting new treatment of ADHD medication

• Concern for quality of care• Health plan administrative data can be

used to measure and encourage timely follow-up care for these children

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ContributorsContributors

• Marc Atkins, PhD• Christy Beaudin, PhD• Ann Doucette, PhD• Richard Hermann, PhD

• Charles Homer, MD• Terry Kramer, PhD• Mary Beth Kiser

• Partially funded by Eli Lilly and McNeil

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ReferenceReference

American Academy of Pedicatrics, Committee on Quality Improvement and Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical Practice Guideline: Treatment of the School-Aged Child with Attention-Deficit/Hyperactivity Disorder. Pedicatrics. 2001; 108: 1033-1044.

AACAP Official Action. Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents, and Adults. J.AM. ACAD. Child Adolesc. Psychiatry, 41:2 Supplement, February 2002.