New HEDIS 2006 Measure: Follow-up
Care for Children Prescribed AttentionDeficit/Hyperactivity Disorder (ADHD)
Medication
Sally Turbyville, Senior Health Care Analyst,
Quality Measurement
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Importance
• 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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Purpose
• 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 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 Design
• Cross-sectional health plan data
– 5288 children identified
– 867 medical record charts reviewed for validation
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Timely 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 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 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 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 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 Numerator
Follow-Up Rates-Requiring ADHD Diagnosis
Commercial
Medicaid
50
Rate
40
45
43
42 40
30
23
20
17
19
14
10
0
Initiation
Initiation
Dx
C&M
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C&M Dx
Timely Follow-Up
% Mean
Initiation
Commercial 42.8
% Range
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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Conclusions
• 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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Contributors
•
•
•
•
• Charles Homer, MD
• Terry Kramer, PhD
• Mary Beth Kiser
Marc Atkins, PhD
Christy Beaudin, PhD
Ann Doucette, PhD
Richard Hermann, PhD
• Partially funded by Eli Lilly and McNeil
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Reference
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 AttentionDeficit/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.
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