1. 1 New HEDIS  2006 Measure: Follow-up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication Sally Turbyville, Senior Health Care Analyst, Quality Measurement

2. 2 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.

3. 3 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

4. 4 Data Source Health plan administrative data –Member demographics and enrollment –Pharmacy claims –Ambulatory claims or encounters Six health plans participated –6 commercial –3 Medicaid

5. 5 Study Design Cross-sectional health plan data –5288 children identified –867 medical record charts reviewed for validation

6. 6 Timely Follow-Up AAP Clinical Practice Guideline 1 –“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

7. 7 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.

8. 8 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.

9. 9 Health Plan Denominator Prevalence of enrolled 6 – 12 year olds –commercial: 16.3 per 1,000 members –Medicaid: 22.6 per 1,000 members

10. 10 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

11. 11 Defining the Numerator

12. 12 Timely Follow-Up % Mean% Range Initiation Commercial42.831.3 – 49.5 Medicaid45.033.3 – 46.7 Continuation & Maintenance Commercial40.024.8 – 48.3 Medicaid42.131.4 – 43.7

13. 13 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

14. 14 Contributors 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

15. 15 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 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.