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

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 1

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. 2

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 3

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 4

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

6. 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 6

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. 7

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. 8

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

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 10

11. Defining the Numerator 11

12. Timely Follow-Up 12

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 13

14. Marc Atkins, PhD Christy Beaudin, PhD Ann Doucette, PhD Richard Hermann, PhD Contributors • Charles Homer, MD • Terry Kramer, PhD • Mary Beth Kiser • Partially funded by Eli Lilly and McNeil 14

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. 15