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## Complete Summary

#### TITLE

Attention-deficit/hyperactivity disorder (ADHD) (initiation phase):
percentage of members 6 to 12 years of age with an ambulatory
prescription dispensed for ADHD medication who had one follow-up visit
with a practitioner with prescribing authority during the 30-day
initiation phase.

#### SOURCE(S)

National Committee for Quality Assurance (NCQA). HEDIS 2008: Healthcare
Effectiveness Data & Information Set. Vol. 2, Technical Specifications.
Washington (DC): National Committee for Quality Assurance (NCQA); 2007
Jul. various p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of members 6 to 12 years
of age with an ambulatory prescription dispensed for ADHD medication who
had one follow-up visit with a practitioner with prescribing authority
during the 30-day initiation phase (see the related National Quality
Measures Clearinghouse \[NQMC\] summary of the National Committee for
Quality Assurance \[NCQA\] measure [Attention-deficit/hyperactivity
disorder (ADHD) (continuation maintenance phase): percentage of members
6 to 12 years of age with an ambulatory prescription dispensed for ADHD
medication who remained on the medication for at least 210 days and who,
in addition to the visit in the initiation phase, had at least two
follow-up visits with a practitioner within 9 months after the
initiation phase
ended](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=10061&string=2786)).

#### RATIONALE

Attention-deficit/hyperactivity disorder (ADHD) 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. Given the high prevalence of ADHD
among school-aged children (4 percent to 12 percent), primary care
clinicians will encounter children with ADHD in their practices
regularly and should have a strategy for diagnosing and long-term
management of this condition.

Practitioners can convey the efficacy of pharmacotherapy to their
patients. The American Academy of Child and Adolescent Psychiatry
guidelines recommend that clinicians provide a schedule for initial
titration and monitoring as well as a schedule for monitoring the drug
maintenance phase. The titration phase of stimulant initiation covers
the period of dose adjustment and often requires two to four weeks of
time after the original dose has been prescribed. Afterward, the child
can be followed regularly for lengthy periods on the same maintenance
dose.

The American Academy of Pediatrics (AAP) guidelines recommend that once
a child is stable, an office visit every three to six months allows
assessment of learning and behavior. Follow-up appointments should be
made at least monthly until the child\'s symptoms have been stabilized.

#### PRIMARY CLINICAL COMPONENT

Attention deficit/hyperactivity disorder (ADHD); medication; follow-up
care

#### DENOMINATOR DESCRIPTION

Members 6 to 12 years of age as of the Index Prescription Episode Start
Date who were dispensed an attention deficit/hyperactivity disorder
(ADHD) medication during the 12-month Intake Period (see the
\"Description of Case Finding\" and \"Denominator
Inclusions/Exclusions\" fields in the Complete Summary)

#### NUMERATOR DESCRIPTION

Members from the denominator with one outpatient, intensive outpatient
or partial hospitalization follow-up visit with a practitioner with
prescribing authority within 30 days after the Index Prescription Start
Date (see the related \"Numerator Inclusions/Exclusions\" field in the
Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Accreditation\
Decision-making by businesses about health-plan purchasing\
Decision-making by consumers about health plan/provider choice\
External oversight/Medicaid\
External oversight/State government program\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Behavioral Health Care\
Managed Care Plans\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Social Workers

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Age 6 to 12 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

-   Attention deficit/hyperactivity disorder (ADHD) is found in 3 to 6
    percent of school-age children; at least 10 percent of behavioral
    problems seen in general pediatric settings are due to the disorder.

-   1 in 4 patients have a follow-up visit with their primary care
    physician within the 30 days following the first ADHD prescription.
    For patients receiving a prescription from a psychiatrist, only 29
    percent reported a follow-up visit with the psychiatrist within 30
    days.

-   Half of physicians in a recent survey reported routine follow-up
    visits for children diagnosed with ADHD.

-   More than 4 million children ages 4 to 17 have been diagnosed with
    ADHD; more than half diagnosed are receiving medication treatment
    for the disorder.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Centers for Disease Control and Prevention (CDC).
Attention-deficit/hyperactivity disorder. \[internet\]. Atlanta (GA):
Centers for Disease Control and Prevention (CDC); 2005\[accessed 2008
Apr 29\].

Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of
attention-deficit/hyperactivity disorder in children and adolescents.
Council on Scientific Affairs, American Medical Association. JAMA1998
Apr 8;279(14):1100-7. \[85 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9546570)

Harpaz-Rotem I, Rosenheck RA. Prescribing practices of psychiatrists and
primary care physicians caring for children with mental illness. Child
Care Health Dev2006 Mar;32(2):225-37.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16441857)

Rushton JL, Fant KE, Clark SJ. Use of practice guidelines in the primary
care of children with attention-deficit/hyperactivity disorder.
Pediatrics2004 Jul;114(1):e23-8.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15231969)

#### ASSOCIATION WITH VULNERABLE POPULATIONS

See the \"Rationale\" field.

#### BURDEN OF ILLNESS

Children with attention deficit/hyperactivity disorder (ADHD) may
experience difficulties in school, troublesome relationships with family
members and peers, and behavioral problems.

#### EVIDENCE FOR BURDEN OF ILLNESS

Clinical practice guideline: diagnosis and evaluation of the child with
attention-deficit/hyperactivity disorder. American Academy of
Pediatrics. Pediatrics2000 May;105(5):1158-70. \[60 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10836893)

#### UTILIZATION

Among children with ADHD, those on medication have shown to have less
frequent and less costly emergency department visits.

#### EVIDENCE FOR UTILIZATION

Leibson CL, Barbaresi WJ, Ransom J, Colligan RC, Kemner J, Weaver AL,
Katusic SK. Emergency department use and costs for youth with
attention-deficit/hyperactivity disorder: associations with stimulant
treatment. Ambul Pediatr2006 Jan-Feb;6(1):45-53.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16443183)

#### COSTS

Estimates of the total annual economic cost for treating children with
attention deficit/hyperactivity disorder (ADHD) in the U.S. range from
\$2 billion to \$11 billion.

#### EVIDENCE FOR COSTS

Leibson CL, Long KH. Economic implications of attention-deficit
hyperactivity disorder for healthcare systems.
Pharmacoeconomics2003;21(17):1239-62. \[96 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14986737)

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Members 6 years as of March 1 of the year prior to the measurement year
to 12 years as of February 28 of the measurement year, who were
continuously enrolled in the organization for 120 days (4 months) prior
to the Index Prescription Start Date through 30 days (1 month) after the
Index Prescription Start Date with no gaps in enrollment (see the
\"Denominator Inclusions/Exclusions\" field)

\**Index Prescription Start Date*. The earliest prescription dispensing
date for an attention deficit/hyperactivity disorder (ADHD) medication
where the date is in the Intake Period\*\* and there is a Negative
Medication History\*\*\*.

\*\**Intake Period*. The 12-month window starting March 1 of the year
prior to the measurement year and ending February 28 of the measurement
year.

\*\*\**Negative Medication History*. A period of 120 days (4 months)
prior to the Index Prescription Start Date, during which time the member
had no ADHD medications dispensed for either new or refill prescriptions
(refer to Table ADD-A in the original measure documentation for ADHD
medications).

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Members 6 to 12 years of age as of the Index Prescription Episode Start
Date who were dispensed an attention deficit/hyperactivity disorder
(ADHD) medication during the 12-month Intake Period (see the
\"Description of Case Finding\" field)

Refer to the original measure documentation for steps to identify the
eligible population.

**Exclusions**

-   Exclude members who had an acute inpatient stay with a principal
    diagnosis of mental health (refer to Table MPT-A in the original
    measure documentation for codes to identify major depression) or
    substance abuse (refer to Table AMM-B in the original measure
    documentation for codes to identify substance abuse) during the 30
    days after the Index Prescription Start Date.

-   Exclude from the eligible population all members diagnosed with
    narcolepsy at any point in their medical history (refer to Table
    ADD-D in the original measure documentation).

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Members from the denominator with one outpatient, intensive outpatient
or partial hospitalization follow-up visit with a practitioner with
prescribing authority within 30 days after the Index Prescription Start
Date (refer to Table ADD-B for codes to identify the follow-up visit;
this must be a face-to-face visit with a practitioner)

Do not count the Index Prescription Start Date visit as the initiation
phase visit.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Analysis by subgroup (stratification on patient factors, geographic
factors, etc.)

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

This measure requires that results are reported separately for the
commercial and Medicaid product lines.

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Follow-up care for children prescribed attention-deficit/hyperactivity
disorder (ADHD) medication (ADD).

#### MEASURE COLLECTION

[HEDIS® 2008: Healthcare Effectiveness Data and Information
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=11336)

#### MEASURE SET NAME

[Effectiveness of
Care](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=11340)

#### MEASURE SUBSET NAME

[Behavioral
Health](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=8&doc=12377)

#### DEVELOPER

National Committee for Quality Assurance

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

National Committee for Quality Assurance\'s (NCQA\'s) Measurement
Advisory Panels (MAPs) are composed of clinical and research experts
with an understanding of quality performance measurement in the
particular clinical content areas.

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

In order to fulfill National Committee for Quality Assurance\'s
(NCQA\'s) mission and vision of improving health care quality through
measurement, transparency and accountability, all participants in
NCQA\'s expert panels are required to disclose potential conflicts of
interest prior to their participation. The goal of this Conflict Policy
is to ensure that decisions which impact development of NCQA\'s products
and services are made as objectively as possible, without improper bias
or influence.

#### ENDORSER

National Quality Forum

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2005 Jan

#### REVISION DATE

2007 Jul

#### MEASURE STATUS

**Please note**: This measure has been updated. The National Quality
Measures Clearinghouse is working to update this summary.

#### SOURCE(S)

National Committee for Quality Assurance (NCQA). HEDIS 2008: Healthcare
Effectiveness Data & Information Set. Vol. 2, Technical Specifications.
Washington (DC): National Committee for Quality Assurance (NCQA); 2007
Jul. various p.

#### MEASURE AVAILABILITY

The individual measure, \"Follow-up Care for Children Prescribed
Attention-deficit/Hyperactivity Disorder (ADHD) Medication (ADD),\" is
published in \"HEDIS® 2008. Healthcare Effectiveness Data & Information
Set. Vol. 2, Technical Specifications.\"

For more information, contact the National Committee for Quality
Assurance (NCQA) at 1100 13th Street, N.W., Suite 1000, Washington, DC
20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site:
[web.ncqa.org](http://web.ncqa.org/).

#### COMPANION DOCUMENTS

The following is available:

-   National Committee for Quality Assurance (NCQA). The state of health
    care quality 2007: industry trends and analysis. Washington (DC):
    National Committee for Quality Assurance (NCQA); 2007. 93 p.

For more information, contact the National Committee for Quality
Assurance (NCQA) at 1100 13th Street, N.W., Suite 1000, Washington, DC
20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site:
[web.ncqa.org](http://web.ncqa.org/).

#### NQMC STATUS

This NQMC summary was completed by ECRI on June 6, 2006. The information
was not verified by the measure developer. This NQMC summary was updated
by ECRI Institute on April 18, 2008. The information was verified by the
measure developer on May 30, 2008.

#### COPYRIGHT STATEMENT

This NQMC summary is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

For detailed specifications regarding the National Committee on Quality
Assurance (NCQA) measures, refer to *HEDIS Volume 2: Technical
Specifications*, available from the NCQA Web site at
[web.ncqa.org](http://web.ncqa.org/).

### Disclaimer

#### NQMC DISCLAIMER

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All measures summarized by NQMC and hosted on our site are produced
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Measures represented on the NQMC Web site are submitted by measure
developers, and are screened solely to determine that they meet the NQMC
Inclusion Criteria which may be found at
<http://www.qualitymeasures.ahrq.gov/about/inclusion.aspx>.

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Readers with questions regarding measure content are directed to contact
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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008