Opportunities for Improving Health Plan Performance on HEDIS Measures for Follow-up Visits among Children Prescribed ADHD Medications
Creators: name: Muser, Erik
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2011

description: Background: The National Committee for Quality Assurance (NCQA) has developed Healthcare Effectiveness Data and Information Set (HEDIS®) measures for commercial and Medicaid health plans to promote health care quality improvement. Two of these measures focus on follow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medications. Success in the first measure (Initiation or INIT Phase) requires patients to have a qualifying claim for follow-up care within 30 days after the date of the first (index) prescription claim for an ADHD medication. Success in the second measure (Continuation Maintenance or CM Phase) requires patients to have two additional qualifying claims for follow-up care within the 270 day period after the Initiation Phase (National Committee for Quality Assurance, 2007). Objectives: To examine characteristics and utilization patterns for patient cohorts defined by performance on the two HEDIS® measures for follow-up care for children prescribed ADHD medication in order to identify potential opportunities for improving measure performance by health plans. Methods: From a commercial claims database of 17 million enrollees a study population was defined using the INIT measure eligibility criteria (6−12 years of age, ≥1 prescription for ADHD medication between 3-1-2007 and 2-29-2008, continuous enrollment for 120 days prior to first ADHD prescription [index] and 300 days following index, and no ADHD prescriptions for 120 days prior to index). Success and failure cohorts for INIT and CM measures, respectively, were compared on demographics and utilization patterns using two-sample t-tests for continuous variables and chi-squared tests for categorical variables. No adjustment was made for multiplicity. Results: Among INIT Phase failures, >15% of patients missed the 30-day mark for having a qualifying claim post index by ≤10 days. INIT Phase failure was also a factor in CM Phase failure with over 76% of CM Phase failures occurring solely due to missing the qualifying follow-up visit within 30 days post index. Pediatricians treated approximately 50% of patients eligible for the measure and had a lower success rate relative to some other specialties. Patients with index prescriptions lower than the modal dose for each product, or with a dose titration within 60 days post index, had relatively higher success rates on the INIT Phase measure. Conclusions: Education for physicians and their staff focused on increasing awareness of the two ADHD HEDIS® measures and emphasizing the importance of follow-up within 30 days of initiation may help health plans improve their performance on these measures. Pediatricians may be an efficient target audience for such education efforts due to the large number of ADHD HEDIS® eligible patients they treat and their relatively lower success rate on the measures. Education efforts should also reinforce clinical practice guidelines that discuss the importance of closely monitoring patients taking ADHD medications in order to titrate doses based upon tolerability and clinical response. Additional research is needed to evaluate how interventions that incorporate these findings impact health plan performance on these ADHD HEDIS® measure and ultimately the quality of care for patients.