NCQA Announces Measures To Assess Health Plan Quality
The National Committee for Quality Assurance (NCQA) has released“ technical specifications” for the 2006 edition of its Health Plan Employer Data and Information Set (HEDIS), adding five new performance measures including one on use of medication in children with attention-deficit/hyperactivity disorder (ADHD).
That measure looks at whether children who have been prescribed ADHD medication have received systematic follow-up office visits to evaluate treatment response and ensure that potential adverse side effects of those medications are avoided.
The NCQA is a nonprofit organization that accredits and certifies health care organizations and manages the evolution of HEDIS, a tool used by health plans to measure and report on their performance.
Psychiatrist Richard Hermann, M.D., a member of the NCQA Behavioral Health Measurement Advisory Panel, told Psychiatric News that the new measure asks two questions: What percentage of children aged 6 to 12 who are prescribed a medication for ADHD had a follow-up visit within 30 days of treatment initiation? And what percentage of those children had two follow-up visits within the subsequent nine months?
“Conceptually, the point is to determine if children who are prescribed medications for ADHD are simply started on a medication and left to their own devices, or if they receive ongoing follow-up care that can address medication issues as well as psychosocial issues,” Hermann said.
He is also chair of the APA Committee on Quality Indicators and an associate professor of medicine and psychiatry at Tufts University School of Medicine, where he is the director of the Center for Quality Assessment and Improvement in Mental Health.
Hermann said that the existing seven HEDIS measures developed for mental health care primarily focus on care of adults. The ADHD measure is the first that specifically evaluates care provided to children
“This is a start toward more broadly addressing the quality of mental health care for kids,” Hermann said. Other areas that might be addressed in ADHD treatment include use of psychosocial treatments, quality of assessments, and accuracy of the resulting diagnosis.
He said ADHD was chosen as a starting point because it is one of the more prevalent psychiatric conditions of childhood and is associated with significant functional problems in academic achievement and social performance.
Hermann added that the condition is often treated by pediatricians, who don't necessarily have the same follow-up practices that a psychiatrist would have.
Other HEDIS mental health measures included in the new specifications are the following:
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Follow-up after hospitalization for mental illness: The percentage of [health plan] members aged 6 and older who were hospitalized for treatment of selected psychiatric disorders and who received ambulatory care from a mental health care provider within (1) seven days and (2) 30 days of hospital discharge.
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Antidepressant medication management: The percentage of members aged 18 years and older who were diagnosed with a new episode of depression and treated with antidepressant medication and who (1) remained on an antidepressant drug during the entire 12-week acute treatment phase; (2) remained on an antidepressant drug for at least six months; and (3) had at least three follow-up contacts with a primary care or mental health care practitioner that were coded with a mental health diagnosis during the 12-week, acute-treatment phase.
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Initiation of alcohol and other drug treatment: The percentage of adults diagnosed with alcohol or drug dependence who begin inpatient or outpatient treatment within 14 days of diagnosis.
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Treatment engagement for alcohol and other drug dependence: The percentage of adults diagnosed with alcohol or drug dependence who engage in treatment, with two treatments occurring within 30 days after initiating treatment.
The other medical measures included in the new specifications include use of spirometry in the diagnosis and assessment of chronic obstructive pulmonary disease, drugs to be avoided in the elderly, annual monitoring of patients on persistent medications, and antibiotic use in adults with acute bronchitis.
Information about quality measures for mental health care can be obtained from a new APPI book written by Hermann, Improving Mental Healthcare: A Guide to Measurement-Based Quality Improvement. It is available for purchase at<http://appi.org/book.cfm?id=62088>.
“HEDIS 2006, Volume 2: Technical Specifications” is available in print and electronic formats and can be ordered by phone at (888) 275-7585 or online at<www.ncqa.org/publications>.▪
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Published online: 19 August 2005
Published in print: August 19, 2005
Notes
For example, one measure asks what percentage of children who are prescribed an ADHD medication had an adequate number of follow-up visits during initiation and maintenance phases of treatment.
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