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
Hermann added that the condition is often treated by pediatricians, who
don't necessarily have the same follow-up practices that a psychiatrist would
Other HEDIS mental health measures included in the new specifications are
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
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
"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>.▪