PMID- 24635013
OWN - NLM
STAT- MEDLINE
DCOM- 20150601
LR  - 20220408
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 30
IP  - 8
DP  - 2014 Aug
TI  - Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice 
      patterns and quality metrics.
PG  - 1687-99
LID - 10.1185/03007995.2014.905461 [doi]
AB  - INTRODUCTION: This study examines incident treatment patterns for 
      attention-deficit/hyperactivity disorder (ADHD) in children seen in eight 
      integrated healthcare delivery systems and identifies factors associated with 
      adherence to Healthcare Effectiveness Data and Information Set (HEDIS) quality 
      measures developed by the National Committee for Quality Assurance (NCQA). 
      METHOD: A retrospective cohort analysis using electronic healthcare data from 
      children aged 3 through 17 years with newly diagnosed ADHD between January 1, 
      2009 and December 31, 2010 was conducted. NCQA quality definitions for initiation 
      and for continuation and maintenance (C&M) of ADHD medications were expanded to 
      include preschoolers and adolescents. Poisson regression models with robust error 
      variance were used to evaluate the association between NCQA HEDIS adherence 
      measures, provider type, patient characteristics and care process measures. 
      RESULTS: Of 6864 children aged 3-17 years old qualifying for incident treatment 
      analyses, 5538 (80.7%) were started on ADHD medication within a year of 
      diagnosis. Adherence to NCQA HEDIS measures was 49.8% for initiation and 45.8% 
      for C&M, with adherence rates higher for mental health than non-mental health 
      providers, school-aged children than adolescents, and for patients concurrently 
      on other psychotropic medications than those who were not. Of those started on 
      ADHD medication, 62.3% were not eligible for C&M analyses according to HEDIS 
      guidelines, because they did not receive continuous (210 of 300 days) ADHD 
      medication treatment, with adolescents less likely than school-aged children to 
      persist with medications. CONCLUSION: Study limitations must be considered, 
      including reliance on electronic medical record data, absence of patient race and 
      sociodemographic data, and limited generalizability to other care contexts. 
      Nevertheless, findings suggest novel strategies are needed to improve the quality 
      of ADHD care processes for children of all ages, because even within integrated 
      delivery systems less than half of children with ADHD received care consistent 
      with NCQA HEDIS standards for initiation and C&M care. RESULTS suggest the need 
      to refine quality measures by including follow-up care in those children not 
      receiving or discontinuing medication treatment, a considerable quality concern 
      not currently captured in NCQA HEDIS standards.
FAU - Bussing, Regina
AU  - Bussing R
AD  - University of Florida, College of Medicine , Gainesville, FL , USA.
FAU - Narwaney, Komal J
AU  - Narwaney KJ
FAU - Winterstein, Almut G
AU  - Winterstein AG
FAU - Newton, Douglas A
AU  - Newton DA
FAU - DeBar, Lynn
AU  - DeBar L
FAU - Boscarino, Joseph A
AU  - Boscarino JA
FAU - Toh, Sengwee
AU  - Toh S
FAU - Pawloski, Pamala
AU  - Pawloski P
FAU - Nordin, James D
AU  - Nordin JD
FAU - Herrinton, Lisa J
AU  - Herrinton LJ
FAU - Mason, Dana
AU  - Mason D
FAU - Daley, Matthew F
AU  - Daley MF
LA  - eng
GR  - 1R01HS019912/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20140407
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Central Nervous System Stimulants)
SB  - IM
MH  - Adolescent
MH  - Attention Deficit Disorder with Hyperactivity/*drug therapy
MH  - Central Nervous System Stimulants/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Delivery of Health Care, Integrated
MH  - Electronic Health Records
MH  - Female
MH  - Guideline Adherence/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Poisson Distribution
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - *Quality Assurance, Health Care
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - United States
OTO - NOTNLM
OT  - Adherence
OT  - Attention-deficit hyperactivity disorder
OT  - Persistence
OT  - Quality measurement
OT  - Stimulant
OT  - Treatment patterns
EDAT- 2014/03/19 06:00
MHDA- 2015/06/02 06:00
CRDT- 2014/03/19 06:00
PHST- 2014/03/19 06:00 [entrez]
PHST- 2014/03/19 06:00 [pubmed]
PHST- 2015/06/02 06:00 [medline]
AID - 10.1185/03007995.2014.905461 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2014 Aug;30(8):1687-99. doi: 10.1185/03007995.2014.905461. 
      Epub 2014 Apr 7.