title: Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Florida, College of Medicine , Gainesville, FL , USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Bussing
authors.forename: Komal J
authors.initials: KJ
authors.lastname: Narwaney
authors.forename: Almut G
authors.initials: AG
authors.lastname: Winterstein
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Newton
authors.forename: Lynn
authors.initials: L
authors.lastname: DeBar
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: Sengwee
authors.initials: S
authors.lastname: Toh
authors.forename: Pamala
authors.initials: P
authors.lastname: Pawloski
authors.forename: James D
authors.initials: JD
authors.lastname: Nordin
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Dana
authors.initials: D
authors.lastname: Mason
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States
chemical_list: D000697:Central Nervous System Stimulants
keywords: Adherence; Attention-deficit hyperactivity disorder; Persistence; Quality measurement; Stimulant; Treatment patterns