ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication

Last updated: May 5, 2017

CMS Measure ID: CMS136v6
Version: 6
NQF Number: 0108
Measure Description:

Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.

b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Initial Patient Population:

Initial Population 1: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period.

Initial Population 2: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who remained on the medication for at least 210 days out of the 300 days following the IPSD, and who had a visit during the measurement period.

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Denominator Exclusion 1: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 30 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

Denominator Exclusion 2: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 300 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

Numerator Statement:

Numerator 1: Patients who had at least one face-to-face visit with a practitioner with prescribing authority within 30 days after the IPSD.

Numerator 2: Patients who had at least one face-to-face visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the Continuation and Maintenance Phase. One of the two visits during the Continuation and Maintenance Phase may be a telephone visit with a practitioner.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version: Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Previous Version: ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Improvement Notation:

Higher score indicates better quality

Guidance:

CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed.

To determine the cumulative medication duration, determine first the number of the medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions.

For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.

Addendum Notes: ICD-10 Value Set addition

Specifications

Release Notes

Header

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exclusions

    Source: QDM Standards

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Section: Denominator Exclusions

    Source: QDM Standards

  • Added a 300-day timing constraint for the ADHD medication to align with the Initial Population description.

    Section: Initial Population

    Source: JIRA (CQM-1724)

  • Removed occurrencing from $InitialADHDMedication as it is not needed.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Section: QDM Data Elements

    Source: QDM Standards

  • Value set Principal (2.16.840.1.113883.3.117.1.7.1.14): Removed Principal.

    Section: QDM Data Elements

    Source: None

  • Combine timing for Medication Dispensed into one statement to simplify the logic.

    Section: QDM Variables

    Source: Measure Lead

  • Rearranged the logic statements to make all sections of the measure match.

    Section: QDM Variables

    Source: Measure Lead

Value Set

  • Value set ADHD Medications (2.16.840.1.113883.3.464.1003.196.12.1171): Deleted 6 RXNORM codes (1251820, 410062, 884660,977844, 977851, 977857).

    Section: None

    Source: None

  • Value set Mental Health Diagnoses (2.16.840.1.113883.3.464.1003.105.12.1004): Added 6 ICD9CM codes (294.20, 294.21, 302.51, 302.52, 302.53, 302.6).

    Section: None

    Source: None

  • Value set Principal (2.16.840.1.113883.3.117.1.7.1.14): Removed Principal value set from measure.

    Section: None

    Source: None

  • Value set Mental Health Diagnoses (2.16.840.1.113883.3.464.1003.105.12.1004): Added 13 ICD10CM codes.

    Section: None

    Source: ICD-10 Addendum

External Resources