Behavioral Health measures as required by HEDIS® are not just for the adult population, but for children and adolescents as well. In particular, there are 3 measures specifically for this population. These measures are outlined below, including a description of each measure and why each measure is important.
This measure looks at the percentage of children between the ages of 6 – 12 years of age with a newly prescribed ADHD medication who had at least three (3) follow-up visits within a 10 month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported:
Importance of the Measure
ADHD is one of the most common chronic conditions of childhood. According to the Centers for Disease Control and Prevention (CDC), the latest statistics (2016) show that approximately 9.4% of children 2 – 17 years of age (6.1 million) had been diagnosed with ADHD. Children with ADHD can experience significant functional problems that can affect academic performance and relationships with family and peers; they may develop behavioral problems as well. Medication is recommended for children 6 years of age and older by the American Academy of Pediatrics (AAP) to control the symptoms of ADHD. Once the child is stable, follow-up visits are essential to monitor any side effects and the efficacy of the medication.
This measure looks at the percentage of children and adolescents 1 – 17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as a first-line treatment. Two age stratifications (1 – 11 years and 12 – 17 years) and a total rate are reported.
Importance of the Measure
While antipsychotic medications may be appropriate for some psychiatric disorders in children, they are often prescribed for nonpsychotic conditions, such as ADHD and disruptive behaviors, conditions more amenable to psychosocial interventions which are considered first-line treatment. This measure ensures that these children on antipsychotics are evaluated for psychosocial interventions and to make sure that these medications are indeed appropriate. Bipolar disorder and schizophrenia and psychotic disorders are the only conditions for which antipsychotics are a first-line treatment for children and adolescents, and both have Food and Drug Administration (FDA) approval for this population.
This measure looks at the percentage of children and adolescents 1 – 17 years of age who had two or more antipsychotic prescriptions and had metabolic testing. Two age stratifications (1 – 11 years and 12 – 17 years) and a total rate are reported on. Measured are the percentage of children and adolescents on antipsychotics who received:
Importance of the Measure
While antipsychotic medications are necessary for treatment for certain diagnosed psychotic disorders in children and adolescents, they can increase the risk of causing serious health concerns, including metabolic health complications, especially weight gain and Type 2 diabetes. Research studies suggest metabolic problems in childhood and adolescence are associated with poor cardio-metabolic outcomes in adulthood. Because of these potential side effects from antipsychotics, it is important to establish a baseline and continuously monitor for metabolic abnormalities, so that appropriate management can be initiated and evaluated while the medication continues. This HEDIS measure is supported by guidelines from the American Academy of Child and Adolescent Psychiatry.
Additional Information on these and other HEDIS measures can be accessed on the Highmark Provider Resource Center at: https://content.highmarkprc.com/Files/EducationManuals/QualityMgmtToolkit/hedis-ref-guide.pdf 
Healthcare Effectiveness Data and Information Set (HEDIS)® and Quality Compass® are registered trademarks of the National Committee for Quality Assurance (NCQA).
Consumer Assessment of Healthcare Providers and Systems (CAHPS)® is a registered trademark of the Agency for Healthcare Research and Quality. CORE is a registered trademark of CAQH.
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