Brief Description of Measure:

​CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD):
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.

Description of Issue:

The standards team expressed concerns with office EHRs having difficulty capturing detailed dispensing information from pharmacy systems.
 
Since the measure intent is to assess for follow-up visits among a population who were prescribed ADHD medication by the provider, we will change the measure to look for prescription events instead of dispensing events. In the logic, ' Medication, Order' will replace 'Medication, Dispensed' as it is most closely aligned with the intent. Note that the reliance on dispensing data was a prior limitation of the HEDIS health plan-level measure when restricted to claims data.

Proposed Solution:

​Before
//Header: 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.

//Header: Definition
Index Prescription Start Date (IPSD): The earliest prescription dispensing date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not dispensed during the 120 days prior.

//Header: Initial Population
Initial Population 1: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period ...
Initial Population 2: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period ...

//Logic
define "First ADHD Medication Dispensed during Intake Period":
        First(["Medication, Dispensed": "ADHD Medications"] FirstADHDMedication
            where Global."EarliestOf"(FirstADHDMedication.relevantDatetime, FirstADHDMedication.relevantPeriod)during Interval[start of "Measurement Period" - 90 days, start of "Measurement Period" + 60 days]
            sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
        )

After
//Header: Description
Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care.

//Header: Definition
Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not prescribed during the 120 days prior.

//Header: Initial Population
Initial Population 1: Children 6-12 years of age who were prescribed an ADHD medication during the Intake Period ...
Initial Population 2: Children 6-12 years of age who were prescribed an ADHD medication during the Intake Period ...

//Logic
define "ADHD Medication Prescribed during Intake Period”:
["Medication, Order": "ADHD Medications"] ADHDMedicationOrder
   where ADHDMedicationOrder.authorDatetime during "Intake Period"
   sort by authorDatetime asc  

This change would also impact the several definitions, replacing the term "Dispensed" with "Prescribed", throughout the logic.

Rationale for Change:

​The goal of this change is to improve clinical relevance of the measure, as well as to address EHR data feasibility concerns expressed by the eCQM standards team.