Ultimately, however, the value of care must include patient and family needs, Dr. Forrest and Dr. Silber wrote.
ADHD quality measure on horizon
Dr. Donna M. Woods noted that some 5 million children between ages 3 and 17 years have been diagnosed with the condition, and that the condition appears to be on the rise.
Dr. Donna M. Woods
The first step was to conduct a systematic review of studies on the outcomes of ADHD treatments. That paper was published in the Academic Pediatrics supplement (Acad. Pediatr. 2014;14(S): S54-60). This type of review for ADHD therapies had never been done before, she said.
The gold standard for good quality ADHD care is improvement in symptoms, and every one of the 35 studies that met her study’s inclusion criteria showed improvement – regardless of whether it was a medication or behavioral therapy.
That literature review showed that “improvement in symptoms could provide the basis for the development of an outcome measure to assess the quality of care for pediatric patients diagnoses with ADHD,” Dr. Woods and her colleagues concluded.
Their work attracted some attention at CMS, which became interested in developing the outcome measure for stage 3 of meaningful use, Dr. Woods said.
The National Committee on Quality Assurance, along with a private consulting firm, has helped create such a measure and is now trying to test it, said Dr. Woods, who acted as an unpaid consultant for the project.
The testing has run into a bit of an obstacle – that it can’t really be incorporated into the adult-centric EHRs that are currently available.
EHRs, MOCs, ACOs all to help drive use
Even as pediatricians lag behind in use of EHRs – and as the market lags in providing a record that will allow them to measure what’s important in pediatrics – many clinicians are participating in quality through the maintenance of certification process.
There are 17 approved practice improvement modules (PIM) offered by the American Board of Pediatrics to clinicians who are maintaining their certification.
Among the ABP-approved PIMs are the ADHD initial diagnosis PIM and the ADHD follow-up PIM. Both are based on guidelines issued by the AAP in 2011.
“The maintenance of certification process is very important,” said Dr. Sachdeva, who said it was one of several things that would likely steer more pediatricians into adopting quality measures.
Also crucial is linking payment to quality, and the push toward integrated delivery systems such as accountable care organizations that will require quality documentation and improvement.
Dr. Sachdeva, Dr. McInerny, and Dr. Perrin wrote that to improve the quality of care and reduce the cost of care, it is critical “to assure that substantial numbers of these measures are adopted into the clinical practice of practicing pediatricians.”
This should not be too difficult, if they are given the right tools, said Dr. Sachdeva.
“I think the compelling argument for pediatricians is that it’s the right thing to do for children,” he said.
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