HEDIS Measures for the Safe & Judicious Use of Antipsychotic Medications in Children and Adolescents 

Why Focus on Antipsychotic Medication Use?

The safe and judicious use of antipsychotic medications is a critical issue for children and youth, especially vulnerable children in Medicaid and foster care. Antipsychotics are powerful medications that are indicated for treating a limited range of children’s mental health problems and come with a potential for serious side effects that have life-long consequences. Many youth receiving antipsychotic medications do not have a primary indication for their use, and prior work done by NCQA showed care that was inconsistent with clinical guidelines. 

Measure Importance

  • Antipsychotic medications are among the most expensive, highest in risk, and fastest growing of therapeutic classes for children with mental disorders. For example, the frequency of prescribing antipsychotics increased from 8.6 per 1,000 children in 1996 to 39.4 per 1,000 in 20021.
  • Although evidence supports use of antipsychotics in youth for certain narrowly defined conditions, the majority of children on antipsychotics do not have one of these conditions2.
  • Antipsychotics have serious, common side effects, including weight gain, hyperprolactinemia, and metabolic disturbance3

What are the Antipsychotic Medication Use Measures?

As part of the Pediatric Quality Measures Program (PQMP), the Agency for Healthcare Research and Quality-Centers for Medicare & Medicaid Services PQMP National Collaborative for Innovation in Quality Measurement (NCINQ) Center of Excellence developed measures assessing the safe and judicious use of antipsychotic medications in children and adolescents (See AHRQ Measures Factsheet link below). The measures are intended for children enrolled in commercial health plans and/or Medicaid and have been used for HEDIS reporting beginning in 2015. 

The measures were developed to encourage a think before prescribing; if prescribing, carefully monitor approach to encourage judicious use of antipsychotic medications: 

Use of Multiple Concurrent Antipsychotics in Children and Adolescents

Children and adolescents who were on two or more concurrent antipsychotic medications for an extended period of time (a lower rate indicates better performance).

  • Denominator: Youth age 1-17 with at least 90 days of antipsychotic use.
  • Numerator: On two or more concurrent antipsychotic medications for at least 90 consecutive days during the year. 

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

Children and adolescents without a primary indication who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. 

  • Denominator: Youth age 1-17 with a new prescription for an antipsychotic who do not have a Food and Drug Administration indication for an antipsychotic.
  • Numerator: Received psychosocial care  prior to or just after starting an antipsychotic. 

Metabolic Monitoring for Children and Adolescents on Antipsychotics

Children and adolescents with ongoing antipsychotic use who had metabolic testing. 

  • Denominator: Youth age 1-17 with continued use of antipsychotics.
  • Numerator: Received both a glucose and a cholesterol test during the year.

Additional Resources

Multiple papers have been published in the literature that relate to the important work of these measures. Some examples are included here:

AHRQ PQMP Background

AHRQ Measures Factsheet 

What now? 

AHRQ awarded a grant to the National Collaborative for Innovation in Quality Measurement, Implementing and Improving (NCINQ II) to continue to improve behavioral health care and outcomes for youth and families through learning and innovation on these quality measures. For more information on this exciting work, please visit the NCINQ main webpage

References

  1. Cooper, WO, Arbogast PG, Ding H, et al. Trends in prescribing of antipsychotic medications for U.S. children. Ambul Pediatr. 2006;6(2):79–83.
  2. Penfold RB, Stewart C, Hunkeler EM, et al. Use of antipsychotic medications in pediatric populations: what do the data say? Curr Psychiatry Rep. 2013;15(12):1–10.
  3. Correll CU, Kratochvil CJ, March JS. Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics. J Clin Psychiatry. 2011;72:655–70.