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The Provider Advisory Committee (PAC) of CBHNP has set a goal of adopting several Clinical Best Practice Guidelines to serve as benchmarks for future quality improvement initiatives. The PAC includes representation from our Provider groups as well as county representation. It meets quarterly to consider proposals for new services and to consider adoption of clinical practice guidelines. The committee has focused on the most common diagnoses seen in our HealthChoices population. The committee has adopted six clinical practice guidelines, and measures have been developed for two. Six Clinical Practice Guidelines have been evaluated and recommended as relevant for the CBHNP Provider Network:
It was decided that all guidelines that are evaluated by PAC and considered helpful will be made available as a reference to Providers to guide practice. Providers may call for a paper copy of any of the above guidelines by contacting the QI Department of CBHNP. For the purposes of measurement of Provider performance on Clinical Practice Guidelines, two of the above were chosen and approved for this purpose:
CBHNP has developed measures of the following elements of these
two approved guidelines:
APA Practice Guideline for the Treatment of Patients with Bipolar Disorder
(Second Edition, Revision April 2002)
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Acute and maintenance treatment options with the best empirical evidence to
support their use include lithium or valproate (Depakote); possible
alternatives include lamotrigine (Lamictal), carbamazepine (Tegretol), or
oxcarbazepine (Trileptal)
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Bipolar disorder with a comorbid substance use disorder is a very common
presentation, with bipolar disorder patients of both sexes showing much higher
rates of substance use than the general population. As a benchmark, the
Epidemiologic Catchment Area (ECA) study found rates of alcohol abuse or
dependence in 46% of patients with bipolar disorder compared to 13% for the
general population. Comparable drug abuse and dependence figures are 41% and
6%, respectively.
For the most recent annual measurement period, of the 2288 CBHNP Members with a
primary diagnosis of Bipolar Disorder, comorbid substance abuse disorders were
identified in 20% of the population. This is roughly only half of the ECA
benchmark percentages, indicating the importance of providing substance abuse
assessment and referral information to the CBHNP Provider Network.
AAP Clinical Practice Guideline: Treatment of School-Aged Child
with Attention-Deficit / Hyperactivity Disorder (October 2001)
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The clinician should recommend stimulant medication and/or behavior therapy, as
appropriate, to improve target outcomes in children with ADHD. Many studies
have documented the efficacy of stimulants in reducing the core symptoms or
ADHD.
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For acute and stabilization treatment with medication, at a minimum, an office
visit at least every 3 to 6 months allows for assessment of learning and
behavior.
For the most recent annual measurement period, of the 2075 CBHNP child Members
with a primary diagnosis of ADHD, 88% had at least 2 psychiatry visits during
the measurement period, and the average number of psychiatry visits was 5.0.
This indicates strong compliance with this aspect of the ADHD guideline.
Please note that these statements are provided as
informational only from the adopted Clinical Practice Guideline. They are not
to be considered diagnostic or medical advice. It is important to work closely
with your doctor and other behavioral health professionals on appropriate
treatment for you. If you would like a copy of any of the above Clinical
Practice Guidelines, they are available at the websites indicated here or by contacting any of the
listed QI personnel lcross@cbhnp.org
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