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The Provider Advisory Committee (PAC) of CBHNP adopts 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. 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 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 developed measures of the following elements for these two approved guidelines: Identify Members with Bipolar Disorder diagnoses who had at least one claim for a
medication management visit in an identified 1-year period of time and identify the physical health plan
(PH-MCO) for each identified Member. For the same annual period, request pharmacy data from the PH-MCO for
each identified Member for the specified medications including generics. Determine the percentage of Bipolar
Disorder patients who are prescribed at least one of the first-line medication options recommended by the
guideline.
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. This measure will identify all Members with Bipolar Disorder diagnoses who had at least one claim for any service in an identified 1-year period of time. The measure then will identify secondary diagnoses of the following Substance-Related Disorders and/or Substance Abuse treatment authorization within the same annual time period within the same annual time period. Determine the percentage of Bipolar Disorder patients who are also diagnosed and/or who have been treated for substance abuse or dependence as recommended by the guideline. Attention-Deficit / Hyperactivity Disorder 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.
This measure will identify Members with ADHD who had at least one claim for a medication management visit in an
identified 1-year period of time. Identify the PH-MCO for each identified Member and for the same annual period,
request pharmacy data from the PH-MCO for each identified Member for specific medications including brand names.
Determine the percentage of ADHD patients who are prescribed at least one of first-line medication options recommended
by the guideline.
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. This measure will identify Members with ADHD diagnoses for a psychiatric evaluation or medication management visit in an identified 1-year period of time. The total the number of psychiatric evaluations or medication management visits in the annual time period will be determined to calculate a percentage who have at least two psychiatry visits in the annual period. A calculation will also be completed for the average number of psychiatry visits of ADHD patients in the annual time period.
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