This application is in response to Program Announcement, """"""""Research on Quality of Care for Mental Disorders (PA -95066). It is a second revised ROI application that is being submitted by a new investigator. Partners in Care for Children (PCC) is a quality of care study for children with Attention Deficit Hyperactivity Disorder (ADHD) in public primary care (PC) and carve-out specialty mental health (SMH) sectors enrolled in a managed care Medicaid program. This project addresses a critical need of service delivery systems that care for public-sector children. Namely, it will provide systematically collected longitudinal data on the clinical processes and outcomes among representative samples of children served in and across both major care sectors, and develop an innovative approach to meaningfully evaluate quality of care over time that is adjusted for child outcomes. These distinctions are critical because ADHD is a major public health problem in children that requires chronic care and is often accompanied by severe functional impairment and long-term adverse developmental outcomes. Nevertheless, evidence for ADHD treatment effectiveness is available, and practice parameters for ADHD care in PC and SMH care settings are established. Yet, in light of these advances, recent community-based studies suggest that ADHD is under-treated and inappropriately treated. Thus to inform the development of quality improvement interventions for public sector children with ADHD, PCC?s aims culminate to reach the goal of identifying child, provider and system characteristics that are related to poor care. Further, to translate PCC findings into practice, we have received strong commitment from public agencies and managed care organizations that this study?s findings will be used to develop quality improvement programs. Using a county-wide sample of children, aged 5-11 years, who are enrolled in a large managed care Medicaid program and have had at least one past year contact with public sector outpatient PC or carve-out SNM services, PCC proposes to meet the following aims: 1. To determine the proportion of children who meet ADHD diagnostic criteria or have a history of past year stimulant medication use among those who are identified as having a disruptive behavior problem in public primary care and specialty mental health care settings, adjusting for confounding parent and child sociodemographic factors. Within this aim, the objectives are: a. to examine the level of ADHD diagnostic accuracy in public primary care and specialty mental health care settings. b. to determine the rate of stimulant medication use among children who do not meet ADHD diagnostic criteria in public primary care and specialty mental health care settings. 2. To develop need-adjusted indicators of poor quality of care that are applicable to this study population using the RAND/IJCLA appropriateness method, a well-established approach that derives criteria from both outcomes evidence tables and judgments from a multi-disciplinary expert panel. 3. To examine the clinical processes, appropriateness of care, and outcomes over time (at 6, 12 months) of children who meet ADHD diagnostic criteria and are treated in public primary care and specialty mental health care settings, adjusting for confounding parent and child factors. Within this aim, the objectives are: a. to describe the clinical processes (diagnosis, assessment, treatment, follow-up), appropriateness of care, and outcomes at the child, family, environment and system levels in public primary care, specialty mental healthcare and co-managed care. b. to identify child, provider and system characteristics that are associated with clinical processes, appropriateness of care and outcomes.
| Zima, Bonnie T; Bussing, Regina; Tang, Lingqi et al. (2010) Quality of care for childhood attention-deficit/hyperactivity disorder in a managed care medicaid program. J Am Acad Child Adolesc Psychiatry 49:1225-37, 1237.e1-11 |
