National Committee for Quality Assurance, Washington, D.C.
Psychiatr Serv. 2019 Nov 1;70(11):1020-1026. doi: 10.1176/appi.ps.201900089. Epub 2019 Jul 24.
This study examined the performance of health plans on two HEDIS measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. Plan characteristics and other contextual factors that may be associated with health plan performance were examined to identify potential strategies for improving care.
The study population included 279 commercial and 169 Medicaid health plans that voluntarily submitted data for care provided in 2016. Bivariate associations between performance on the two measures and each plan characteristic (eligible population size, region, profit status, model type, and operating in a state with legislation on prior authorization for antipsychotics) were examined. Main-effects multivariable linear regression models were used to examine the combined association of plan characteristics with each measure.
Performance rates on both measures were comparable for commercial and Medicaid plans. Among commercial plans, not-for-profit plans outperformed for-profit plans on both measures. Commercial and Medicaid plans in the North performed significantly better on the metabolic monitoring measure. Commercial plans in the South and Medicaid plans in the West performed significantly worse on the first-line psychosocial care measure. Plans operating in states requiring prior authorization performed significantly better on the metabolic monitoring measure.
This study identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggest that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
本研究考察了两项 HEDIS 指标在健康计划中的表现：为服用抗精神病药物的儿童和青少年进行代谢监测，以及为非适应证服用抗精神病药物的儿童和青少年提供一线心理社会护理的情况。检查了与健康计划绩效相关的计划特征和其他背景因素，以确定改善护理的潜在策略。
研究人群包括 279 家商业健康计划和 169 家医疗补助健康计划，这些计划自愿提交了 2016 年提供的护理数据。检查了这两项措施与每项计划特征（合格人口规模、地区、盈利状况、模式类型以及在有抗精神病药物事先授权立法的州运营）之间的表现之间的双变量关联。使用多变量线性回归模型来检查计划特征与每项措施的综合关联。
商业和医疗补助计划在这两项措施上的绩效率相当。在商业计划中，非营利计划在这两项措施上的表现均优于营利计划。在北方的商业和医疗补助计划在代谢监测措施方面表现明显更好。在南方的商业计划和在西部的医疗补助计划在一线心理社会护理措施方面的表现明显更差。需要事先授权的州运营的计划在代谢监测措施方面的表现明显更好。
本研究确定了与儿科抗精神病药物处方相关的质量措施中与健康计划绩效相关的关键计划特征和其他背景因素。研究结果表明，质量措施与事先授权等政策相结合，可以鼓励为弱势群体提供更好的护理服务。
