Public invited to help shape new antipsychotic medication use measures for Medicaid and CHIP

May 03, 2013

Three-week public comment period begins April 29, 2013

WASHINGTON, D.C. — The AHRQ-CMS CHIPRA National Collaborative for Innovation in Quality Measurement (NCINQ) invites the public to comment on seven proposed Antipsychotic Medication Use measures. The measures are being developed under the Pediatric Quality Measurement Program (PQMP), which aims to produce measures that can be used by states, health care purchasers, consumers and policymakers to understand and improve the quality of health care for children in Medicaid and the Children’s Health Insurance Program (CHIP). NCINQ is a Center of Excellence under the PQMP program and is led by the National Committee for Quality Assurance (NCQA). These measures were developed in coordination with MEDNET, another AHRQ-funded effort to promote quality specifically focused on improving the provision of mental health treatment service for Medicaid beneficiaries, and build on the quality measures developed through the Rutgers University- based, multistate MEDNET consortium.

Antipsychotic medication use is a critical area of importance for measure development given their increased use in children and adolescents. While antipsychotics offer the potential for effective treatment of psychiatric disorders in children, they can also increase a child’s risk for developing health concerns such as metabolic and physical health complications. Growing concerns about the safety and effectiveness of antipsychotic medications in children and adolescents has created a need for quality measures to help assess antipsychotic prescribing practices in this population. NCINQ is exploring the use of these measures for a general population of children as well as for children in the foster care system.

During the public comment period, stakeholders will have an opportunity to advise NCINQ on antipsychotic medication use measures for children and adolescents enrolled in Medicaid and CHIP. Comments on the importance and feasibility of these measures will be particularly useful. The public comment period begins at 9:00 a.m. ET on April 29, 2013, and ends at 5:00 p.m. ET on May 17, 2013. 

Proposed Measures

Measures to Assess Appropriateness/Overuse of Medications

  • Children on Higher than Recommended Doses of Antipsychotics: Antipsychotic medications can cause serious adverse effects even at low doses. This measure will assess the number of children who are on doses that are higher than recommended for antipsychotic medications.
  • Use of Antipsychotics in Very Young Children: Although certain antipsychotic medications have been identified as appropriate treatment for specific disorders in this younger population, questions remain about the safety and effectiveness of antipsychotic medication use in children age 5 years and under.
  • Use of Multiple Concurrent Antipsychotics in Children: Use of several antipsychotics at the same time is becoming more frequent in the mental health treatment of children and adolescents. However, there are clinical and safety concerns around this practice.
  • Use of Antipsychotics in Children without a Primary Indication: While antipsychotic medications may be prescribed in children with certain conditions, such as psychosis, bipolar disorder, and tic disorders, they are increasingly being used without a first-line indication. This measure will assess how often children are prescribed antipsychotics without a first-line indication.

Measures to Assess Use of Needed Services Associated with Medication Use

  • Follow-Up Care for Children on Antipsychotics: This measure will assess how frequently children and adolescents on antipsychotics receive a follow-up visit.
  • Metabolic Screening for Children on Antipsychotics: Children and adolescents on antipsychotic medications may experience adverse metabolic and other physical changes. This measure will assess whether glucose and cholesterol screening occurred for children and adolescents on these medications.
  • Access to Psychosocial Care for Children on Antipsychotics: Non-pharmacological treatment options, including psychosocial intervention, are an important part of treating children and adolescents with psychiatric disorders, even in cases where medication is indicated.  

“Public comment is an important part of developing strong measures,” said Sarah Hudson Scholle, NCQA’s Vice President of Research & Analysis. “We are excited to introduce quality measures that will improve health outcomes for children and their families, and hope to hear from many interested parties.”

How to Participate in Public Comment

To read and comment on the proposed specifications, visit

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

About the National Collaborative for Innovation in Quality Measurement
The National Collaborative for Innovation in Quality Measurement (NCINQ) is a consortium of leaders and organizations committed to advancing pediatric measurement as part of the Agency for Healthcare Research and Quality Pediatric Quality Measures Program. The team is a multi-state and multi-stakeholder collaborative with a focus on pediatric care quality. Collaborating organizations and leaders include the National Committee for Quality Assurance; Nationwide Children’s Hospital; New York University and the New York State Office of Mental Health; the National Partnership for Women and Families; the American Academy of Pediatrics; Rutgers, the State University of New Jersey; and a broad network of major health plans, provider groups, families, and consumers. This project is supported by grant number U18HS020503 from the Agency for Healthcare Research and Quality.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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