Stephen V. Faraone, Michael J. Silverstein , Kevin Antshel, Joseph Biederman, David W. Goodman, Oren Mason, Andrew A. Nierenberg, Anthony Rostain, Mark A. Stein and Lenard A. Adler
Journal of Attention Disorders, 1–15, 2018, DOI: 10.1177/1087054718804354
This manuscript reviews the results of the first phase of Quality Measures (QM) Initiative of the American Professional Society of ADHD and Related Disorders (APSARD). QMs (sometimes described as Quality Indicators) are critical metrics to the delivery and assessment of state-of-the-art health care; QMs numerically describe outcomes, patient perceptions, processes quantify health care processes, outcomes, patient perceptions, and systems. The authors followed the pathway outlined by the U.S. Agency for Healthcare Research and Quality (AHRQ) for the development of QMs; the manuscript describes the first phase, the development of draft QMs. This was a four-step process: 1) a literature search for adult ADHD QMs; (2) having experts develop a “wide net” of potential QMs in the areas of screening, diagnosis, treatment, follow-up, care coordination, and patient experience; (3) cross-referencing this “wide-net” of QMs to existing adult ADHD guidelines; (4) have ADHD experts rate the importance, reliability, validity, feasibility, and usability of the QMs via an online survey. The top 10 QMs from the expert survey were: Screening: % high-risk patients screened (e.g., depressed patients, family history of ADHD), Diagnosis: % patients treated for ADHD having documented DSM-5 diagnosis of ADHD, % patients with ADHD with review of other psychiatric disorders, % patients with ADHD with documentation of impairment, Treatment initiation: % patients receiving ADHD medications for whom treatment alternatives, benefits and risks have been discussed, % patients with ADHD assessed for vitals prior to medication treatment, % patients with ADHD for whom warnings and contraindications for medication were reviewed, Treatment follow-up: % patients with ADHD where validated measure of symptom change used to assess treatment efficacy at least annually, % patients stabilized on an ADHD medication seen at least once per year, % patients prescribed medication for ADHD seen within 1 month of initial prescription. This manuscript is important for clinicians because it is the first step toward the development of QMs for adult ADHD, which have not existed to date; if validated through field testing in the second phase of the initiative, these QM may be important metrics of health care quality in the care of patients with ADHD.