Managing ADHD BARB PERIARD MD FOREST HILLS PEDIATRIC ASSOCIATES GRAND RAPIDS, MI

Transcription

1 Managing ADHD BARB PERIARD MD FOREST HILLS PEDIATRIC ASSOCIATES GRAND RAPIDS, MI

2 How are you going to manage ADHD? AAP Clinical Practice Guidelines HEDIS Measures Why? Good Care Better reimbursement MOC

3 AAP Clinical Guidelines Evaluate patients for ADD/ADHD who demonstrate concerns Should meet DSM IV Criteria Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of ADHD Parent Preferences and Goals Influence ADHD Treatment Decisions

4 HEDIS Measure 6-12 year old children newly prescribed ADHD medication INITIATION PHASE: One visit < 30 days after Index Prescribing Start Date (IPSD) CONTINUATION AND MAINTENANCE PHASE: Two visits during months 2 10 after IPSD One visit can be a phone follow up Up%20Care%20for%20Children%20Prescribed%20ADHD%20Medication.pdf

5 How can OP help you meet these measures? Diagnosis Index Prescription Start Date Follow Up Initial Continuation and Maintenance Medications Capturing your ADHD Data

6 ADHD Diagnosis 1. Mentioned at a WCC Task for Reception Staff to schedule New Assessment appointment: SEE PRINT SCREEN 2. Parent calls and says they want their child evaluated for ADHD Message sent to ADHD/CC Care Coordinator calls patient to determine if the assessment is appropriate 3. States they ve been seen elsewhere, have dx and would like to start meds Reception: Message sent to ADHD/CC Copy of documents requested ADHD/CC: Reviewed the documentation Modified Initial Assessment appointment scheduled with ADHD/CC

7 Routine order for Initial ADHD Evaluation is present on the Assess/Plan F/U tab of every WCC template ages 5 and up

8 Diagnosis and the Care Coordinator Care Coordinator assumes care until the IPSD 1. Care Coordinator Appointment Prepopulated Template walks ADHD/CC through the history: SEE PRINT SCREEN ADHD/CC discusses: ADD/ADHD, Meds, Appointment expectations, goals Patient Exit Note with goals: SEE PRINT SCREEN Optional CHADIS Survey to help with ideas for specific goals: SEE PRINT SCREEN Vanderbilts Parent does on ipad: SEE PRINT SCREEN Teacher obtained to invite via CHADIS

9 In the Template: Attention Concerns: Initial Visit, History questions are prompted in the HPI and the ROS

10 On the Summary page, choose Patient Exit Note tab & click REBUILD SUMMARY to create the Exit Note to PRINT. You can see if you EDIT CRITERIA that the EXIT NOTE includes very little besides the PATIENT INSTRUCTIONS

11 If the parent is struggling with ideas re: what goals to set, The Alternate Order exists to send the Survey to the Portal. If you are prepared to invite the Teacher you can order that task too

12 Here a task has been assigned to Annika Skywalker s account to complete the survey for Chewbacca

13 Diagnosis and the Care Coordinator 2. Receipt of documents Permission for teacher: HIPAA Vanderbilts scored MANUALLY added to diagnostic tests: SEE PRINT SCREEN Create Review of Forms Encounter with the scoring: SEE PRINT SCREEN Call patient and schedule IPSD appt, 1 week phone f/u AND 2 week f/u appt: SEE PRINT SCREEN

14 Vanderbilt scores are manually transcribed into diagnostic tests in order to track more easily under the cross-tab function.

15 The Review of Forms Template prompts for documentation in the Assessment; and a place to document the dates of follow up appts

16 The 3 standing orders to schedule the Next 3 appointments are standing orders In the Review of Forms template

17 Initial Appointment: Index Prescribing Start Date ADHD 1 st Doctor Visit Template Include Assessment from ADHD/CC Review of Forms Copy from previous encounters or phone message: SEE PRINT SCREEN ROS: Just positives or all Plan or Patient Instructions Goals discussed over the phone but documented in the previous encounter Prescriptions written Template Pick List Common Med Favorites Write it for ONLY 3 weeks Exit Note given with Goals Standing orders for Reception to CONFIRM remaining 2 appointments For ADHD Coordinator: Phone f/u 1 week For Physician: Recheck in < 30 days

18 I have selected this encounter to copy but exclude the negative ROS I will next click the Apply to Current Encounter button You can include the information from previous encounters by clicking on the Prior Notes tab

19 I can choose what components of the previous encounter I want to include

20 Follow up in < 30 days ADHD/CC Phone follow up at 1 week Success with Goals? Medication: Side effects? Adjustments? Start a future-dated appt with above update for use at next appt: SEE PRINT SCREEN Or document a phone call as an encounter < 30 Day Appt with PCP Prescription Rx s for now and one month from now Onus is on the patient for refills Follow up Standing ADHD Care Coordinator: Phone f/u 2 months Alternate Order for ADHD/CC phone f/u in 1 week Alternate Order for Physician f/u in 2 weeks

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22 Ensuring refills Providing multiple Rx s at one time: SEE PRINT SCREEN In Michigan: Have 60 days to fill a Rx for a controlled substance Must have different Rx numbers so need to be separate Rx s Need a fill date written for the Rx that is NOT intended to be filled the day it s written Patient responsible for requesting refills every 2 months With refill request for months 5 & 6 Confirm ADHD/CC has a task to Initiate the f/u process

23 We have defined 2 different User-Assigned Titles for each ADHD medication. One medication has NTF for Not To Fill until: which is written in the 2 nd line of the Rx. A patient will receive 2 Rx s, one will have a handwritten (or typed) date for when it should be filled

24 These 2 Rx s will be printed in the 4-to-a-page format by clicking The dropdown box next to the print icon

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26 Follow Up Appointments in days For HEDIS: Need two visits in this timeframe Multiple options One visit can be a phone call needs to be RN or higher Group Visit Telemedicine Prepare for the visit with an ADHD/CC phone call Start the Encounter with the history taken via phone Update the goals Invite the teacher via CHADIS

27 Ongoing ADHD Management ADHD/CC 150 day reminder serves to: Confirm appt is scheduled SEE PRINT SCREEN Send Surveys to Portal, CHADIS ADHD/CC calls 1 month prior to appt review: meds, goals Or start an Update to ADHD Care Plan Encounter

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29 A task is put in the chart 5 months into the future to the ADHD/CC to start the process of preparing for the next ADHD visit. This task will not be visible to the ADHD/CC on her to do list until it is past due.

30 Capturing your ADHD Registry OP Care Plans Spreadsheet Demographic Analysis / Recall Run Report for: Diagnosis of ADHD (all the SNOMED Codes) Medications last visit / next visit Phone visit

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34 Meeting the Guidelines ADHD/CC reviewing the Registry Prioritize those closest to not meeting the Guidelines Put a reminder in the chart Use Message Exchange Personal phone calls Capture an ADHD visit if time permits Red Flag reminder: Task for Pop up misc note Generate a Recall Report Review ADHD at their Well Check Ups If stable If med changes needed ADHD Encounter with modifier

35 Good ADHD Care Providing an Exit Note Meds Objective criteria Setting goals CHADIS Were they achieved? New goals Smart surveys Improvement over time Quick response when problems arise Appointments CHADIS Knowing the patients

36 Other ideas to help manage ADHD Group Visits Telemedicine Routing ADHD calls to ADHD Care Coordinator CHADIS Surveys for: QI process Use for MOC Vanderbilt Parent & Teacher Initial Parent & Teacher follow up Goals

37 LIVE Examples Initial Patient seeing Care Coordinator Review of Forms Visit IPSD Visit Follow up Visit Medication / Refill prescribing Recall report CHADIS

38 Glossary of Terms ADHD/CC: ADHD Care Coordinator CHADIS: Child Health and Assessment Interactive System Online tool for survey administration and scoring FHPA: Forest Hills Pediatric Associates HEDIS: Healthcare Effectiveness Data and Information Set IPSD: Index Prescribing Start Date MOC: Maintenance of Certification NCQA: National Committee for Quality Assurance QI: Quality Initiative