Provider Specialty and Receipt of Metabolic Monitoring for Children Taking Antipsychotics.
Elizabeth Shenkman, Lindsay Thompson, Regina Bussing, Christopher B Forrest, Jennifer Woodard, Yijun Sun, Jasmine Mack, Kamila B Mistry, Matthew J Gurka
Author Information
Elizabeth Shenkman: Departments of Health Outcomes and Biomedical Informatics and eshenkman@ufl.edu.
Lindsay Thompson: Pediatrics, Institute for Child Health Policy and.
Regina Bussing: Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida.
Christopher B Forrest: Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Jennifer Woodard: Departments of Health Outcomes and Biomedical Informatics and.
Yijun Sun: Departments of Health Outcomes and Biomedical Informatics and.
Jasmine Mack: Departments of Health Outcomes and Biomedical Informatics and.
Kamila B Mistry: Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland.
Matthew J Gurka: Departments of Health Outcomes and Biomedical Informatics and.
BACKGROUND AND OBJECTIVES: Metabolic monitoring is important for children taking antipsychotic medication, given the risk for increased BMI, impaired glucose metabolism, and hyperlipidemia. The purpose was to examine the influence of provider specialty on the receipt of metabolic monitoring. Specifically, differences in the receipt of recommended care when a child receives outpatient care from a primary care provider (PCP), a mental health provider with prescribing privileges, or both was examined. METHODS: Medicaid enrollment and health care and pharmacy claims data from 2 states were used in the analyses. Providers were assigned to specialties by using a crosswalk of the National Provider Identifier numbers to specialty type. A total of 41 078 children were included. RESULTS: For both states, 61% of children saw ≥1 provider type and had adjusted odds ratios for receiving metabolic monitoring that were significantly higher than those of children seeing PCPs only. For example, children seeing a PCP and a mental health provider with prescribing privileges during the year had adjusted odds of receiving metabolic monitoring that were 42% higher than those seeing a PCP alone ( < .001). CONCLUSIONS: Shared care arrangements significantly increased the chances that metabolic monitoring would be done. For states, health plans, and clinicians to develop meaningful quality improvement strategies, identifying the multiple providers caring for the children and potentially responsible for ordering tests consistent with evidence-based care is essential. Provider attribution in the context of shared care arrangements plays a critical role in driving quality improvement efforts.
