This section describes key drivers for improving target measure performance for the safe and judicious use of antipsychotic medications in children and adolescents. Following the key driver diagrams, additional information for each change idea and actionable pathways that support improvement are presented. In addition, summaries of measure-specific improvement strategies implemented by health plans, associated performance results, and identified facilitators and barriers to goal realization are provided.
Key Driver Diagrams for Target Measures
For each measure, a high-level hierarchical matrix diagram is presented that provides a visual representation of the desired outcome, primary drivers, secondary drivers, and associated change ideas. These key driver diagrams support the selection and implementation of change ideas for Plan-Do-Study-Act (PDSA) cycles (Institute for Healthcare Improvement (IHI)) and can be used as a roadmap to plan a QI project.
For example, once the measure of focus is selected, evaluate each primary driver to see what may be most impactful on the aim of the QI work. Once a primary driver of interest is chosen, review the more specific secondary drivers to determine which one(s) best support achievement of the desired outcome. As the direction of the QI work becomes more focused, consider the provided actionable change ideas and associated resources and tools. When clicked, the link for each change idea presented in the key driver diagrams below directs to the relevant change idea details and resources in Table 2.
Given the NCINQ learning collaborative focused primarily on performance improvement at the health plan level, the key driver diagrams and change ideas presented below largely reflect QI initiatives through the lens of health plans. However, given the complex, dynamic, and integrated nature of health delivery systems, many of the change ideas may also be applicable at the clinician or patient (e.g., youth and family) level.
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Measure
Metabolic Monitoring for Children and Adolescents on Antipsychotics Measure
Use of Multiple Concurrent Antipsychotics in Children and Adolescents Measure