For the HEDIS (Health Effectiveness Data and Information Set) SMI (Serious Mental Illness) and SUD (Substance Use Disorder) measure, if an antipsychotic is dispensed and then discontinued, does the patient remain in the denominator for that year's measurement?

HEDIS SSD Measure: Antipsychotic Discontinuation and Denominator Status

Yes, if an antipsychotic is dispensed and then discontinued, the patient remains in the denominator for that year's HEDIS SSD (Schizophrenia and Substance Use Disorder) measure.

Understanding the HEDIS SSD Measure Denominator

The HEDIS SSD measure tracks appropriate medication management for patients with serious mental illness, specifically focusing on antipsychotic medication adherence. When a patient has an antipsychotic dispensed during the measurement year:

• They enter the denominator for that measurement year
• They remain in the denominator regardless of subsequent discontinuation
• The measure evaluates whether appropriate follow-up and medication management occurred

This approach ensures accountability for monitoring patients who may be at risk after medication discontinuation, which is particularly important given the high rates of discontinuation and associated risks.

Risks of Antipsychotic Discontinuation

Discontinuation of antipsychotics carries significant clinical risks:

• 72% of patients discontinue their initial antipsychotic within the first year of treatment 1
• Mean time to discontinuation is approximately 7.2 months 1
• Discontinuation can lead to unexpected and unmonitored return of symptoms 2
• Approximately 25% of patients using antipsychotics discontinue their medication after psychiatric hospital discharge 3

Clinical Implications for Providers

Since patients remain in the denominator after antipsychotic discontinuation, providers should:

1. Document discontinuation reasons: The most common reasons for discontinuation are side effects and patient belief they no longer need medication 4

2. Implement tapering when appropriate: Gradual tapering is recommended to avoid withdrawal symptoms or rebound worsening of symptoms 2

3. Monitor for symptom recurrence: Develop a monitoring plan as symptom return may take weeks to months after discontinuation 2

4. Consider risk factors for discontinuation: Higher risk is associated with:

   • Younger age
   • Longer duration of untreated psychosis
   • Lower baseline functioning
   • Higher side effect burden 1

5. Maintain follow-up: Even after discontinuation, patients should receive appropriate follow-up care to monitor for relapse and ensure safety

Quality Measurement Considerations

The HEDIS SSD measure design reflects the importance of maintaining accountability for patients who have been prescribed antipsychotics, even after discontinuation. This approach:

• Ensures patients receive appropriate monitoring after medication changes
• Aligns with clinical guidelines that emphasize the importance of careful discontinuation processes
• Recognizes the high risk period following antipsychotic discontinuation

Common Pitfalls to Avoid

1. Assuming discontinued patients are removed from the denominator: This misconception may lead to inadequate follow-up for patients who have discontinued medication.

2. Abrupt discontinuation: Prescribers should taper medication slowly to avoid withdrawal symptoms or rebound worsening 2.

3. Insufficient monitoring after discontinuation: Patients require continued monitoring after discontinuation as symptoms may return weeks to months later 2.

4. Failing to document discontinuation rationale: Clear documentation of the clinical reasoning behind discontinuation is essential for quality care and measurement reporting.

By understanding that patients remain in the denominator for the HEDIS SSD measure after antipsychotic discontinuation, providers can ensure appropriate monitoring and follow-up care for this vulnerable population.