Timing and Intensity of Early Intervention Service Use and Outcomes Among a Safety-Net Population of Children
Timing and Intensity of Early Intervention Service Use and Outcomes Among a Safety-Net Population of Children
复制标题
DOI：
10.1001/jamanetworkopen.2018.7529
复制
发表时间：
2019-01-01
影响因子：
13.8
通讯作者：
Morrato, Elaine H.
中科院分区：
文献类型：
--
作者：
McManus, Beth M.;Richardson, Zachary;Morrato, Elaine H.
重要性 联邦针对每个儿童的早期干预 (EI) 拨款有所下降，而改善儿童发展和功能的责任却有所增加。了解高价值的 EI 服务和系统至关重要。目的 检验 EI 服务的及时性和强度，以及服务强度和结果之间的关联。设计、设置和参与者 这项二次数据分析队列研究将 2014 年 10 月 1 日至 2016 年 9 月 30 日的儿科初级保健电子健康记录和 EI 计划记录联系起来。样本来自大型城市安全网卫生系统和 EI 计划，年龄小于 35 个月，检查发育障碍或发育迟缓。数据分析于 2017 年 12 月 15 日至 2018 年 5 月 15 日进行。 暴露 该研究包括对病情类型和严重程度、种族和民族、家庭收入、保险类型、性别、出生体重和语言的测量。 主要结果和测量 EI 的及时性（转介至 EI 护理计划的天数）、总体服务强度（每月小时数）和核心 EI 服务（物理、职业、言语治疗和发育性发育）干预）和功能改变（以 13 分制衡量）。调整后的分位数中位数回归估计了及时性和强度。调整后的线性回归估计功能变化。 结果 在接受 EI 护理计划的 722 名儿童中（接受 EI 护理计划的中位[四分位距]时间为 56.0 [1.0-111.0] 天），457 名 (63.3%) 为男性，447 名 (62.0%) 年龄小于 12 个月，207 名 (28.7%) 年龄为 12 至 24 个月， 68 名 (9.3%) 年龄为 25 至 35 个月。共有663名儿童（91.8%）的家庭年收入低于2万美元； 305 名（43%）的样本儿童在 45 天期限内接受了 EI 护理计划。 EI 强度的中位数（四分位距）为每月 2.7 (2.3-3.6) 小时。生活在联邦贫困线以上的儿童接受了更高的职业治疗强度（b，1.9；95% CI，0.9-3.0）。临床严重程度越高，越能及时收到 EI 护理计划。与婴儿相比，2 岁儿童几乎提前 2 个月接受护理计划（b，-52.0；95% CI，-79.7 至 -24.3）。在具有完整结果信息的儿童 (n = 448) 中，每月增加一小时的 EI 服务与 3 点功能增益相关 (b, 3.0; 95% CI, 1.5-5.9)。 结论和相关性 在这项研究中，较高的 EI 服务强度与更好的功能增益相关，但研究中的大多数儿童接受了延迟护理和/或低服务强度。临床和 EI 记录的联系可以作为改进 EI 流程的框架。
IMPORTANCE Federal per-child early intervention (EI) appropriations have declined, while accountability for improving children's development and function has increased. It is critical to understand high-value EI services and systems.OBJECTIVE To examine EI service timeliness and intensity, and the association between service intensity and outcomes.DESIGN, SETTING, AND PARTICIPANTS This secondary data analysis cohort study linked pediatric primary care electronic health records and EI program records from October 1, 2014, to September 30, 2016. Sample children from a large, urban safety-net health system and EI program who were younger than 35 months with a developmental disability or delay were examined. Data analysis was conducted from December 15, 2017, to May 15, 2018.EXPOSURES The study included measures of condition type and severity, race and ethnicity, family income, insurance type, sex, birth weight, and language.MAIN OUTCOMES AND MEASURES The timeliness of EI (days from referral to EI care plan), service intensity (hours per month) overall and for core EI services (physical, occupational, speech therapy, and developmental intervention), and change in function (measured on a 13-point scale). Adjusted quantile median regression estimated timeliness and intensity. Adjusted linear regression estimated change in function.RESULTS Of the 722 children who received an EI care plan (median [interquartile range] time to receive EI care plan, 56.0 [1.0-111.0] days) 457 (63.3%) were male, 447 (62.0%) were younger than 12 months, 207 (28.7%) were 12 to 24 months, and 68 (9.3%) were 25 to 35 months. A total of 663 children (91.8%) had a household income of less than $ 20 000 annually; 305 (43%) of the sample children received an EI care plan within the 45-day deadline. Median (interquartile range) for EI intensity was 2.7 (2.3-3.6) hours per month. Children living above the federal poverty threshold received greater occupational therapy intensity (b, 1.9; 95% CI, 0.9-3.0). Greater clinical severity was associated with more timely receipt of an EI care plan. Compared with infants, 2-year-old children received a care plan almost 2 months sooner (b, -52.0; 95% CI, -79.7 to -24.3). An additional hour per month of EI service was associated with a 3-point functional gain (b, 3.0; 95% CI, 1.5-5.9) among children with complete outcomes information (n = 448).CONCLUSIONS AND RELEVANCE In this study, greater EI service intensity was associated with better functional gains, yet most children in the study received delayed care and/or low service intensity. Clinical and EI record linkages could serve as a framework for improving EI processes.