QUALITY OF CARE FOR CHILDREN WITH SPECIAL NEEDS IN MC

人们对接受特殊医疗护理的儿童提出了许多关切 需求(CSHCN)在注册时将面临获得医疗服务的限制 管理医疗计划，其中医疗保健使用、成本和专科使用 严格控制，可能导致不利的健康后果。 这些担忧在很大程度上是基于轶事和管理的影响 对CSHCN的护理质量的关注是未知的。的主要目的是 建议的研究是为了评估选定的组织的效果 九种不同管理型护理组织在流程上的特点 以及对有特殊卫生保健需要的儿童的护理结果。这些 9名MCO正在参与佛罗里达州的健康儿童计划， 全州范围内旨在为未参保儿童提供保险的倡议 他们没有医疗补助资格，而且他们的父母负担不起私立 保险公司。其次，CSHCN的护理过程和结果 哪些人参加了佛罗里达医疗补助计划或参加了以下五项中的一项 将对不同的商业MCO进行评估。因为CSHCN通常需要 来自多个提供商的服务，这些MCO组织功能 很可能对S接触到的孩子影响最大 儿科医生和专家以及对儿童的护理协调 被选为研究纳入对象。以下是组织机构 建议的研究包括以下特点：1. 提供商网络；2.使用事前授权程序 专科转诊，3.疾病管理的存在和类型 程序，以及4.MCO的所有权状态。护理质量将 为患有哮喘、糖尿病和CSHCN的儿童评估不同的 按其功能状态汇总的条件。以下是 保健结果包括：保健使用和支出， 特殊医疗保健使用情况、健康状况、缺课天数以及 限制活动天数。一些疾病特有的结果也是 包括在内。研究设计为准实验设计，数据为 预期在两年内收集。为了进行这项研究， 我们将使用涵盖一系列已注册CSHCN的丰富数据集 在不同的管理性护理安排中。这些数据集包括个人- 分级医疗使用和登记数据并辅之以电话 S少年儿童健康状况调查及病案复核信息 和功能状态。

Many concerns have been raised that children with special health care needs (CSHCN) will face restricted access to care when enrolled in managed care plans where health care use, costs, and speciality use are strictly controlled, potentially resulting in adverse health outcomes. These concerns are largely based on anecdote and the effect of managed care on the quality of care for CSHCN is unknown. The primary aim of the proposed research is to assess the effect of selected organizational features of nine different managed care organizations on the processes and outcomes of care for children with special health care needs. These nine MCOs are participating in the Florida Healthy Kids Program, a statewide initiative designed to provide coverage to uninsured children who are not Medicaid eligible and whose parents cannot afford private insurance. Secondarily, the processes and outcomes of care for CSHCN who are enrolled in the Florida Medicaid Program or in one of five different commercial MCOs will be assessed. Because CSHCN often require services from multiple providers, those MCO organizational features that are likely to have the greatest impact on the children s access to pediatricians and specialists and on care coordination for the children were selected for study inclusion. The following organizational features are included in the proposed research: 1. Characteristics of the provider network; 2. The use of prior authorization procedures for speciality referrals, 3. Presence and type of disease management programs, and 4. The ownership status of the MCO. Quality of care will be assessed for children with asthma, diabetes, and CSHCN with varying conditions aggregated by their functional status. The following outcomes of care are included: health care use and expenditures, specialty health care use, health status, missed school days, and restricted activity days. Some disease-specific outcomes also are included. The research design is a quasi-experimental design, with data collected prospectively over a two year period. To conduct this study, we will use rich data sets covering a range of CSHCN who are enrolled in diverse managed care arrangements. These data sets include person- level health care use and enrollment data supplemented with telephone survey and medical record review information about the children s health and functional status.