QUALITY OF CARE FOR CHILDREN WITH SPECIAL NEEDS IN MC

许多人担心，接受特殊医疗保健的儿童 需要（CSHCN）将面临有限的获得照顾时，登记参加 管理式医疗计划，其中医疗保健使用、成本和专业用途 严格控制，可能导致不良健康后果。 这些担忧在很大程度上是基于轶事和管理的影响， CSHCN的护理质量尚不清楚。 的主要目的 拟议的研究是评估选定的组织的影响， 九个不同的管理式护理组织的流程特点 对有特殊卫生保健需要的儿童的护理和结果。这些 九个MCO正在参加佛罗里达健康儿童计划， 旨在为无保险儿童提供保险的全州范围的倡议 不符合医疗补助条件且父母负担不起私人医疗费用的人 保险 其次，CSHCN的护理过程和结果 参加佛罗里达医疗补助计划或五个医疗补助计划之一的人 将评估不同的商业MCO。 因为CSHCN经常需要 来自多个提供商的服务，这些MCO组织功能， 可能对儿童获得 儿科医生和专家以及儿童护理协调 入选研究。 下列组织 本研究的特点包括：1.特性 供应商网络; 2.使用事先批准程序， 专科转诊，3.疾病管理的存在和类型 程序，4。MCO的所有权状态。 护理质量将 对患有哮喘、糖尿病和CSHCN的儿童进行评估， 按其功能状态汇总的条件。 以下 护理的结果包括：卫生保健的使用和支出， 专业医疗保健使用，健康状况，缺课日，以及 限制活动日。 一些特定疾病的结果也是 包括. 本研究设计为准实验设计， 在两年内前瞻性收集。为了进行这项研究， 我们将使用丰富的数据集，涵盖一系列CSHCN注册人员 在不同的管理式护理安排中。 这些数据集包括人- 一级卫生保健使用和登记数据，辅以电话 儿童健康调查和病历审查信息 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.