ACCESS AND QUALITY OF CARE FOR LOW-INCOME ADOLESCENTS

第二十一条倡议是州和联邦为无保险、合法收入的儿童和青少年提供保险的最大努力之一，其中大多数人将被安置在某种管理式护理安排中。 评估这些青少年计划的卫生保健质量至关重要，因为青少年有独特的卫生保健需求，但面临许多障碍，以获得针对这些需求的卫生保健。 虽然大多数青少年是健康的，但越来越多的青少年正在从事具有潜在有害健康影响的冒险行为，如无保护的性活动和药物使用。 其他人有慢性健康问题。 拟议的研究的主要目的是评估儿童保健，佛罗里达的儿童健康保险计划的组织功能的影响，对获得和提供初级和预防保健的青少年，年龄12至19岁。被诊断为有危险行为的青少年和患有慢性疾病的青少年将被包括在内。 我们将评估KidCare计划组成部分的组织特征以及参与MdCare青少年初级和预防保健的不同MCO和提供者实践。 KidCare计划提供了一个独特的机会，可以研究15个不同的MCO和保险公司，以及不同的提供者实践和超过65，000名青少年。 在本研究中，我们将研究以下组织特征：1。一般组织特征，2。推广的营销和教育战略，3。与初级保健提供者的财务安排，4。控制成本的非财务安排，5。质量保证体系，6。青少年健康和护理协调方案的存在，以及7。使用技术系统。 护理的以下结果包括：遵守预防性卫生保健指南，卫生保健使用和支出，健康状况，缺课，未满足的需求，对护理的满意度，以及自付卫生保健支出。 该研究设计是准实验性的，在两年的时间内前瞻性地收集数据。 为了进行这项研究，我们将使用丰富的数据集，涵盖了一系列的青少年谁是登记在与佛罗里达的标题二十一倡议相关的各种管理式护理安排。 这些数据集包括个人层面的医疗保健使用和登记数据，并辅以电话调查数据。

The Title XXI initiative represents one of the largest state and federal efforts to provide insurance coverage for uninsured, law-income children and adolescents, the majority of whom will be placed in some type of managed care arrangement. Assessing health care quality in these programs for adolescents is critical because adolescents have unique health care needs; yet face many barriers to obtaining health care that is targeted toward those needs. While most adolescents are healthy, an increasing number are engaging in risk-taking behaviors that have potentially deleterious health effects, such as unprotected sexual activity and substance use. Others have chronic health conditions. The primary aim of the proposed research is to assess the effects of the organizational features of KidCare, Florida's children's health insurance program, on access to and provision of primary and preventive care for enrolled adolescents, ages 12 to 19. Adolescents with diagnoses that are indicative of risky behaviors and those with chronic conditions will be included. We will assess the organizational features of the KidCare Program components and the different MCOs and provider practices participating in MdCare on adolescents' primary and preventive care. The KidCare Program presents a unique opportunity to study 15 different MCOs and insurers, with diverse provider practices, and over 65,000 adolescents. In the proposed research, we will study the following organizational characteristics: 1. General organizational characteristics, 2. Marketing and educational strategies for outreach, 3. Financial arrangements with primary care providers, 4. Non-financial arrangements to control costs, 5. Quality assurance approaches, 6. Presence of adolescent wellness and care coordination programs, and 7. Use of technology systems. The following outcomes of care are included: compliance with preventive health care guidelines, health care use and expenditures, health status, missed school days, unmet need, satisfaction with care, and out-of-pocket spending for health care. The research design is quasi-experimental, with data collected prospectively over a two year period. To conduct this study, we will use rich data sets covering a range of adolescents who are enrolled in diverse managed care arrangements associated with Florida's Title XXI initiative. These data sets include person-level health care use and enrollment data supplemented with telephone survey data.