ACCESS AND QUALITY OF CARE FOR LOW-INCOME ADOLESCENTS

第21条倡议代表了州和联邦政府为没有保险的合法收入儿童和青少年提供保险的最大努力之一，他们中的大多数人将被安置在某种类型的管理式医疗安排中。评估这些青少年项目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；然而，在获得针对这些需求的卫生保健方面面临许多障碍。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，例如无保护的性活动和吸毒。其他人有慢性健康问题。拟议研究的主要目的是评估KidCare（佛罗里达州儿童健康保险计划）的组织特征对12至19岁登记的青少年获得和提供初级和预防性保健的影响。被诊断出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项目组成部分的组织特征，以及参与MdCare青少年初级和预防性护理的不同mco和提供者的做法。儿童护理计划提供了一个独特的机会，研究15个不同的mco和保险公司，有不同的提供者实践，超过65,000名青少年。在拟进行的研究中，我们将研究以下组织特征：1。2.组织总体特征；营销和教育策略外展，3。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；质量保证方法；青少年健康和护理协调项目的存在；技术系统的使用。保健的下列结果包括：遵守预防性保健指南、保健使用和支出、健康状况、缺课天数、未满足的需求、对保健的满意度和自费保健支出。研究设计是准实验的，在两年的时间里前瞻性地收集数据。为了进行这项研究，我们将使用丰富的数据集，涵盖一系列青少年，这些青少年参加了与佛罗里达州第21条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.