ACCESS AND QUALITY OF CARE FOR LOW-INCOME ADOLESCENTS

第 XXI 条倡议是州和联邦为未投保、有合法收入的儿童和青少年提供保险的最大努力之一，其中大多数人将接受某种类型的管理式护理安排。 评估这些计划中针对青少年的医疗保健质量至关重要，因为青少年有独特的医疗保健需求；但在获得针对这些需求的医疗保健方面面临许多障碍。 虽然大多数青少年都很健康，但越来越多的青少年从事可能对健康产生潜在有害影响的冒险行为，例如无保护的性活动和药物滥用。 其他人患有慢性健康问题。 拟议研究的主要目的是评估佛罗里达州儿童健康保险计划 KidCare 的组织特征对 12 至 19 岁登记青少年获得和提供初级和预防性护理的影响。诊断显示有危险行为的青少年和患有慢性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 青少年初级和预防性护理的不同 MCO 和提供者实践。 KidCare 计划提供了一个独特的机会来研究 15 家不同的 MCO 和保险公司、不同的提供者实践以及超过 65,000 名青少年。 在拟议的研究中，我们将研究以下组织特征：1.一般组织特征，2.外展营销和教育策略，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.质量保证方法，6.青少年健康和护理协调计划的存在，以及7.技术系统的使用。 包括以下护理结果：遵守预防性医疗保健指南、医疗保健使用和支出、健康状况、缺课、未满足的需求、对护理的满意度以及自付费用的医疗保健支出。 该研究设计是准实验性的，在两年内前瞻性地收集数据。 为了进行这项研究，我们将使用涵盖一系列青少年的丰富数据集，这些青少年参加了与佛罗里达州第 XXI 条倡议相关的各种管理式护理安排。 这些数据集包括个人医疗保健使用情况和登记数据，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.