ACCESS AND QUALITY OF CARE FOR LOW-INCOME ADOLESCENTS

标题XXI倡议是州和联邦政府为未参保、合法收入的儿童和青少年提供保险的最大努力之一，他们中的大多数将被置于某种类型的管理性护理安排中。评估这些青少年方案中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从事具有潜在有害健康影响的冒险行为，例如无保护措施的性行为和药物使用。其他人则有慢性健康问题。这项拟议的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岁登记的青少年获得和提供初级和预防性护理的影响。被诊断为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的不同MCO和提供者在青少年初级保健和预防保健方面的做法。KidCare计划提供了一个独特的机会来研究15个不同的MCO和保险公司，他们拥有不同的提供者实践，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。护理的结果包括：遵守预防性保健指南、保健使用和支出、健康状况、缺课天数、未得到满足的需要、护理满意度和自付保健支出。这项研究设计是准试验性的，数据是在两年的时间里预期收集的。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的第21章倡议相关的不同管理保健安排。这些数据集包括个人级别的医疗保健使用和登记数据，并辅之以电话调查数据。

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.