PREDICTING VACCINE STATUS & ED USE IN MEDICAID NEWBORNS

这一研究生涯奖的总体目标是为Evaline A.Alessandrini博士的专业、学术和研究发展做出贡献。通过将对门诊和急救服务的关注、对儿科弱势群体的坚定承诺以及儿科急救方面的专业知识结合起来，Alessandrini博士希望为儿科结果和卫生服务研究领域做出重大贡献。她计划通过一项全面的跨学科计划来实现这些目标，其中包括与J.Sanford Schwartz医学博士一起担任导师，并完成在卫生服务研究、公共政策和高级研究方法方面的正式培训和独立研究。Alessandrini博士希望利用这一奖项，在儿科成果和卫生服务研究领域确立自己的学术领袖地位。在美国，公平获得初级卫生保健是一个被证明难以实现的社会目标。尽管试图通过医疗补助和其他计划改善获得初级卫生保健的机会，但儿童的贫困仍然与医生接触减少、无法找到医疗院以及对急诊室(ED)的依赖增加有关。这位候选人之前的研究表明，与参加按服务付费的医疗补助的婴儿相比，医疗补助管理保健并没有改变一组新生儿的ED使用或免疫状态。她现在希望发展强大的卫生服务研究技能，以产生所需的知识，以更有效地改善贫困儿童的门诊护理。目前这项研究的具体目标有三个。首先，将制定临床预测规则，以确定参加医疗补助计划的新生儿有延迟接种疫苗和依赖急诊室提供门诊护理的风险。接下来，临床预测规则将在不同的人群中进行前瞻性验证，以确保它们是可用的和通用的工具。最后，将通过与病历审查的比较来评估行政索赔数据的准确性。该研究项目的广泛目标是找出使贫困儿童面临初级保健保健服务不足风险的因素，并查明这些儿童，以便采取有效的干预措施。

The overall goal of this research career award is to contribute to the professional, academic and research development of Dr. Evaline A. Alessandrini. By combining a focus on ambulatory and emergency services, a strong commitment to vulnerable pediatric populations and expertise in pediatric emergency care, Dr. Alessandrini hopes to make significant contributions to the field of pediatric outcomes and health services research. She plans to achieve these goals via a comprehensive, interdisciplinary program that includes a preceptorship with J. Sanford Schwartz, M.D., and completion of formal training and independent study in health services research, public policy and advanced research methodology. Dr. Alessandrini hopes to use this award to establish herself as an academic leader in the area of pediatric outcomes and health services research. Equitable access to primary health care is a social goal that has proved difficult to achieve in the U.S. Despite attempts to improve access to health care through Medicaid and other programs, poverty among children continues to be associated with decreased physician contacts, inability to identify a medical home and increased reliance on the emergency department (ED). The candidate's previous research demonstrated that Medicaid managed care did not alter ED use or immunization status in a cohort of newborns compared to infants enrolled in fee-for- service Medicaid. She now hopes to develop strong health services research skills to generate the knowledge required to more effectively improve ambulatory care for indigent children. The specific aims of the current study are three-fold. First, clinical prediction rules will be developed to identify Medicaid enrolled newborns at risk for delayed immunization and reliance on the ED for ambulatory care. Next, the clinical prediction rules will be prospectively validated in different populations, assuring that they are usable and generalized tools. Finally, the accuracy of administrative claims data will be assessed by comparison to medical record review. The broad goals of the research project are to delineate factors that place poor children at risk for inadequate primary care health services and to identify these children so that effective interventions may be made.