TENNCARE GAPS FOR CHILDREN: ASTHMA CLINICAL OUTCOMES

改善哮喘儿童的护理是一个国家 儿童哮喘被纳入健康教育计划， 儿童2000年目标（目标11.1：减少哮喘住院）。 某些 已知儿童群体处于不良哮喘结果的高风险中， 包括导致急诊室就诊的急性加重， 住院和死亡。 这些孩子在不良后果的高风险 包括城市环境中的儿童、少数民族和贫困儿童， 传统上由医疗补助计划服务的人群。 在以前的研究中， 精心管理，包括患者教育，书面哮喘计划， 哮喘药物的直接使用已被证明可以改善临床结果 哮喘儿童的情况。 然而，缺乏获得保健的机会威胁着一个国家的安全。 儿童接受经证明有效的干预措施的潜力， 威胁临床结果的改善。 对于入学的高危儿童 在医疗补助计划中，注册人数的缺口是获得医疗服务的一个潜在威胁。 拟议的研究旨在量化入学差距的影响， 田纳西州的哮喘儿童医疗补助计划使用两种临床 结果：急诊就诊和哮喘住院。 一 历史队列研究将使用长期的田纳西州 医疗补助研究数据库。 该队列将包括儿童会议 根据哮喘的卫生保健接触和填充的哮喘定义 哮喘药的处方 多变量负二项 社会人口学特征与哮喘的回归控制 严重程度将用于确定急诊就诊率 或住院治疗对于入学率有差距的儿童来说更大， 孩子们没有入学的差距。 这项评估将提供急需的 关于具体政策或缺乏政策的影响的信息（即 确保患有某些慢性疾病的儿童继续入学） 患有最常见的慢性疾病之一的高危儿童的临床结果 童年的健康状况。 评价也将普遍提高 了解对卫生保健获取的威胁如何潜在地影响 儿童高危人群的临床结局。

Improving the care of children with asthma is a national priority, evidenced by the inclusion of childhood asthma in the Healthy Children 2000 goals (Goal 11.1: reduce asthma hospitalizations). Certain groups of children are known to be at high risk for adverse asthma outcomes, which include acute exacerbations leading to emergency department visits, hospitalizations, and death. These children at high risk of adverse outcomes include children in urban settings, minorities, and poor children, the same populations traditionally served by Medicaid programs. In previous studies, careful management, involving patient education, written asthma plans, and directed use of asthma medications has been shown to improve clinical outcomes of children with asthma. However, lack of access to health care threatens a child s potential to receive proven effective interventions, which in turn threatens improvements in clinical outcomes. For high-risk children enrolled in Medicaid, gaps in enrollment are one potential threat to access to care. The proposed study is designed to quantify the effect of gaps in enrollment in Tennessee's Medicaid program for children with asthma using two clinical outcomes: emergency department visits and hospitalizations for asthma. A historical cohort study will be conducted using a long-standing Tennessee Medicaid research database. The cohort will include children meeting definitions of asthma based on health care encounters for asthma and filled prescriptions for asthma medications. Multivariate negative binomial regression controlling for sociodemographic characteristics and asthma severity will be used to determine if the rate of emergency department visits or hospitalizations is greater for children experiencing gaps in enrollment or children without gaps in enrollment. This evaluation will provide much needed information on the effects of specific policies or lack of policies (i.e. to ensure continuous enrollment for children with certain chronic illnesses) on clinical outcomes for high-risk children having one of the most common chronic health conditions in childhood. The evaluation will also increase general understanding of how threats to health care access potentially influence clinical outcomes in high-risk populations of children.