Exploring the Impact of Pediatric Behavioral Health Screening on Health Care Use

描述（由申请人提供）：儿童精神疾病的患病率日益增加，这要求儿科医生提高对行为健康（BH）问题的检测，以识别以前未识别的儿童，并促进进入心理健康治疗。然而，很少有人知道的影响，儿科BH筛选卫生保健利用和精神药物的使用。扩大这方面的知识是至关重要的，为制定筛查计划和评估其成本效益。为此，本研究将探讨儿科BH筛查的实施与BH和非BH护理使用的数量和质量之间的关系。 本研究的具体目的是：1）评估健康儿童访视时BH筛查的影响（6.5至16.5奥尔兹）对保健服务使用的数量和质量的影响（初级保健，门诊，住院和急诊部门BH和非BH访问）和精神药物的使用在剑桥健康联盟（CHA）系统和全州的医疗补助儿童和青少年;和2）确定种族/民族的程度，年龄和社会经济（SES）差异对BH筛查对医疗保健使用的数量和质量的影响（初级保健、门诊、住院和急诊科BH和非BH就诊）和精神药物。 为了实现这些目标，我们提出了一个创新的，探索性的，以人口为基础的，纵向研究采用中断时间序列（ITS）设计，以检查BH和非BH医疗保健的人口利用率的变化后，在两个环境中实施BH筛选：CHA-一个当地的安全网系统和全州的医疗补助保险儿童。我们将在健康儿童访视时使用儿科症状自评量表（PSC）分析在BH筛查开始前后来自CHA 4家诊所的现有数据。CHA于2003年开始筛查，比全州强制筛查早4年。然后，为了验证这些发现，我们将使用马萨诸塞州的医疗补助行政索赔数据，在2008年Rosie D诉Romney诉讼补救措施之前和之后，该补救措施要求在儿科预防性就诊时进行全州范围的BH筛查，以及不需要强制筛查的纽约的对照州。分析的结合将提供一套跨越多个人群和支付者的结果，从而提供一种创新的方法，以最大限度地减少固有的偏见，最大限度地提高优势和普遍性。 认识到功能障碍、症状披露和筛查项目解释的阈值可能因种族和其他群体而异，我们将按种族/人种、SES和年龄检查BH筛查和使用之间的关系。我们将使用相同的数据集并进行分层ITS分析。 总的来说，这项研究的意义在于它对儿童心理健康政策和初级保健实践的影响。这项调查将产生的结果有可能 在全国范围内为儿童行为健康筛查提供信息，同时为以下方面提供重要数据： 未来的儿童心理健康干预。 公共卫生相关性：儿童和青少年的行为健康问题往往得不到治疗，或者在早期治疗很久之后才被发现。这项研究有可能提高青年行为健康问题的早期发现和有效治疗。通过探索筛查对未来治疗和其他医疗保健用途的影响，这项研究将为行为健康筛查计划的发展提供信息，包括针对种族和民族多样化人群的计划。

DESCRIPTION (provided by applicant): The increasing prevalence of mental illness in children requires that pediatricians improve detection of behavioral health (BH) problems to identify previously unidentified children and facilitate entry into mental health treatment. Yet, little is known about the impact of pediatric BH screening on health care utilization and psychotropic medication use. Expanding this knowledge is critical to informing the development of screening programs and assessing their cost effectiveness. Towards this end, the study will explore the relationship between implementation of pediatric BH screening and the quantity and quality of BH and non-BH care use. The specific aims of the study are:1) To evaluate the impact of BH screening at the well-child visit (6.5 to 16.5 year olds) on the quantity and quality of health care use (primary care, ambulatory, in-patient and emergency department BH and non-BH visits) and psychotropic medication use in the Cambridge Health Alliance (CHA) system and state-wide among Medicaid children and adolescents; and 2) To determine the magnitude of racial/ethnic, age and socio-economic (SES) differences regarding the impact of BH screening on the quantity and quality of health care use (primary care, ambulatory, in-patient and emergency department BH and non-BH visits) and psychotropic medication in the same systems. To achieve these aims, we propose an innovative, exploratory, population-based, longitudinal study using an interrupted time series (ITS) design to examine changes in population utilization rates of BH and non-BH health care after the implementation of BH screening in two environments: CHA-a local safety-net system-and statewide among Medicaid insured children. We will analyze existing data from 4 clinics of CHA prior to and following initiation of BH screening with the Pediatric Symptom Checklist (PSC) at well child visits. CHA initiated screening in 2003 - 4 years prior to statewide mandatory screening. Then to validate these findings, we will use Medicaid administrative claims data for Massachusetts, prior to and following the Rosie D vs. Romney lawsuit remedy in 2008, which mandated statewide BH screening at pediatric preventive visits, and the control state of New York where no mandatory screening is required. The combination of analyses will provide a set of results spanning multiple populations and payers thus offering an innovative approach to minimizing inherent biases and maximizing strengths and generalizability. Recognizing that thresholds for dysfunction, symptom disclosure, and interpretation of screening items, may vary across ethnicities and other groups, we will examine the relationship between BH screening and utilization by ethnicity/race, SES and age. We will use the same datasets and perform stratified ITS analyses. Overall, the study's significance lies in its implications for child mental health policy and primary care practices. This investigation will generate results that have the potential to inform child behavioral health screening practices nationally while providing important data for future child mental health interventions. PUBLIC HEALTH RELEVANCE: Behavioral health problems in children and adolescents often go untreated or are recognized long after early treatment could have been available. This study has the potential to improve the early detection and effective treatment of behavioral health problems in youth. By exploring the effect screening has on future treatment and other health care use, this study will inform the development of behavioral health screening programs, including those targeting racially and ethnically diverse populations.