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

描述(申请人提供)：儿童精神疾病的日益流行要求儿科医生改进对行为健康(BH)问题的检测，以识别以前身份不明的儿童，并促进进入精神健康治疗。然而，对儿科BH筛查对医疗保健利用和精神药物使用的影响知之甚少。扩大这方面的知识对于指导筛查计划的发展和评估其成本效益至关重要。为此，这项研究将探索儿科BH筛查与BH和非BH护理使用的数量和质量之间的关系。这项研究的具体目的是：1)评估在健康儿童(6.5至16.5岁)就诊时对剑桥健康联盟(CHA)系统和全州医疗补助儿童和青少年的卫生保健使用(初级保健、门诊、住院和急诊BH就诊)和精神药物使用的数量和质量的影响；以及2)确定种族/民族、年龄和社会经济(SES)差异对相同系统中的卫生保健使用(初级保健、门诊、住院和急诊科BH和非BH就诊)和精神药物使用的数量和质量的影响。为了实现这些目标，我们提出了一项创新的、探索性的、以人群为基础的纵向研究，使用中断时间序列(ITS)设计来检查在两种环境中实施BH筛查后BH和非BH卫生保健的人口利用率的变化：CHA-本地安全网系统-以及全州范围内的医疗补助参保儿童。我们将分析4家CHA诊所在儿童就诊时使用儿科症状检查表(PSC)开始BH筛查之前和之后的现有数据。CHA在2003年开始筛查--比全州范围的强制性筛查早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管理索赔数据，在2008年Rosie D vs.Romney诉讼补救措施之前和之后，该诉讼补救措施强制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对照纽约州。分析的结合将提供一套跨越多个人口和付款人的结果，从而提供一种创新的方法，最大限度地减少固有偏见，最大限度地发挥优势和推广能力。认识到功能障碍的阈值、症状披露和筛查项目的解释可能因种族和其他群体而异，我们将按种族/种族、社会经济地位和年龄检查BH筛查和利用之间的关系。我们将使用相同的数据集，并对其进行分层分析。总体而言，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。这项调查将产生具有潜力的结果 向全国儿童行为健康筛查实践提供信息，同时为 未来儿童心理健康干预。

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.