Interstate Variation in Healthcare Utilization Among Children with ASD

描述（由申请人提供）：本R01申请旨在支持开展一项大型国家研究，该研究将全面确定州一级自闭症相关政策对自闭症谱系障碍（ASD）儿童公共资助医疗保健利用的影响。该研究的三个主要目的是：1)对可能影响ASD儿童医疗补助报销医疗服务的州政策和做法进行深入检查；2)提供准确的国家和州一级的ASD儿童公费医疗保健利用估计；3)研究人口学、临床和护理系统特征对相关服务使用的类型、强度和模式的相对贡献。为了实现这些目标，我们将审查和编码所有相关的州一级政策文件，以确定每个州的ASD公共资助医疗服务提供系统。我们将通过与负责自闭症相关健康服务的州行政人员的访谈来补充这次普查。最近一年的可用医疗补助申请将用于衡量国家和州一级的服务利用率和相关支出。然后，我们将研究国家政策、学区、家庭和儿童特征与服务利用的独立关联。这些发现将为各州为越来越多的自闭症儿童制定适当的护理标准和相关政策提供关键信息，并可能导致改善护理的政策模式。这项研究将为未来的研究奠定基础，在未来的研究中，来自其他系统的服务利用数据和关于家庭经验和结果的主要数据将与医疗保健数据联系起来。这项研究还将为衡量未来系统级干预措施的效果提供一个基线。最后，研究结果将为一个概念框架提供证据，以了解各州如何解决慢性残疾儿童的需求，在这种情况下，最佳治疗方案和预期结果是不确定的。

DESCRIPTION (provided by applicant): This R01 application seeks support to conduct a large national study that will comprehensively identify the impact of state level autism-related policies on the publicly funded healthcare utilization of children with autism spectrum disorders (ASD). The three primary aims of the study are to 1) conduct an intensive examination of state policies and practices that may affect Medicaid-reimbursed healthcare delivery to children with ASD; 2) provide accurate national and state-level estimates of publicly-funded healthcare utilization among children with ASD; and 3) examine the relative contribution of demographic, clinical and system-of-care characteristics on the types, intensity and patterns of related service use. To accomplish these aims, we will review and code all relevant state-level policy documents to define the publicly funded healthcare service delivery system for ASD in each state. We will supplement this census through interviews with state administrators responsible for ASD-related health services. This most recent year of available Medicaid claims will be used to measure service utilization and associated expenditures at the national and state levels. We will then examine the independent associations of state policies, and school district, family and child characteristics with service utilization. These findings will provide critical information to states as they develop appropriate standards of care and related policies for the growing number of children diagnosed with ASD, and will potentially lead to policy models that improve care. This study will set the stage for future studies in which service utilization data from other systems and primary data about families' experiences and outcomes are linked to data on healthcare. The study also will provide a baseline against which to measure the effects of future system-level interventions. Finally, the results will provide evidence for a conceptual framework for understanding how states address the needs of children with chronic disabilities in which the best course of treatment and expected outcomes are uncertain.