Understanding Early Intervention Value: Investigating the Effect of a Statewide Care Coordination Model on EI Resource Use and Outcomes

摘要 有功能限制的婴儿和幼儿是一个重要的群体，因为他们代表了一个 普遍（即17%的儿童）和昂贵的群体，值得更多地关注基于价值的交付， 发育和治疗（即，物理治疗）服务。最常见的治疗服务提供 针对这一人群的系统是C部分早期干预（EI），花费了联邦政府4.6亿美元 2017年以家庭为中心的护理协调（FC-CC）是一项联邦EI任务，也是价值的“关键”- 基于儿科服务提供。然而，很少有人知道各州如何遵守其FC-CC授权， FC-CC如何影响EI儿童和家庭结局。我们建议填补知识空白， 使用混合方法提供和实施FC-CC。首先，我们试图了解 这是一个名为“婴儿和幼儿全球结果”（GO 4 IT）的全州EI FC-CC模型的效果。GO4IT 将家庭评估、护理规划过程、成果衡量与确定 突出的家庭需求，个性化的服务类型和强度，并改善儿童的全球措施 功能我们的定量分析将使用科罗拉多州EI行政数据库（n = 75，600）和 马萨诸塞州（78,500人），并在全州范围内实施GO 4 IT，这提供了一个 对基于价值的EI服务提供的“外生冲击”，使我们能够检查EI服务使用的变化 和GO 4 IT之前和之后的结果。GO 4 IT的实施类似于“自然实验”。 与治疗状态，科罗拉多，实施GO 4 IT在采样期间，和比较 没有这样做的州（马萨诸塞州）。我们假设GO 4 IT将导致更快的治疗成功时间 (Aim 1），更好的结果和更少的支出（目标2）相比，在MA的EI服务交付。然而，测试这个 一个假设需要检查的不仅仅是利用率、成本和结果。因此，我们的定性研究 (Aim 3）将提供一个更细致入微的图片，具体的FC-CC活动中，EI计划从事 并允许我们定义和评估具体的方法。在这样做的过程中，我们寻求提供基于证据的 建议作为EI计划的指导，努力提高他们计划的价值。在目标3中， 我们将与EI利益相关者（州EI协调员和数据管理员）进行大约30次访谈， 供应商，以及CO和MA的父母[代表每个州5-6个有影响力的EI计划集水区]， 确定FC-CC机制、成功经验和最佳做法。GO 4 IT是服务交付的一个例子 旨在最好地满足家庭需求的一揽子计划，同时也为家庭和教育机构提供信息 提供者促进家庭参与护理规划和最佳结果。鉴于缺乏 证据我们希望我们的研究提供证据，用于为未来实施家庭的努力提供信息- 中心护理协调方案。该提案符合人权事务高级专员办事处基于价值的供资优先事项 护理，包括有特殊卫生保健需要的儿童的优先人群，并与卫生 实现高价值医疗保健系统的服务研究优先事项（NOT-HS-19-011）， 对0-3岁的儿童。

Abstract Infants and toddlers with functional limitations are an important population because they represent a prevalent (i.e. 17% of children) and costly group that warrants greater attention on value-based delivery of developmental and therapeutic (i.e., physical therapy) services. The most common therapy service delivery system for this population is Part C Early Intervention (EI), which cost the federal government $460 Million in 2017. Family-centered care coordination (FC-CC) is a federal EI mandate and the “lynchpin” of value- based pediatric service delivery. Yet, little is known about how states comply with their FC-CC mandate or how FC-CC influences EI child and family outcomes. We propose to fill the knowledge gaps surrounding the provision and implementation of FC-CC using a mixed methods approach. First, we seek to understand the effect of a statewide EI FC-CC model called Global Outcomes for Infants and Toddlers (GO4IT). GO4IT integrates family assessment, care planning processes, outcomes measurement with the goal of identifying salient family needs, individualizing service type and intensity, and improving global measures of child function. Our quantitative analysis will use state EI administrative databases for Colorado (n≈ 75,600) and Massachusetts (n≈ 78,500) and is in the context of state-wide implementation of GO4IT, which provide an “exogenous shock” to value-based EI service delivery that allows us to examine changes in EI service use and outcomes before and after GO4IT. The implementation of GO4IT is analogous to a “natural experiment” with a treatment state, Colorado, which implemented GO4IT during the sample period, and a comparison state which did not (Massachusetts). We hypothesize that GO4IT will result faster time to treatment success (Aim 1), better outcomes and less spending (Aim 2) compared to EI service delivery in MA. Yet, testing this hypothesis requires an examination of more than utilization, cost, and outcomes. Thus, our qualitative study (Aim 3) will provide a more nuanced picture of specific FC-CC activities in which EI programs are engaged and allow us to define and assess specific approaches. In doing so we seek to provide evidenced-based recommendations as a guide for EI programs who strive to improve the value of their programs. In Aim 3, we will conduct about 30 interviews with EI stakeholders (state EI coordinator and data manager, EI providers, and parents in CO and MA [representing 5-6 influential EI program catchment areas per state] to determine FC-CC mechanisms, successes, and best practices. GO4IT is one example of a service delivery package designed to best meet the needs of families while also providing information for families and EI providers to promote family engagement in care planning and optimal outcomes. Given the dearth of evidence we hope our study provides evidence that is used to inform future efforts to implement family- centered care coordination programs. The proposal aligns with AHRQs funding priorities of value-based care, includes the priority population of children with special health care needs, and aligns with the Health Services Research Priorities for Achieving a High Value Healthcare System (NOT-HS-19-011) with a focus on children ages 0-3.