Interstate Variation in Healthcare Utilization Among Children with ASD

描述（由申请人提供）：此R 01申请寻求支持，以进行一项大型的全国性研究，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儿童（ASD）公共资助的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保健服务的国家政策和实践进行深入研究; 2）提供ASD儿童公共资助医疗保健利用的准确国家和州一级估计;以及3）研究人口统计、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。我们将通过采访负责ASD相关卫生服务的州行政人员来补充这一普查。最近一年的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的独立协会，学区，家庭和儿童的特点与服务利用。这些发现将为各州制定适当的护理标准和相关政策提供关键信息，以应对越来越多的被诊断患有ASD的儿童，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家庭经验和结果的主要数据与医疗保健数据相关联。这项研究还将提供一个基线，用以衡量今后系统一级干预措施的效果。最后，研究结果将提供证据的概念框架，了解国家如何解决慢性残疾儿童的需要，其中最佳的治疗过程和预期的结果是不确定的。

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.