Interstate Variation in Healthcare Utilization Among Children with ASD

描述(由申请人提供)：这份R01申请寻求支持进行一项大型全国性研究，全面确定州一级自闭症相关政策对患有自闭症谱系障碍(ASD)儿童的公共资助医疗保健利用的影响。这项研究的三个主要目的是：1)对可能影响向自闭症儿童提供医疗补助报销的医疗保健服务的州政策和做法进行深入研究；2)对自闭症儿童利用公共资金的医疗保健提供准确的国家和州一级估计；3)检查人口、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，以定义每个州为ASD提供的公共资金医疗服务提供系统。我们将通过采访负责自闭症相关卫生服务的州行政人员来补充这次人口普查。最近一年可获得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。然后我们将考察国家政策的独立关联，以及学区、家庭和儿童特征与服务利用的关系。这些发现将为各州为越来越多的被诊断为自闭症的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，在这些研究中，来自其他系统的服务利用数据以及有关家庭经历和结果的原始数据将与医疗保健数据联系起来。这项研究还将提供衡量未来系统一级干预措施效果的基线。最后，研究结果将为一个概念性框架提供证据，以了解各国如何满足慢性残疾儿童的需要，在这些儿童中，最佳治疗方案和预期结果尚不确定。

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.