The Relationship Between State EPSDT Policies, Well-Child Care and Age of Autism

州 EPSDT 政策、良好儿童保育和自闭症年龄之间的关系

• 批准号: 7998056
• 负责人: Amy Marie Daniels
• 金额: $ 4.14万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-29 至 2012-06-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7998056
• 关键词: Academy; Address; Adherence; Affect; Age; Age-Years; American; Area; Autistic Disorder; Caring; Child; Child Care; Child health care; Cognition; Communities; Data; Development; Developmental Disabilities; Diagnosis; Disease; Early Diagnosis; Early identification; Early treatment; Enrollment; Foundations; Frequencies; Future; Goals; Guidelines; Health Policy; Health Services Research; Intervention; Knowledge; Medicaid; Mission; National Institute of Mental Health; Nursery Schools; Outcome; Pediatrics; Policies; Public Health; Quality of life; Recommendation; Relative (related person); Research; Research Training; Resource Allocation; Sampling; School-Age Population; Screening procedure; Services; Severities; Source; Symptoms; Time; Training Programs; Translating; Variant; career; child mental health service; dissemination research; geographic difference; health care delivery; health practice; improved; intervention program; public health relevance; public health research

DESCRIPTION (provided by applicant): The overall goal of the proposed research and training plan is to prepare the Ms. Daniels for an academic career in child mental health services research and, more specifically, to enable her to understand and study the mechanisms through which policies affect health practice and contribute to improved outcomes for children with developmental disabilities such as autism. The proposed research will be implemented in the context of a comprehensive training program that has the following objectives: 1) to develop content knowledge in the application of policy to public health research, specifically policies that affect the health care delivery and outcomes for children with developmental disabilities; 2) to develop a methodological foundation in the combined use of administrative and policy data for addressing important health policy and services research questions; and 3) to engage in the dissemination of research findings and networking with the broader child mental health services research community. Early identification of autism is critical to achieving the best possible outcomes for children; studies spanning the last few decades consistently demonstrate that intensive early-intervention programs improve cognition and reduce core symptoms of autism. Recent studies have shown that autistic disorder can be reliably diagnosed starting from when a child is two years of age; however, many children are not diagnosed until they reach school age. Delayed diagnosis translates into a missed opportunity to provide crucial services to reduce the disorder's severity and improve developmental outcomes and quality of life. While recent studies have advanced our understanding of factors that influence age of diagnosis, many identified factors are not modifiable. Previous studies have found significant geographic variation in age of diagnosis, yet have failed to identify community- or state-level factors that adequately explain this variation. Efforts to reduce age of diagnosis must be informed by a broader understanding of the mechanisms through which policies affect health practice and the extent to which health practice leads to improvements in child health outcomes. The proposed study will address these issues through the following questions: 1) To what extent do states' Early and Periodic Screening, Diagnosis and Treatment (EPSDT) policies affect child-level compliance with American Academy of Pediatrics (AAP) guidelines for well-child care?, 2) Are children with autistic disorder whose well-child care complies with AAP guidelines diagnosed earlier?,and3) Is having a usual source of care independently associated with age of diagnosis, independent of adherence to these AAP guidelines? These questions will be investigated through an in-depth examination of service use claims over the two-year period prior to diagnosis in a sample of preschool- aged children who were enrolled in Medicaid sometime between 2001 and 2005. The proposed project is aligned with the mission and objectives of the National Institute of Mental Health in that it will address research gaps relative to enhancing of services to address the diverse needs of children with autism. PUBLIC HEALTH RELEVANCE: The proposed study has the potential to affect public health policy and intervention strategies in the areas well-child care and the early detection and diagnosis of autistic disorder. This study may help to inform future recommendations related to the frequency and timing well-child care for pre-school aged children. In addition, findings may help to inform state policy decisions relative to the allocation of resources for the early detection of autistic disorder.

描述（由申请人提供）：拟议的研究和培训计划的总体目标是准备丹尼尔斯女士在儿童心理健康服务研究的学术生涯，更具体地说，使她能够理解和研究政策影响健康实践的机制，并有助于改善自闭症等发育障碍儿童的结果。拟议的研究将在一个综合培训计划的背景下实施，该计划具有以下目标：1）在公共卫生研究政策的应用中发展内容知识，特别是影响发育障碍儿童的卫生保健提供和结果的政策; 2）为行政和政策数据的综合使用奠定方法学基础，以解决重要的卫生政策和服务研究问题;以及3）参与研究成果的传播，并与更广泛的儿童心理健康服务研究界建立联系。 自闭症的早期识别对于儿童获得最佳结果至关重要;过去几十年的研究一致表明，密集的早期干预计划可以改善认知并减少自闭症的核心症状。最近的研究表明，自闭症可以从孩子两岁开始可靠地诊断;然而，许多孩子直到学龄才被诊断出来。延迟诊断意味着错过了提供关键服务的机会，以降低疾病的严重程度，改善发育结果和生活质量。虽然最近的研究促进了我们对影响诊断年龄的因素的理解，但许多确定的因素是不可改变的。以前的研究发现，诊断年龄存在显著的地理差异，但未能确定社区或州一级的因素，充分解释这种变化。在努力降低诊断年龄的同时，必须更广泛地了解政策影响卫生实践的机制以及卫生实践在多大程度上改善儿童健康结果。 拟议的研究将通过以下问题解决这些问题：1）各州的早期和定期筛查、诊断和治疗（EPSDT）政策在多大程度上影响儿童对美国儿科学会（AAP）儿童保健指南的依从性？2)其良好儿童护理符合AAP指南的自闭症儿童是否会被早期诊断出来？，和3）是否有一个通常的护理来源独立相关的诊断年龄，独立于遵守这些AAP指南？这些问题将通过对2001年至2005年期间某个时候参加医疗补助计划的学龄前儿童样本在诊断前两年期间的服务使用索赔进行深入检查来调查。拟议的项目与国家精神卫生研究所的使命和目标相一致，因为它将解决与加强服务以满足自闭症儿童的各种需求有关的研究差距。 公共卫生关系：这项研究有可能影响公共卫生政策和干预策略，在儿童保健和自闭症的早期发现和诊断领域。这项研究可能有助于告知未来的建议有关的频率和时间良好的儿童保育学龄前儿童。此外，研究结果可能有助于为国家政策决策提供有关自闭症早期检测资源分配的信息。