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: 8205431
• 负责人: Amy Marie Daniels
• 金额: $ 3.11万
• 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 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8205431
• 关键词: Academy; Accident and Emergency department; Accounting; Address; Adherence; Adolescence; Adult; Affect; Age; Age-Years; American; Area; Autistic Disorder; Caring; Characteristics; Child; Child Care; Child health care; Chronic; Clinical Practice Guideline; Cognition; Communities; Congresses; Data; Detection; Development; Developmental Delay Disorders; Developmental Disabilities; Diagnosis; Disease; Early Diagnosis; Early identification; Early treatment; Education; Enrollment; Foundations; Frequencies; Funding; Future; Goals; Guidelines; Health; Health Policy; Health Services; Health Services Research; Health system; Healthcare; Hospitalization; Incentives; Individual; Intellectual functioning disability; Intervention; Knowledge; Lead; Life; Link; Medicaid; Methods; Mission; National Institute of Mental Health; Nursery Schools; Outcome; Patients; Pediatrics; Periodicity; Play; Policies; Population Heterogeneity; Preventive; Public Health; Quality of Care; Quality of life; Recommendation; Relative (related person); Research; Research Training; Resource Allocation; Role; Sampling; Schedule; School-Age Population; Schools; Screening procedure; Services; Severities; Single-Payer System; Source; Strategic Planning; Symptoms; Time; Training Programs; Translating; United States; Vaccination; Variant; Visit; aged; career; child mental health service; child well being; disability; dissemination research; geographic difference; health care delivery; health practice; improved; improved functioning; intervention program; public health research; treatment program

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.

说明(申请人提供)：拟议的研究和培训计划的总体目标是为丹尼尔斯女士在儿童心理健康服务研究方面的学术生涯做好准备，更具体地说，使她能够了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。拟议的研究将在综合培训计划的背景下实施，该计划有以下目标：1)发展将政策应用于公共卫生研究的内容知识，特别是影响发育障碍儿童的保健提供和结果的政策；2)发展综合使用行政和政策数据的方法基础，以解决重要的卫生政策和服务研究问题；以及3)参与传播研究结果并与更广泛的儿童心理健康服务研究界建立网络联系。及早识别自闭症对于为儿童取得可能的最佳结果至关重要；过去几十年的研究一直表明，密集的早期干预计划可以改善认知，减少自闭症的核心症状。最近的研究表明，自闭症从儿童两岁开始就可以得到可靠的诊断；然而，许多儿童直到学龄才被诊断出来。延误的诊断意味着错过了提供关键服务的机会，以减轻疾病的严重程度，改善发展结果和生活质量。虽然最近的研究提高了我们对影响诊断年龄的因素的理解，但许多已确定的因素是不可修改的。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来充分解释这种差异。降低诊断年龄的努力必须更广泛地了解政策影响保健做法的机制，以及保健做法在多大程度上改善儿童的健康结果。这项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)儿童护理指南的遵从性？2)儿童护理良好符合AAP指南的自闭症儿童是否较早得到诊断？3)通常的护理来源是否独立于诊断年龄，独立于对这些AAP指南的遵守？这些问题将通过对2001年至2005年期间参加医疗补助的学龄前儿童的样本进行诊断前两年内服务使用索赔的深入审查来调查。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不同需求有关的研究差距。