Examining the impact of healthcare systems changes on healthcare use and health outcomes for children in foster care

项目摘要 与同龄人相比，贫困儿童的健康状况较差;对于寄养儿童， 这些风险因虐待和家庭外安置而加剧， 和行为健康结果。寄养青年的医疗保健使用和健康结果的变化是 儿童福利制度、照顾者、儿童个人的特点和医疗保健制度。 不幸的是，医疗保健和儿童福利系统之间的沟通是脱节的， 风险和不断增加的反应性和紧急医疗保健使用。本研究的目的是评估 保健服务模式对促进青年健康的结果，并了解与 寄养儿童的医疗保健使用和健康结果的变化。提供一个全面的观点， 儿童的功能，这项研究利用了12年的儿童福利和EHR数据（N ~ 9，600例患者） 结合医疗补助索赔数据和护理人员以及一部分青年（N = 200），以实现三个目标：1）评估医疗保健提供模式对医疗保健使用和健康 寄养青少年的成果，因为：a）授权访问本身; B）初级保健，授权访问， 在同一医疗保健系统内提供的专业护理;以及c）协调信息共享， 医疗保健和儿童福利系统。2)确定医疗保健使用和健康结果变化的原因 与儿童福利制度有关的（例如，寄养状态）和照顾者特征（例如，看法 医疗保健）。3)了解儿童的特征（例如，诊断，健康风险行为，年龄，性别，种族 和种族）导致医疗保健使用和健康结果随时间的变化。这是最 全面审查迄今为止寄养青年的医疗保健使用和健康结果的驱动因素。 将针对通过该赠款确定的导致健康结果差异最大的机制 在未来的研究中，评估如何修改医疗保健提供实践和医疗保健之间的协作， 和儿童福利系统，以改善寄养青年的健康状况。通过检查医疗保健使用情况， 健康结果，我们将能够更好地阐明医疗保健系统干预措施的作用， 更好的健康成果。

Project Summary Children exposed to poverty experience poorer health compared to their peers; for children in foster care, these risks are compounded by maltreatment and out-of-home placement, resulting in even worse physical and behavioral health outcomes. Variation in healthcare use and health outcomes for foster youth is the result of the child welfare system, the caregiver, the individual child’s characteristics, and the healthcare system. Unfortunately, communication across healthcare and child welfare systems is disjointed, compounding health risk and increasing reactive and emergent healthcare use. The goals of this study are to evaluate the impact of healthcare delivery models on health outcomes for foster youth and understand factors associated with variation in healthcare use and health outcomes among children in foster care. To provide a holistic view of children’s functioning, this study leverages 12 years of linked child welfare and EHR data (N ~ 9,600 patients) in combination with Medicaid claims data and caregiver and self-reported health status for a subset of youth (N = 200) to accomplish three aims: 1) Evaluate models of healthcare delivery on healthcare use and health outcomes among foster youth as a result of: a) mandated visits alone; b) primary care, mandated visits, and specialty care delivered within the same healthcare system; and c) coordinated information sharing between healthcare and child welfare systems. 2) Identify causes of variation in healthcare use and health outcomes related to child welfare system (e.g., foster care status) and caregiver characteristics (e.g., perceptions of healthcare). 3) Understand how child characteristics (e.g., diagnoses, health risk behaviors, age, gender, race and ethnicity) contribute to variation in healthcare use and health outcomes over time. This is the most comprehensive examination of drivers of healthcare use and health outcomes among foster youth to date. Mechanisms identified through this grant that account for the most variation in health outcomes will be targeted in future studies evaluating how to modify healthcare delivery practices and collaboration across healthcare and child welfare systems to improve health outcomes for foster youth. By examining healthcare use and health outcomes, we will be better positioned to articulate where healthcare systems interventions parlay to better health outcomes.