Understanding Early Intervention Value: Investigating the Effect of a Statewide Care Coordination Model on EI Resource Use and Outcomes

了解早期干预价值：调查全州护理协调模式对 EI 资源使用和结果的影响

• 批准号: 10431869
• 负责人: Beth Marie McManus
• 金额: $ 40万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10431869
• 关键词: Understanding; Early; Intervention; Value; Investigating

Abstract Infants and toddlers with functional limitations are an important population because they represent a prevalent (i.e. 17% of children) and costly group that warrants greater attention on value-based delivery of developmental and therapeutic (i.e., physical therapy) services. The most common therapy service delivery system for this population is Part C Early Intervention (EI), which cost the federal government $460 Million in 2017. Family-centered care coordination (FC-CC) is a federal EI mandate and the “lynchpin” of value- based pediatric service delivery. Yet, little is known about how states comply with their FC-CC mandate or how FC-CC influences EI child and family outcomes. We propose to fill the knowledge gaps surrounding the provision and implementation of FC-CC using a mixed methods approach. First, we seek to understand the effect of a statewide EI FC-CC model called Global Outcomes for Infants and Toddlers (GO4IT). GO4IT integrates family assessment, care planning processes, outcomes measurement with the goal of identifying salient family needs, individualizing service type and intensity, and improving global measures of child function. Our quantitative analysis will use state EI administrative databases for Colorado (n≈ 75,600) and Massachusetts (n≈ 78,500) and is in the context of state-wide implementation of GO4IT, which provide an “exogenous shock” to value-based EI service delivery that allows us to examine changes in EI service use and outcomes before and after GO4IT. The implementation of GO4IT is analogous to a “natural experiment” with a treatment state, Colorado, which implemented GO4IT during the sample period, and a comparison state which did not (Massachusetts). We hypothesize that GO4IT will result faster time to treatment success (Aim 1), better outcomes and less spending (Aim 2) compared to EI service delivery in MA. Yet, testing this hypothesis requires an examination of more than utilization, cost, and outcomes. Thus, our qualitative study (Aim 3) will provide a more nuanced picture of specific FC-CC activities in which EI programs are engaged and allow us to define and assess specific approaches. In doing so we seek to provide evidenced-based recommendations as a guide for EI programs who strive to improve the value of their programs. In Aim 3, we will conduct about 30 interviews with EI stakeholders (state EI coordinator and data manager, EI providers, and parents in CO and MA [representing 5-6 influential EI program catchment areas per state] to determine FC-CC mechanisms, successes, and best practices. GO4IT is one example of a service delivery package designed to best meet the needs of families while also providing information for families and EI providers to promote family engagement in care planning and optimal outcomes. Given the dearth of evidence we hope our study provides evidence that is used to inform future efforts to implement family- centered care coordination programs. The proposal aligns with AHRQs funding priorities of value-based care, includes the priority population of children with special health care needs, and aligns with the Health Services Research Priorities for Achieving a High Value Healthcare System (NOT-HS-19-011) with a focus on children ages 0-3.

抽象的 功能限制的婴儿和幼儿是一个重要人群 普遍（即17％的儿童）和昂贵的群体，值得对基于价值的交付的更多关注 发育和治疗（即物理疗法）服务。最常见的治疗服务提供 该人群的系统是C部分的早期干预（EI），损失了联邦政府4.6亿美元 在2017年。以家庭为中心的护理协调（FC-CC）是联邦EI授权和价值的“ Lynchpin” 基于儿科服务。但是，关于各州如何遵守其FC-CC授权或 FC-CC如何影响EI儿童和家庭成果。我们建议填补周围的知识空白 使用混合方法方法提供和实施FC-CC。首先，我们试图理解 全州EI FC-CC模型称为婴儿和幼儿的全球结果（GO4IT）的影响。 GO4IT 综合家庭评估，护理计划过程，成果测量，目的是确定 显着的家庭需求，个性化的服务类型和强度以及改善儿童的全球措施 功能。我们的定量分析将使用科罗拉多州的状态EI管理数据库（N≈75,600）和 马萨诸塞州（N≈78,500），是在全州范围内实施的Go4it的背景下 基于价值的EI服务交付的“外源性冲击”使我们能够检查EI服务使用的变化 以及GO4IT之前和之后的结果。 GO4IT的实施类似于“自然实验” 使用治疗状态，科罗拉多州在样本期间实施了GO4IT，并进行了比较 没有（马萨诸塞州）的状态。我们假设GO4IT将导致更快的时间进行治疗成功 （AIM 1），与MA中的EI服务交付相比，更好的结果和更少的支出（AIM 2）。但是，测试这个 假设需要对利用，成本和结果进行更多的检查。那，我们的定性研究 （AIM 3）将为参与EI计划的特定FC-CC活动提供更细致的图片 并允许我们定义和评估特定方法。为此，我们寻求提供基于证据的 建议作为EI计划的指南，他们努力提高计划的价值。在AIM 3中， 我们将对EI利益相关者（州EI协调员兼数据经理，EI）进行大约30次访谈 提供者以及CO和MA的父母[每个州的5-6个有影响力的EI计划集水区] 确定FC-CC机制，成功和最佳实践。 GO4IT是服务交付的一个例子 旨在最佳满足家庭需求的包装，同时还为家庭和EI提供信息 提供者促进家庭参与护理计划和最佳成果。鉴于死亡 我们希望我们的研究提供证据的证据，用于为实施家庭的未来努力提供信息 - 中心护理协调计划。该提案与基于价值的AHRQ资金优先级保持一致 护理包括有特殊医疗保健需求的儿童的优先人群，并与健康保持一致 为了获得高价值医疗保健系统（NOT-HS-19-011）的服务研究重点 关于0-3岁的儿童。