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 功能受限的婴幼儿是一个重要的人群，因为他们代表了 普遍存在（即 17% 的儿童）且成本高昂的群体，值得更多关注基于价值的交付 发育和治疗（即物理治疗）服务 最常见的治疗服务。 针对这一人群的系统是 C 部分早期干预 (EI)，联邦政府为此花费了 4.6 亿美元 2017 年。以家庭为中心的护理协调 (FC-CC) 是联邦 EI 的一项指令，也是价值的“关键” 然而，人们对各州如何遵守其 FC-CC 指令或规定知之甚少。 FC-CC 如何影响 EI 儿童和家庭结果。我们建议填补相关知识空白。 使用混合方法来提供和实施 FC-CC 首先，我们力求了解。 名为“婴幼儿全球成果”(GO4IT) 的联邦 EI FC-CC 模型的影响。 整合家庭评估、护理计划流程、结果测量，以识别 突出的家庭需求，个性化服务类型和强度，并改进全球儿童衡量标准 我们的定量分析将使用科罗拉多州的州 EI 管理数据库 (n≈ 75,600) 和 马萨诸塞州 (n≈ 78,500)，并且处于全州范围内实施 GO4IT 的背景下，该计划提供了 基于价值的 EI 服务交付的“外源冲击”使我们能够检查 EI 服务使用的变化 GO4IT 实施前后的结果 GO4IT 的实施类似于“自然实验”。 与在样本期内实施 GO4IT 的治疗州科罗拉多州进行比较 没有的州（马萨诸塞州）我们发现 GO4IT 将缩短治疗成功的时间。 与马萨诸塞州的 EI 服务相比（目标 1），效果更好，支出更少（目标 2）。 假设需要检查的不仅仅是利用率、成本和结果。因此，我们的定性研究。 （目标 3）将提供 EI 计划参与的特定 FC-CC 活动的更细致的描述 并让我们能够定义和评估具体方法，在此过程中，我们寻求提供基于证据的方法。 作为努力提高项目价值的 EI 项目指南的建议 在目标 3 中， 我们将与 EI 利益相关者（州 EI 协调员和数据经理、EI CO 和 MA 的提供者和家长 [代表每个州 5-6 个有影响力的 EI 项目覆盖区] 确定 FC-CC 机制、成功和最佳实践 GO4IT 是服务交付的一个示例。 套餐旨在最好地满足家庭的需求，同时还为家庭和 EI 提供信息 鉴于缺乏护理计划和最佳结果，医疗服务提供者应促进家庭参与。 证据 我们希望我们的研究提供证据，用于为未来实施家庭- 该提案符合 AHRQ 基于价值的资助优先事项。 护理，包括有特殊卫生保健需求的儿童的优先人群，并与卫生署保持一致 实现高价值医疗保健系统的服务研究优先事项 (NOT-HS-19-011)，重点关注 针对0-3岁的儿童。