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为丹尼尔斯女士做好准备，以使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，从而有助于改善诸如自闭症等发育障碍的儿童的成果。拟议的研究将在具有以下目标的全面培训计划的背景下实施：1）在将政策应用于公共卫生研究中，特别是影响发育障碍儿童的医疗保健提供和成果的政策； 2）为解决重要的健康政策和服务研究问题的行政和政策数据的联合使用中建立方法论基础； 3）与更广泛的儿童精神卫生服务研究社区进行研究发现和联网。 早期对自闭症的识别对于实现儿童最佳结果至关重要。过去几十年的研究始终表明，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，从孩子两岁的时候就可以可靠地诊断出自闭症。但是，许多儿童直到达到学龄才被诊断出来。延迟的诊断转化为错过的机会，以提供重要的服务，以减少疾病的严重程度并改善发展结果和生活质量。尽管最近的研究已经提高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无法修改的。先前的研究发现，诊断年龄的地理差异很大，但未能识别出充分解释这种变化的社区或州级因素。必须通过对政策影响健康实践以及健康实践导致儿童健康成果的改善的程度的机制进行更广泛的理解来告知降低诊断年龄的努力。 拟议的研究将通过以下问题解决这些问题：1）国家的早期和周期性筛查，诊断和治疗（EPSDT）政策会影响儿童水平遵守美国儿科学院（AAP）的福利护理准则（AAP）准则，2）与AAP指南相关的自闭症儿童是否与AAP Indifution相关联？遵守这些AAP指南？这些问题将在诊断前的两年内对服务使用索赔进行深入研究，以在2001年至2005年期间某个时候入学的学龄前儿童样本中。拟议的项目与国家心理健康研究所的使命和目标保持一致，因为它将在为解决各种儿童提供服务的研究中，以解决各种儿童的研究空白。 公共卫生相关性：拟议的研究有可能影响夫妇护理领域的公共卫生政策和干预策略以及自闭症疾病的早期发现和诊断。这项研究可能有助于告知与学前教育儿童的频率和定时夫妇护理有关的未来建议。此外，发现可能有助于为国家政策决策提供有关早期发现自闭症疾病的资源分配的信息。