Experiences With Health Care Coordination
Conditions
Brief summary
The proposed study uses a recent policy change in Ohio as a natural experiment to assess outcomes and experiences of children who qualify for Medicaid under the Aged, Blind, Disabled category and their caregivers in an ACO model of care compared to their previous outcomes and experiences in a traditional fee-for-service model.
Detailed description
Children with disabilities have complex healthcare needs requiring multiple providers in multiple locations. The lack of coordinated care for this vulnerable population leads to poorer outcomes, higher costs, and increased stress and time demands for patients and their caregivers. Traditionally, under arrangements known as fee-for-service, there have been no financial incentives for providers to coordinate care; however, the Affordable Care Act is changing that. Accountable care organizations (ACOs) are groups of healthcare providers that organize in new ways to take responsibility for the care of a defined population. ACOs share in any savings associated with improved quality and efficiency of the care they provide. Although most ACOs currently do not cover children with disabilities, many are considering adding these to the populations they serve. Yet little is known about effectiveness of the care coordination strategies they employ on children with disabilities. The goal of this research is to assess care coordination for and patient-centered outcomes of children with disabilities (who qualify for Medicaid under the Aged, Blind, Disabled category (ABD) under an ACO as compared with traditional fee-for-service plans. The investigators will use a recent policy change in Ohio that mandates children with disabilities move from traditional fee-for-service Medicaid plans into managed care arrangements such as ACOs. This mandate resulted in 8,000 disabled children automatically becoming part of the nation's largest pediatric ACO. The investigators will use multiple methods, including focus groups, interviews, a survey, medical record data, and Medicaid claims, to compare patient experiences and care under the ACO with experiences and care under the previous fee-for-service model. What impact will this research have? Our research will inform ACOs about the relative benefits and challenges of coordinating care and improving the health outcomes of children with disabilities and will help those organizations determine whether or not they can adequately serve the needs of this population. In addition, the findings will provide patients and caregivers with valuable information that can help them make decisions when faced with an increasingly common scenario, for example: The parents of a child with cerebral palsy receive a letter from their state Medicaid program that children are being enrolled in an 'accountable care organization.' How certain can they be that their child's care will be improved? What are the problems that might occur? The investigators will engage patients, their caregivers, and health system stakeholders throughout the research process. Patient advocates have been involved in the design of our study. A patient advisory panel comprised of caregivers and advocates of disabled children will guide our project by providing advice at quarterly meetings. In addition, the investigators plan to collect data from more than 2,800 patient voices through direct study participation.
Interventions
None listed
Sponsors
Patient-Centered Outcomes Research Institute
University of North Carolina, Chapel Hill
Study design
Observational model
OTHER
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
3 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Stakeholder Interviews \- Be associated with the ACO as ACO leadership, a care coordinator, a payor or policy-maker. Caregiver Interviews * Currently live in south-central Ohio * Have lived in south-central Ohio since July 2012 * Be a caregiver of a child ages 3-18 who qualifies for Medicaid under the Aged, Blind, and Disabled category Focus Groups, Caregivers and Youth * Currently live in south-central Ohio * Have lived in south-central Ohio since July 2012 * Be a caregiver of a child ages 3-18 who qualifies for Medicaid under the Aged, Blind, and Disabled (ABD) category, who receives care at Nationwide Children's Hospital, Partners for Kids * For youth focus groups, be a child ages 14-18 who qualifies for Medicaid under the Aged, Blind, and Disabled category, who is intellectually capable of participating in focus groups, and who receives care at Nationwide Children's Hospital, Partners for Kids
Exclusion criteria
* Non-English-speaking * For youth focus groups, intellectual disabilities that preclude being able to participate in a focus group
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Caregivers Who Reported That Their Child Has a Designated Care Coordinator | 12 month lookback from time of survey | This outcome was measured using the validated tool, Family Experiences with Coordination of Care (FECC) survey. The FECC survey is made up of 20 separate and independent quality indicators related to care coordination for children with medical complexity. To be included in the denominator for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date. To measure the percent of caregivers who reported that their child has a designated care coordinator among those in the denominator, caregivers needed to have answered yes to one of the following two questions: Did anyone in the main provider's office help you to manage your child's care or treatment from different doctors or care providers? or Did anyone outside of the main provider's office help you to manage your child's care or treatment from different doctors or care providers?. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Caregivers Who Reported Receiving a Comprehensive Written After-visit Summary in the Past 12 Months | 12 month lookback from time of survey | This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that they received a written after-visit summary from their child's main provider's office. Caregivers then had to report that the written after-visit summary contained all of the following elements: current problem list, current medication list, drug allergies, specialists involved in the child's care, planned follow-up, and what to do for problems related to the outpatient visit. |
| Percent of Caregivers Who Reported That Their Child's Primary Care Provider Created a Shared Care Plan for Their Child | 12 month lookback from time of survey | This outcome was measured using FECC survey. Caregivers needed to have answered yes to the following question: Has the main provider created a shared care plan for your child?. |
| Use of One or More Well-child Visits <=6 Years Old | 23 months before policy change (2013), 36 months post | Indicator of use of an age-appropriate well-child visit for children less than or equal to 6 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the Accountable Care Organization (ACO). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Use of One or More Well-child Visits >=12 Years Old | 23 months before policy change (2013), 36 months post | Use of an age-appropriate well-child visits for children greater than or equal to 12 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the ACO. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Indicator of Use of Primary Care | 23 months before policy change (2013), 36 months post | An indicator of one or more outpatient visits to primary care providers (PCP). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Use of Outpatient Medicaid Visits to Other Behavioral Health Providers | 23 months before policy change (2013), 36 months post | Use of one or more outpatient visits to other mental health specialists besides psychiatrists. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Emergency Department Use | 23 months before policy change (2013), 36 months post | Indicator of utilization of emergency department. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Use of Hospitalizations | 23 months before policy change (2013), 36 months post | Indicator of hospitalization for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Follow-up Within 7 Days After Hospitalization | 23 months before policy change (2013), 30 months post | Indicator of follow-up within 7 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Follow-up Within 30 Days After Hospitalization | 23 months before policy change (2013), 36 months post | Indicator of having follow-up within 30 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Percent of Caregivers Who Reported That Their Care Coordinator Asked About Caregiver Concerns and Changes in the Child's Health | 3 month lookback from time of survey | This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date AND were contacted by their care coordinator in the past 3 months. Caregivers then had to respond positively to both of the following two questions: In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if you had any concerns about your child's health or treatment? and In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if your child's health had changed in any way?. |
| Hospitalization for Mental Illness | 23 months before policy change (2013), 36 months post | Indicator of hospitalization for mental illness for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Follow-up Within 7 Days After Hospitalization for Mental Illness | 23 months before policy change (2013), 36 months post | Indicator of follow-up within 7 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Follow-up Within 30 Days After Hospitalization for Mental Illness | 23 months before policy change (2013), 36 months post | Indicator of follow-up within 30 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Medication Use - Antidepressants | 23 months before policy change (2013), 36 months post | Indicator of antidepressant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Medication Use - Anticonvulsants | 23 months before policy change (2013), 36 months post | Indicator of use of anticonvulsant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Medication Use - Anti-anxiety Medications | 23 months before policy change (2013), 36 months post | Indicator of use of anti-anxiety medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Medication Use - Anti-psychotic Medications | 23 months before policy change (2013), 36 months post | Indicator of use of anti-psychotic medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Medication Use - ADHD Medications | 23 months before policy change (2013), 36 months post | Indicator of use of attention deficit hyperactivity disorder (ADHD) medications. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Medication Use - Asthma Medications | 23 months before policy change (2013), 36 months post | Indicator of asthma medications fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero. |
| Follow-up Within 30 Days After ADHD Prescription | 23 months before policy change (2013), 36 months post | Indicator of one or more follow-up visits within 30 days after ADHD (attention deficit hyperactivity disorder) prescription. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero. |
| Hospital Readmissions Within 30 Days After Discharge | 23 months before policy change (2013), 36 months post | Indicator of hospital readmissions within 30 days after discharge. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control group include any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of readmissions in a year to an indicator that the number was greater than zero. |
Participant flow
Recruitment details
Claims data records for 64,382 participants were analyzed to address Claims Data Analysis (Aim 3).
Pre-assignment details
64,382 met eligibility criteria for inclusion in the claims data analysis which was non-human subjects research.
Participants by arm
| Arm | Count |
|---|---|
| ACO Stakeholder Interviews Stakeholders from the ACO, insurance payers, departments of health, and representatives from other stakeholder organizations who have knowledge of/experience with care coordination for children with disabilities before and after the 2013 policy change. Informants included leaders, staff, clinicians, representatives Medicaid managed care organizations, and representatives from public health organizations. | 24 |
| Caregiver & Youth Focus Groups Caregivers of children with disabilities, and youth (i.e. patients) with disabilities.
To be eligible to participate, the child (as the participant, OR of the caregiver) must:
1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disable (ABD) status since at least one year before the policy change;
2. Be no more than 18 years of age at the time of data collection; and
3. Have been, at the time of the policy change, at least 14 years of age for youth (patient) focus groups, or 2 years of age for caregiver focus groups. | 35 |
| Caregiver Interviews Caregivers of children with disabilities. To be eligible to participate, the caregiver's child must: 1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disabled (ABD) status since at least one year before the policy change; 2. Be no more than 18 years of age at the time of data collection; and 3. Have been, at the time of the policy change, at least 2 years of age. | 33 |
| Caregiver Survey Caregivers of children with disabilities who are part of the ACO, and fall into one of three categories: 1) children with ABD status with continuous enrollment since July 2013; 2) children with ABD status with 12 month continuous enrollment as of February 2015; and 3) children who were ABD status as of July 2013 who are no longer eligible for ABD but qualify for Medicaid and are still in the ACO. | 2,062 |
| Claims Data-ACO Sample Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes any child who was ABD status at any point during August 2011-June 2016; dataset does not include children without ABD status. These are unique participants. They were not consented or considered enrolled. | 17,356 |
| Claims Data-Control Sample Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes children with disabilities on Medicaid under ABD who moved from fee-for-service coverage to non-ACO managed care. Excluded children who enrolled in managed care before the policy change and children not in managed care after the policy change. These are unique participants. They were not consented or considered enrolled. | 47,026 |
| Total | 66,536 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Pediatric Adult Caregiver Survey (Aim 2) | Withdrawal by Subject | 0 | 0 | 0 | 34 | 0 | 0 |
Baseline characteristics
| Characteristic | Caregiver & Youth Focus Groups | Caregiver Interviews | Caregiver Survey | Claims Data-ACO Sample | Claims Data-Control Sample | Total | ACO Stakeholder Interviews |
|---|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 2 Participants | 0 Participants | 0 Participants | 17356 Participants | 47026 Participants | 64384 Participants | — |
| Age, Categorical >=65 years | 1 Participants | 0 Participants | 38 Participants | 0 Participants | 0 Participants | 39 Participants | — |
| Age, Categorical Between 18 and 65 years | 31 Participants | 33 Participants | 2019 Participants | 0 Participants | 0 Participants | 2083 Participants | — |
| Age, Continuous | 38.6 years | 40 years | — | 12.3 years | 12.7 years | 12.6 years | — |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 76 Participants | 0 Participants | 0 Participants | 76 Participants | — |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 35 Participants | 30 Participants | 1981 Participants | 0 Participants | 0 Participants | 2046 Participants | — |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 3 Participants | 4 Participants | 17356 Participants | 47026 Participants | 64389 Participants | — |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 10 Participants | 29 Participants | 68 Participants | 107 Participants | — |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 10 Participants | 141 Participants | 209 Participants | 360 Participants | — |
| Race (NIH/OMB) Black or African American | 12 Participants | 13 Participants | 628 Participants | 5102 Participants | 21633 Participants | 27388 Participants | — |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 67 Participants | 0 Participants | 0 Participants | 67 Participants | — |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 2 Participants | 4 Participants | 57 Participants | 63 Participants | — |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 79 Participants | 774 Participants | 2029 Participants | 2882 Participants | — |
| Race (NIH/OMB) White | 23 Participants | 20 Participants | 1265 Participants | 11306 Participants | 23030 Participants | 35644 Participants | — |
| Region of Enrollment United States | 35 Participants | 33 Participants | 2061 Participants | 17356 Participants | 47026 Participants | 66535 Participants | 24 Participants |
| Sex: Female, Male Female | 33 Participants | 32 Participants | 1908 Participants | 5901 Participants | 16224 Participants | 24098 Participants | — |
| Sex: Female, Male Male | 2 Participants | 1 Participants | 153 Participants | 11455 Participants | 30802 Participants | 42413 Participants | — |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 24 | 0 / 35 | 0 / 33 | 0 / 2,096 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 24 | 0 / 35 | 0 / 33 | 0 / 2,096 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 24 | 0 / 35 | 0 / 33 | 0 / 2,096 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Percent of Caregivers Who Reported That Their Child Has a Designated Care Coordinator
This outcome was measured using the validated tool, Family Experiences with Coordination of Care (FECC) survey. The FECC survey is made up of 20 separate and independent quality indicators related to care coordination for children with medical complexity. To be included in the denominator for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date. To measure the percent of caregivers who reported that their child has a designated care coordinator among those in the denominator, caregivers needed to have answered yes to one of the following two questions: Did anyone in the main provider's office help you to manage your child's care or treatment from different doctors or care providers? or Did anyone outside of the main provider's office help you to manage your child's care or treatment from different doctors or care providers?.
Time frame: 12 month lookback from time of survey
Population: To be included in the analysis for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Caregiver Survey | Percent of Caregivers Who Reported That Their Child Has a Designated Care Coordinator | 864 Participants |
Secondary
Emergency Department Use
Indicator of utilization of emergency department. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Emergency Department Use | 49,358 person-year observations |
| Claims Data-Control Sample | Emergency Department Use | 142,579 person-year observations |
95% CI: [0.0036, 0.0289]
Secondary
Follow-up Within 30 Days After ADHD Prescription
Indicator of one or more follow-up visits within 30 days after ADHD (attention deficit hyperactivity disorder) prescription. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children who received ADHD (attention deficit hyperactivity disorder) prescription
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Follow-up Within 30 Days After ADHD Prescription | 75,757 person-year observations |
| Claims Data-Control Sample | Follow-up Within 30 Days After ADHD Prescription | 214,253 person-year observations |
95% CI: [0.011, 0.0284]
Secondary
Follow-up Within 30 Days After Hospitalization
Indicator of having follow-up within 30 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children who were hospitalized
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Follow-up Within 30 Days After Hospitalization | 10,602 person-year observations |
| Claims Data-Control Sample | Follow-up Within 30 Days After Hospitalization | 31,968 person-year observations |
95% CI: [-0.0328, 0.0197]
Secondary
Follow-up Within 30 Days After Hospitalization for Mental Illness
Indicator of follow-up within 30 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children who were hospitalized for mental illness
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Follow-up Within 30 Days After Hospitalization for Mental Illness | 1,484 person-year observations |
| Claims Data-Control Sample | Follow-up Within 30 Days After Hospitalization for Mental Illness | 7,409 person-year observations |
95% CI: [-0.1492, 0.0116]
Secondary
Follow-up Within 7 Days After Hospitalization
Indicator of follow-up within 7 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 30 months post
Population: Children who were hospitalized
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Follow-up Within 7 Days After Hospitalization | 10,602 person-year observations |
| Claims Data-Control Sample | Follow-up Within 7 Days After Hospitalization | 31,968 person-year observations |
95% CI: [-0.0129, 0.0431]
Secondary
Follow-up Within 7 Days After Hospitalization for Mental Illness
Indicator of follow-up within 7 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children hospitalized for mental illness
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Follow-up Within 7 Days After Hospitalization for Mental Illness | 1,484 person-year observations |
| Claims Data-Control Sample | Follow-up Within 7 Days After Hospitalization for Mental Illness | 7,409 person-year observations |
95% CI: [-0.1025, 0.044]
Secondary
Hospitalization for Mental Illness
Indicator of hospitalization for mental illness for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children hospitalized for mental illness. Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Hospitalization for Mental Illness | 49,358 person-year observations |
| Claims Data-Control Sample | Hospitalization for Mental Illness | 142,579 person-year observations |
95% CI: [-0.0031, 0.0044]
Secondary
Hospital Readmissions Within 30 Days After Discharge
Indicator of hospital readmissions within 30 days after discharge. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control group include any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of readmissions in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Children who were hospitalized
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Hospital Readmissions Within 30 Days After Discharge | 10,602 person-year observations |
| Claims Data-Control Sample | Hospital Readmissions Within 30 Days After Discharge | 31,968 person-year observations |
95% CI: [-0.0374, 0.0163]
Secondary
Indicator of Use of Primary Care
An indicator of one or more outpatient visits to primary care providers (PCP). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Indicator of Use of Primary Care | 49,358 person-year observations |
| Claims Data-Control Sample | Indicator of Use of Primary Care | 142,579 person-year observations |
95% CI: [-0.0109, 0.0099]
Secondary
Medication Use - ADHD Medications
Indicator of use of attention deficit hyperactivity disorder (ADHD) medications. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - ADHD Medications | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - ADHD Medications | 142,579 person-year observations |
95% CI: [-0.0178, -0.0043]
Secondary
Medication Use - Anti-anxiety Medications
Indicator of use of anti-anxiety medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - Anti-anxiety Medications | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - Anti-anxiety Medications | 142,579 person-year observations |
95% CI: [0.0001, 0.0106]
Secondary
Medication Use - Anticonvulsants
Indicator of use of anticonvulsant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - Anticonvulsants | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - Anticonvulsants | 142,579 person-year observations |
95% CI: [0.0009, 0.0107]
Secondary
Medication Use - Antidepressants
Indicator of antidepressant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - Antidepressants | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - Antidepressants | 142,579 person-year observations |
95% CI: [0.001, 0.0134]
Secondary
Medication Use - Anti-psychotic Medications
Indicator of use of anti-psychotic medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - Anti-psychotic Medications | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - Anti-psychotic Medications | 142,579 person-year observations |
95% CI: [-0.0096, 0.0017]
Secondary
Medication Use - Asthma Medications
Indicator of asthma medications fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Medication Use - Asthma Medications | 49,358 person-year observations |
| Claims Data-Control Sample | Medication Use - Asthma Medications | 142,579 person-year observations |
95% CI: [-0.0036, 0.0086]
Secondary
Percent of Caregivers Who Reported Receiving a Comprehensive Written After-visit Summary in the Past 12 Months
This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that they received a written after-visit summary from their child's main provider's office. Caregivers then had to report that the written after-visit summary contained all of the following elements: current problem list, current medication list, drug allergies, specialists involved in the child's care, planned follow-up, and what to do for problems related to the outpatient visit.
Time frame: 12 month lookback from time of survey
Population: To be included in the analysis for this measure, caregivers first had to report that they received a written after visit summary in the past 12 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Caregiver Survey | Percent of Caregivers Who Reported Receiving a Comprehensive Written After-visit Summary in the Past 12 Months | 523 Participants |
Secondary
Percent of Caregivers Who Reported That Their Care Coordinator Asked About Caregiver Concerns and Changes in the Child's Health
This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date AND were contacted by their care coordinator in the past 3 months. Caregivers then had to respond positively to both of the following two questions: In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if you had any concerns about your child's health or treatment? and In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if your child's health had changed in any way?.
Time frame: 3 month lookback from time of survey
Population: Percentage of participants who reported that their child visited more than one doctor's office or used more than one kind of health care service in the last 12 months and who were contacted by their care coordinator in the past 3 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Caregiver Survey | Percent of Caregivers Who Reported That Their Care Coordinator Asked About Caregiver Concerns and Changes in the Child's Health | 261 Participants |
Secondary
Percent of Caregivers Who Reported That Their Child's Primary Care Provider Created a Shared Care Plan for Their Child
This outcome was measured using FECC survey. Caregivers needed to have answered yes to the following question: Has the main provider created a shared care plan for your child?.
Time frame: 12 month lookback from time of survey
Population: Participants who responded to the question, Has the main provider created a shared care plan for your child?
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Caregiver Survey | Percent of Caregivers Who Reported That Their Child's Primary Care Provider Created a Shared Care Plan for Their Child | 985 Participants |
Secondary
Use of Hospitalizations
Indicator of hospitalization for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Use of Hospitalizations | 49,358 person-year observations |
| Claims Data-Control Sample | Use of Hospitalizations | 142,579 person-year observations |
95% CI: [-0.002, 0.0111]
Secondary
Use of One or More Well-child Visits >=12 Years Old
Use of an age-appropriate well-child visits for children greater than or equal to 12 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the ACO. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Patients who are greater than or equal to 12 years of age
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Use of One or More Well-child Visits >=12 Years Old | 24,342 person-year observations |
| Claims Data-Control Sample | Use of One or More Well-child Visits >=12 Years Old | 72,803 person-year observations |
95% CI: [0.029, 0.0722]
Secondary
Use of One or More Well-child Visits <=6 Years Old
Indicator of use of an age-appropriate well-child visit for children less than or equal to 6 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the Accountable Care Organization (ACO). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: The overall data included children up to 18 years of age; however, only those children less than or equal to 6 years of age were included in the analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Use of One or More Well-child Visits <=6 Years Old | 9,235 person-year observations |
| Claims Data-Control Sample | Use of One or More Well-child Visits <=6 Years Old | 25,106 person-year observations |
95% CI: [-0.0469, 0.034]
Secondary
Use of Outpatient Medicaid Visits to Other Behavioral Health Providers
Use of one or more outpatient visits to other mental health specialists besides psychiatrists. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.
Time frame: 23 months before policy change (2013), 36 months post
Population: Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caregiver Survey | Use of Outpatient Medicaid Visits to Other Behavioral Health Providers | 49,358 person-year observations |
| Claims Data-Control Sample | Use of Outpatient Medicaid Visits to Other Behavioral Health Providers | 142,579 person-year observations |
95% CI: [-0.0318, 0.0096]