Health Services Research
Descriptive Outcomes and Variation Studies
Adolescent health care services
Fairbrother G
This project involved consulting for the Institute of Medicine’s Committee on Adolescent Service in developing data and reviewing the literature on adolescent health care needs, the settings where health services are delivered to adolescents, and the types of providers who engage with both general and special populations of youth at various points in the health care system.
Within State and Cross State Variations in Childhood Obesity
Simpson L, Bethell C, Cooper J, Goodman E
This study used the National Survey of Children’s Health to examine the contribution of state characteristics to prevalence of childhood obesity and disparities in prevalence by income, race/ethnicity, and insurance. It also examined the correlations between disparities on any one of these dimensions with the overall state prevalence in childhood obesity.
Disparities in Health Care Quality
Berdahl T (AHRQ), Dougherty D (AHRQ), Owens P, Simpson L, McCormick M (Harvard)
This descriptive study is the 2009 issue of the Annual Report on Health Care for Children, published each year since 2002. This year’s emphasis is on examining racial and ethnic disparities in quality of care in both ambulatory and inpatient settings for children within categories of income and public insurance.
Effectiveness Research: Developing and Testing Innovations in Health Care Delivery and Public Health
Determinants of Health-Related Quality of Life in JIA
NIAMS P60 AR047784-06A2. Glass, PI; Seid, RO1 Subcomponent PI
Improving health-related quality of life (HRQOL) is a key treatment goal for children with Juvenile Idiopathic Arthritis (JIA), but there is a gap in our knowledge of how medical and non-medical variables determine HRQOL in the context of ongoing treatment. The objective of the study is to determine the pathways by which medical variables (biological, physiological, clinical, physical function) and non-medical variables (individual, family, environmental characteristics) predict HRQOL in children being actively treated for JIA. The central hypothesis is that, for children with JIA undergoing treatment, HRQOL is determined, in part, by biological, physiological, clinical, and functional variables, and that individual, family, and environmental variables have both direct and indirect effects on HRQOL. The rationale for this research is that successful completion of this project will lead to a thorough understanding of the drivers of between-patient differences in HRQOL outcomes and to identification of additional therapeutic targets, thus enabling clinicians to maximize HRQOL for children with JIA and to maximize the effect of JIA treatments on HRQOL. Improving HRQOL is a fundamental goal of the U.S. health care system, yet too little is known about the ways in which changes in medical variables as a result of treatment interact with non-medical variables to produce changes in HRQOL. This research represents a step towards ensuring optimal HRQOL for children with JIA and for other chronically ill children.
Improving Patient Flow in Outpatient Clinics
Froehle C
The objectives of this initiative include: reducing patient waiting time; maintaining, if not increasing, provider utilization; increasing the number of patients that can be seen during a clinic; and improving the ability of clinical managers to respond adeptly to unforeseen deviations from the day's schedule. Based on the extant research literature and previous initiatives, we realize that improving patient flow in outpatient environments and achieving these objectives will require rethinking multiple aspects of how the clinic is managed and necessitate the use of innovative operational/analytical tools. Scheduling of patient arrivals is a key contributor to the quality of flow in a clinic; the correct set of scheduling policies, whether derived theoretically or developed empirically, can provide a more robust and efficient flow of patients into the clinic. Also, the application of lean process design techniques will provide improvements by way of reducing redundancy, waste, and error. Improved flow will also require better coordination and communication among care providers and patients. By implementing (or, if needed, developing) cutting-edge operational technologies, such as real-time location systems and flow management analytics, the clinical management platform that will emerge should offer significant reductions in patient waiting, provider inefficiency, and care delivery costs.
Describing the Health Needs of Children and Their Families and the Health System’s Response
The Health Needs of Children in Northern Kentucky
Simpson L, Mitchell M
This study includes qualitative (focus groups and key informant interviews) and quantitative methods (analysis of secondary data sets, as well as community surveys) to assess the leading health concerns of stakeholders and residents of Northern Kentucky and compare/contrast them with the epidemiology of the leading causes of morbidity and mortality for children, as well as patterns of care and unmet needs. Datasets being used include vital statistics, the 2000 and 2005 Child Well Being Surveys (fielded by CPRC), hospital discharge data, Medicaid claims, injury surveillance data, and program data from the state (e.g., Title V programs, cancer registries, etc).
The Childhood Obesity Action Network
This national network was established by the National Initiative for Children’s Healthcare Quality (NICHQ) in 2007 to accelerate actions and improvements in addressing the obesity epidemic among children. It has both clinical and policy components so as to ensure that innovation and progress in care settings is then translated to policymakers for further action, support or spread. To date, three policy reports have been produced: one on overall health policy strategies (Simpson et al), one on patterns of cross-state and within-state disparities in childhood obesity (Simpson et al) and necessary strategies to tackle these disparities, and one on current strategies to pay for obesity-related services in the public and private sectors (Simpson et al).
Insurance Program Design and Implementation
Impact of Citizen Documentation Requirement on Medi-Cal
Fairbrother G
This study is examining the impact of changes to Medicaid as part of the Deficit Reduction Act to require citizen documentation as part of every Medicaid application on enrollment in California. This study uses focus groups to assess the effect on different populations in different parts of the state, interviews with county assistance officials, and analysis of enrollment data to determine effect of this policy.
Assessing the Effects of Semi-Annual Status Review for Medi-Cal in California
Fairbrother G
This study assess the effects of a recent legislative change taken in the face of a budget crisis, to repeal the 12-month continuous eligibility provision for children in Medi-Cal (the Medicaid program in California) and offer, instead, six months of eligibility. Research and experience with similar programs in other states have shown that children tend to fall off the rolls at renewal and reporting junctures. Many child advocates contend that the SAR, like other reporting requirements, is simply a means of reducing enrollment and, hence, immediate expenditure in Medi-Cal, rather than an evidenced-based tool to ensure fair and efficient use of resources. This project uses quantitative and qualitative methods to assess the impact of this policy on enrollment patterns, on program cost, and on effects of gaps in coverage on care.
Evaluating and Improving Medicaid in Ohio
Fairbrother G (PI), Simpson L (co-PI), Mitchell M
This project is developing policy data needed for the upcoming budget and legislative debates in Ohio. It has three main objectives relating to the key policy issues: to assess best practices for enrolling children, to develop a system for monitoring enrollment and retention (overall and by county, race/ethnicity, urban/rural and other key subgroups), and to assess the coverage and care needs for special needs children. The first two objectives respond to the fact that two out of every three uninsured children in Ohio is currently eligible for the Ohio Medicaid program and are intended to help the state increase the number of currently-eligible children who are enrolled. The last objective responds to the fact that the Children’s Buy-In program, designed for special needs children in families earning more than 300% FPL has had very low take up.
OFHS Study
This project is using the 2008 and 2004 OFHS to study changes in the Medicaid program in Ohio over that time. In order to assure that the Medicaid program in Ohio reaches, enrolls, and retains eligible children and parents, it is important to understand reasons why they are not insured. In Ohio, there are an estimated 119,000 uninsured children, two-thirds of which are eligible for Medicaid. This study is investigating barriers to participation and possible remedies, describing differences between program participants and eligible non-participants, and contrasting participation patterns between 2004 and 2008.
Paying for Obesity: A Changing Landscape
Simpson L
This study used key informant interviews and literature/report review to describe the degree to which purchasers and payers in both the public and private sectors were covering obesity-related services and programs, as well as using other innovative payment tools to address the epidemic.
