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Arch Pediatr Adolesc Med. 2012 Jan;166(1):68-73. doi: 10.1001/archpediatrics.2011.714.

The interplay of outpatient services and psychiatric hospitalization among Medicaid-enrolled children with autism spectrum disorders.

Author information

  • 1Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Third Floor, Philadelphia, PA 19104, USA. mandelld@upenn.edu

Abstract

OBJECTIVE:

To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

DESIGN:

Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

SETTING:

The Medicaid-reimbursed health care system in the continental United States.

PARTICIPANTS:

Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428).

MAIN EXPOSURES:

Use of respite care and therapeutic services, based on procedure codes.

MAIN OUTCOME MEASURES:

Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9).

RESULTS:

Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization.

CONCLUSIONS:

Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.

PMID:
22213753
[PubMed - indexed for MEDLINE]
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