Hoagwood Kimberly E, Kelleher Kelly, Zima Bonnie T, Perrin James M, Bilder Scott, Crystal Stephen
Kimberly E. Hoagwood (
Kelly Kelleher is the vice president of community health and community health services research at Nationwide Children's Hospital, in Columbus, Ohio.
Health Aff (Millwood). 2016 Jul 1;35(7):1266-70. doi: 10.1377/hlthaff.2015.1423.
Closing the gap between evidence-based clinical practice standards and their inclusion in routine practice continues to be a major goal of health policy reforms. This gap is especially large for the care of children with psychiatric disorders-especially those from low-income families, many of whom are insured through Medicaid. To address this gap, we analyzed trends over ten years (2001-10) from Medicaid claims data describing changes over time in medication, psychotherapy, and combined treatment services for children diagnosed with attention deficit hyperactivity disorder (ADHD). Over this time, more children received treatments that conformed to practice standards, including the use of combination treatments of medication and psychotherapy. Rates of combined treatment increased by 74 percent, rates of psychotherapy alone more than doubled, and rates of medication alone decreased by 18 percent. Rates of diagnoses without any reimbursed treatment decreased by 39 percent. These trends suggest increasing adherence to clinical practice standards by providers serving children with ADHD in the Medicaid population, although the quality of those services is unknown.
缩小循证临床实践标准与将这些标准纳入常规医疗之间的差距，仍然是卫生政策改革的一个主要目标。对于患有精神疾病的儿童，尤其是那些来自低收入家庭且许多通过医疗补助计划参保的儿童来说，这一差距尤为巨大。为了弥补这一差距，我们分析了十年（2001年至2010年）期间医疗补助计划索赔数据的趋势，这些数据描述了被诊断患有注意力缺陷多动障碍（ADHD）的儿童在药物治疗、心理治疗及联合治疗服务方面随时间的变化情况。在此期间，更多儿童接受了符合实践标准的治疗，包括药物与心理治疗的联合使用。联合治疗的比例增加了74%，单纯心理治疗的比例增加了一倍多，单纯药物治疗的比例下降了18%。未接受任何报销治疗的诊断比例下降了39%。这些趋势表明，为医疗补助计划覆盖人群中患有ADHD的儿童提供服务的医疗服务提供者对临床实践标准的遵循程度有所提高，尽管这些服务的质量尚不清楚。
