The Ohio State University, Columbus, OH, USA.
Nationwide Children's Hospital, Columbus, OH, USA.
J Gen Intern Med. 2021 Jun;36(6):1682-1688. doi: 10.1007/s11606-020-06513-7. Epub 2021 Jan 19.
While in some studies, the patient-centered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults.
To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare.
Retrospective study of medical billing data.
The study sample included CAST patients (N = 490) who were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years.
The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services).
CAST patients had significantly greater odds of receiving any preventive service than Medicare-enrolled (OR = 10.3; 95% CI = 7.6-13.9) and privately insured (OR = 3.1; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3; 95% CI = 14.7-28.0; vaccinations OR = 5.5; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0; 95% CI = 1.6-2.5; vaccinations OR = 3.3; 95% CI = 2.6-4.1).
Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.
虽然在一些研究中，以患者为中心的医疗之家与其他人群的预防服务的增加有关，但关于医疗之家在满足自闭症成年人医疗需求方面的有效性的文献却很少。
比较专为自闭症成年人（称为自闭症服务和过渡中心“CAST”）设计的以患者为中心的医疗之家的患者接受预防服务的情况，以及美国有私人保险或医疗保险的自闭症成年人的全国样本。
医疗计费数据的回顾性研究。
研究样本包括 490 名 CAST 患者（根据人口统计学特征与医疗保险登记的自闭症成年人（N=980）和私人保险的自闭症成年人（N=980）进行倾向评分匹配）。受试者的中位年龄为 21 岁，79%为男性，中位观察时间为 2.2 年。
主要结果是根据医疗保险学习网络和 AAPC（前身为美国专业编码员协会）定义的任何预防服务的接受情况。次要结果包括接受特定预防服务类型（即一般健康和健康服务、筛查、咨询和治疗、疫苗接种和性/生殖健康服务）。
与医疗保险登记的（比值比 [OR] = 10.3；95%置信区间 [CI] = 7.6-13.9）和私人保险的（OR = 3.1；95%CI = 2.3-4.2）自闭症成年人相比，CAST 患者接受任何预防服务的可能性显著更高。与医疗保险受益人（筛查 OR = 20.3；95%CI = 14.7-28.0；疫苗接种 OR = 5.5；95%CI = 4.3-7.0）或私人保险受益人（筛查 OR = 2.0；95%CI = 1.6-2.5；疫苗接种 OR = 3.3；95%CI = 2.6-4.1）相比，CAST 患者也更有可能接受筛查和疫苗接种。
通过 CAST 接受护理的自闭症成年人接受预防保健服务的可能性明显高于自闭症成年人的全国样本。需要进行未来的比较有效性试验，以严格评估以初级保健为基础的改善自闭症成年人护理的举措的影响。
