Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

We are interested in a study of existing state Medicaid data of EPSDT services to assess the application and variation of EPSDT across states.

We are interested in knowing: 1) the variability in application across states (e.g. compliance rates - appointment completion and no show rates and billing differences and variability between urban and rural areas)*, 2) the association, if any, to identification of developmental and health conditions in children under the age of 10 and treatment of those identified conditions and 3) what impact states modification to EPSDT, allowed under the DRA (see below), has had on identification of developmental and health concerns and treating those identified conditions.

*It appears that methods used to track and report EPSDT services/data across states varies. We are interested in knowing what the differences are. Having such information will assist in the development of an improved, standardized method for collecting data and enhance the ability to compare the application and outcome of EPSDT services and related data across states.

EPSDT was established in 1967 as a means “to discover, as early as possible, the ills that handicap our children" and to provide "continuing follow up and treatment so that handicaps do not go neglected" (source - http://www.hrsa.gov/epsdt/overview.htm) and is required to be used by state Medicaid programs. Under the Deficit Reduction Act of 2005 (DRA, enacted February 2006), states were given the option to modify the approach to delivery of services to children enrolled in Medicaid.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

We are interested in the variation and applicability of EPSDT across states as it relates to identification of developmental and health concerns and treatment of identified concerns, and specifically what modifications and variations have the biggest impact on children’s health outcomes.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients of interest include children under the age of 10, with particular interest in children under the age of six. EPSDT has prescriptive testing schedules – we are interested in knowing the variation and applicability of these tests across states particularly as it relates to diagnostic/screening appointment compliance rates and methods used to improve appointment compliance with physicians and parents/guardians of the target population.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

We are particularly interested in Medicaid and SCHIP populations.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

1. Early and timely diagnosis of physical, emotional and developmental conditions in children

2. Treatment of identified conditions

Describe any health-related risks, side effects, or harms that you are concerned about.

We are interested in whether or not there is any variability in harms, risks and/or side effects as a result of the variable application of EPSDT across states as it relates to short and long term health outcomes.

We are interested in reducing harms that result in inappropriate state or national policies and/or diversion of resources that are made as a result of comparing state by state data that may/may not be accurately capturing state’s application of EPSDT.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Depression and other mental health disorders
• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Diabetes mellitus
• Functional limitations and disability
• Obesity
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Children
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

As indicated in question #1 EPSDT is required by states and as a result millions of State Medicaid dollars are spent on these exams on an annual basis. We are interested in learning what the variation and applicability of screening and diagnosis is across states to determine whether or not this variability results in different outcomes. We want to ensure that we are making the best use of limited Medicaid resources and targeting them towards methods and tools that are the most effective and produce the best outcomes for children.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The variability in the application of EPSDT across states has been an on-going concern for Medicaid programs. We see that these research questions are timely given the current emphasis on health care reform and comparative effectiveness. As EPSDT has been in effect for over 40 years and recent legislation has enabled states to make adjustments to the application of EPSDT, such a study could inform state policymakers to improve the delivery of EPSDT services and ultimately lead to improved health, developmental, mental and education/employment outcomes for the target population.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

State Medicaid programs are required by law to ensure that the screenings are conducted on the children enrolled in their state and as a result of the new law in 2005 we are able to modify our approach. However, states do not have good evidence to determine best practices. Push back from local pediatricians on the EPSDT requirements and the payment mechanisms that limit payment for the tests make it even more critical that we are requiring tests that are evidence based. This in turn can assure that the resources are used to the greatest benefit for children and the state overall. It may prove easier to get physicians, parents and guardians all “on board” with testing if the evidence base supports such work.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will help to determine what modifications we should be implemented in our state(s) under the DRA program and to assess the effectiveness of the program in meeting its objectives. Improvements to data collection and reporting mechanisms derived from research findings could improve the effectiveness of screenings and provide reliable benchmarks upon which to measure performance.

Describe the timeframe in which an answer to your question is needed.

As soon as possible

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

See question #3a. above

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will help to determine what modifications we should be implemented in our state(s) under the DRA program and to assess the effectiveness of the program in meeting its objectives. Improvements to data collection and reporting mechanisms derived from research findings could improve the effectiveness of screenings and provide reliable benchmarks upon which to measure performance.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

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