The interplay of outpatient services and psychiatric hospitalization among Medicaid-enrolled children with autism spectrum disorders.
OBJECTIVE
To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).


METHODS
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.


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


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


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


METHODS
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.
Center 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
David S
DS
Mandell
Ming
M
Xie
Knashawn H
KH
Morales
Lindsay
L
Lawer
Megan
M
McCarthy
Steven C
SC
Marcus
D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000191:economics / Q000628:therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012144:Respite Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D014481:United States; D055815:Young Adult