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

Author(s): Mandell, D.S., Ming Xie, M.S., Morales, K.H., Lawer, L., McCarthy, M., and Marcus, S.C. (2012)

Published In: Arch Pediatr Adolesc Med, 166 (1): 68-73

Study Aim/Purpose: The study’s aim was to examine whether increasing outpatient respite and therapeutic services resulted in reduced use of psychiatric hospitalizations among children with autism spectrum disorders (ASDs) 

Summary of Methods: The authors used a retrospective cohort study to examine the association of respite and therapeutic outpatient service use in the preceding 60 days with risk of psychiatric hospitalization for children with ASDs. The authors used Medicaid claims data from November 1, 2003 through December 31, 2004 to calculate service use. The study sample included 28,428 Medicaid-enrolled children, adolescents and young adults aged 5 through 21 who had at least two outpatient claims in May-October 2003 associated with a primary diagnosis of autistic disorder. The primary independent variable of interest was use of outpatient respite and therapeutic services and the dependent variable was psychiatric hospitalization. Child demographic characteristics (obtained from the Medicaid eligibility file) and State characteristics (obtained from Area Resource File) that may affect the observed associations were also included in the analysis. Logistic regression analysis was used to assess the association between cumulative expenditures over the past 60 days for outpatient respite and therapeutic services and hospital admission, controlling for sociodemographic and state level variables. 

Summary of key Results: 2.4 percent of the sample experienced at least 1 hospitalization during the study year associated with a diagnosis of ASD. Analysis of the adjusted odds of hospitalization associated with respite use in the preceding 60 days found that “each $1000 increase in respite expenditures in the preceding 60 days was associated with an 8% decrease in the odds of hospitalization;” however, no association was found between the use of therapeutic outpatient services and risk of hospitalization. 

Study Limitations (as cited by authors): The authors acknowledged that the accuracy of the ASD diagnosis in Medicaid claims is unknown and has not specifically been studied. They also noted that the process used for categorizing procedure codes has not been validated and may have affected observed associations between service use and hospitalization. 

Authors’ Discussion/Conclusions: Explaining potential causal links between respite care use and decreased hospitalization, the authors state that “raising a child with ASD is fraught with challenges and can place considerable stress on families. Respite and home-and community-based aides may considerably reduce stress on families, leading to reduced hospitalization rates.” The authors also find that the study “results have important implications for state policy and practice,” including the expansion of Medicaid community-based options by States to ensure the availability of respite and other community-based services for children with ASD.