OBJECTIVE: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. METHODS: We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non–ASD-related illnesses. RESULTS: Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P < .05). A greater proportion of children in the ASD group used special educational services (76% vs 7% in the control group, P < .05). After adjusting for child demographic characteristics and non–ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017–$4259) higher health care costs and $14 061 (95% CI: $4390–$24 302) higher aggregate non–health care costs, including $8610 (95% CI: $6595–$10 421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents. CONCLUSIONS: The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

The economic burden of childhood autism spectrum disorders

STUDY OBJECTIVE
Frequent users of emergency departments (EDs) are a relatively small group of vulnerable patients accounting for a disproportionally high number of ED visits. Our objective is to perform a systematic review of the type and effectiveness of interventions to reduce the number of ED visits by frequent users.


METHODS
We searched MEDLINE, EMBASE, CINAHL, PsychINFO, the Cochrane Library, and ISI Web of Science for randomized controlled trials, nonrandomized controlled trials, interrupted time series, and controlled and noncontrolled before-and-after studies describing interventions targeting adult frequent users of EDs. Primary outcome of interest was the reduction in ED use. We also explored costs analyses and various clinical (alcohol and drug use, psychiatric symptoms, mortality) and social (homelessness, insurance status, social security support) outcomes.


RESULTS
We included 11 studies (3 randomized controlled trials, 2 controlled and 6 noncontrolled before-and-after studies). Heterogeneity in both study designs and definitions of frequent users precluded meta-analyses of the results. The most studied intervention was case management (n=7). Only 1 of 3 randomized controlled trials showed a significant reduction in ED use compared with usual care. Six of the 8 before-and-after studies reported a significant reduction in ED use, and 1 study showed a significant increase. ED cost reductions were demonstrated in 3 studies. Social outcomes such as reduction of homelessness were favorable in 3 of 3 studies, and clinical outcomes trended toward positive results in 2 of 3 studies.


CONCLUSION
Interventions targeting frequent users may reduce ED use. Case management, the most frequently described intervention, reduced ED costs and seemed to improve social and clinical outcomes. It appears to be beneficial to patients and justifiable for hospitals to implement case management for frequent users in the framework of a clear and consensual definition of frequent users and standardized outcome measures.

Effectiveness of interventions targeting frequent users of emergency departments: a systematic review

Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criter...

World Health Organization disability assessment schedule 2.0: An international systematic review

Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care

Children's health and development outcomes follow a social gradient: the further up the socioeconomic spectrum, the better the outcomes. Based upon a review of multiple forms of evidence, and with a specific focus upon Australia, this article investigates the causes of these socially produced inequities, their impact upon health and development during the early years and what works to reduce these inequities. Using VicHealth's Fair Foundations framework, we report upon child health inequity at three different levels: the socioeconomic, political and cultural level; daily living conditions; the individual health-related behaviours. Although intensive interventions may improve the absolute conditions of significantly disadvantaged children and families, interventions that have been shown to effectively reduce the gap between the best and worst off families are rare. Numerous interventions have been shown to improve some aspect of prenatal, postnatal, family, physical and social environments for young children; however, sustainable or direct effects are difficult to achieve. Inequitable access to services has the potential to maintain or increase inequities during the early years, because those families most in need of services are typically least able to access them. Reducing inequities during early childhood requires a multi-level, multi-faceted response that incorporates: approaches to governance and decision-making; policies that improve access to quality services and facilitate secure, stable, flexible workplaces for parents; service systems that reflect the characteristics of proportionate universalism, function collaboratively, and deliver evidence-based programs in inclusive environments; strong, supportive communities; and information and timely assistance for parents so they feel supported and confident.

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Early childhood development and the social determinants of health inequities

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1753-6405.12211

Factors that drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW.

Income alone is an insufficient indicator of poverty, which is a multidimensional phenomenon. Previous research demonstrates that Indigenous people are disadvantaged according to multiple indicators and the nature and solutions to poverty differ depending on location. In this paper the interconnected aspects of Indigenous poverty in New South Wales major cities are demonstrated based on a framework developed by the Productivity Commission's Steering Committee for the Review of Government Service Provision (SCRGSP 2003). In this framework, headline indicators identify multiple areas of disadvantage and strategic change indicators represent possible causes of disadvantage that can be targeted by policy makers. The results of an econometric analysis, using 2002 National Aboriginal and Torres Strait Islander Social Survey data, suggest the key causes of Indigenous disadvantage and the interdependence of headline indicators, including health, labour force outcomes, education, income, victimisation and incarceration. The recent New South Wales policy approach Two Ways Together recognises this interdependence and has the potential to improve Indigenous welfare in New South Wales major cities. However, an examination of specific policy documents and preliminary evidence drawn from changes in the gaps between Indigenous and non-Indigenous outcomes indicates that further progress is required to reduce Indigenous poverty in major cities of New South Wales.

Indigenous Poverty In New South Wales Major Cities: A Multidimensional Analysis

This brief methods paper explains how to use the NSW Government Health Costs of Care Standards to estimate the cost of presentations to emergency departments (ED) in NSW. We begin with a discussion of the allocation of presentations according to visit type, triage category and mode of separation to urgency disposition group (UDG) class for the purpose of allocating cost weights and how to apply these weights to estimate the cost per presentation. The discussion is then extended to incorporate a suggested approach for estimating ED costs when mode of separation is known but visit type and triage category are unknown; we do this by using the distribution of current NSW ED presentations by visit type, triage category and mode of separation to calculate the average cost for each mode of separation.

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Estimating the cost of Emergency Department presentations in NSW. CHERE Working Paper 2014/01

The report Financial Resilience in Australia 2015 highlights the concept of resilience as a process that ‘enables individuals to bounce back after adverse events and experiences, adapt to changing circumstances, and deal with environmental stress.’ The report defines financial resilience as: ‘the ability to access and draw on internal capabilities and appropriate, acceptable and accessible external resources and supports in a time of financial adversity’. Over the past five years CSI and NAB have worked in partnership to understand the level of financial exclusion in Australia. Over the past year, the two organisations have sought to redefine thinking beyond access to products and services and to provide a more robust and holistic approach to defining and measuring the level of financial health in Australia.

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Financial resilience in Australia 2015

People with cognitive disabilities face specific forms of discrimination and disadvantage in the criminal justice system, including in legal proceedings. While unfitness-to-stand-trial provisions are intended to assist in avoiding unfair trials, in application, such laws can exacerbate disadvantage. A recent research project sought to increase the participation of accused persons with cognitive disabilities in legal proceedings by developing, implementing and evaluating a model in which disability support workers were embedded in legal services in three Australian jurisdictions. This paper details the findings of a cost-benefit analysis undertaken of that model compared with the common outcomes for accused persons with cognitive disability, including a finding of unfitness to stand trial. The analysis provides evidence of how a tailored programme intervention at a critical point can provide savings in police, courts and custody costs in addition to improving the timeliness and quality of outcomes for people with cognitive disabilities.

Rebecca Reeve

Papers

Factors that drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW.

Indigenous Poverty In New South Wales Major Cities: A Multidimensional Analysis

Estimating the cost of Emergency Department presentations in NSW. CHERE Working Paper 2014/01

Financial resilience in Australia 2015

The economic case for improving legal outcomes for accused persons with cognitive disability: an Australian study