For Professional Services Related to Closing the Gap in Pediatric Eye care a Network Adequacy Study

For Professional Services Related to Closing the Gap in Pediatric Eye care a Network Adequacy Study Arizona Eye Care Network Adequacy Working Title: Closing the Gap in Pediatric Eye Care: A Network Adequacy Study Study Team: Dr. Swapna Reddy (co-PI), Dr. Rizwana Biviji (co-PI), Nikita Vora (Emory undergraduate student), Cindy Reynolds (ASU graduate student) Project Timeline: April 2022 - August 2022 Timeline: Field work start in April 2022- complete in June 2022 Purpose: According to the National Center for Childrens Vision and Eye Health, up to 28% of school-age children have vision problems that may impact their ability to develop, learn and acquire literacy and reading skills. It is expected that the rate of vision problems in children will continue to increase due to the rising incidence of myopia, also known as nearsightedness. The primary aim of the study is to determine where pediatric eye care network adequacy (capacity to provide local vision services for children) exists and where there are gaps in eye care for children. Network adequacy is defined by the extent services are accessible by region, type of care available (Optometry/Ophthalmology), payment accepted (insurance), ages served, and in which languages services are offered. Inadequate networks can prevent pediatric patients from being able to see the eye care providers that they trust and depend upon. Facilitating access to routine and recommended eye care screenings and services for children is imperative to achieve overall improved health outcomes, educational achievements and reduce health disparities. To improve our understanding of the gaps in eye care for children and how to reduce those gaps, we will conduct a study of network adequacy among professionals holding themselves out as pediatric eye care providers in Arizona. This study will test multiple components of childrens access to eye care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, language access and compliance with regulatory standards. We will contact business practices where listed professionals provide eye care services, following a standardized interview script to be conducted by student researchers and aimed at office staff (practice schedulers and representatives). The variables of interest are: (i) time until the next available appointment, (ii) if the practice was reached, (iii) if the practice accepts a specific insurance plan, (iv) variances in appointment availability by plan, (v) language services offered, (vi) region of practice, (vii) ages served and (viii) types of care available. We intend to utilize a census approach to identify, catalog, and attempt to call all of the unique practices identified in the inclusion criteria across Arizona. Study results will be used by Eyes on Learning (EOL) coalition partners, the EOL Advisory Board and other vision experts and advocates to inform the strategic activities of the Eyes On Learning coalition and target efforts to improve childrens vision health in Arizona. Methodology: ASU researchers will conduct an initial and thorough literature review on the overall issue nationally and if available, in Arizona. Next, the ASU research team will connect with the Arizona Medical Board, Arizona Board of Optometry and Arizona Osteopathic Medical Association for updated lists of practicing ophthalmologists (MD and DO) and optometrists in Arizona, determine groups or practices for listed and active providers and connect with all listed practices via a secret shopper survey to determine network adequacy and access to care by examining the study variables of (i) time until the next two available appointments, (ii) if the practice was reached, (iii) identifying accepted plans, (iv) variances in appointment availability by plan (especially public vs. private), (v) language services offered, (vi) region of practice, (vii) ages served and (viii) types of care available. The survey will be developed in accordance with ASU Institutional Review Board standards. Data Collection and Procedures- 1. In order to capture the most comprehensive data to avoid duplication between providers, we will collapse the list of individual providers provided by the Arizona Medical Board, Arizona Board of Optometry and Arizona Osteopathic Medical Association to listed business practices in the state of Arizona. First, we will review the mailing address to identify all providers working at that business practice. Second, we will contact all practices on the list and include a question in our script during the phone interview whether the provider serves children and what age group. If the provider serves children (birth to 18 years), we will proceed with setting an appointment as part of the secret shopper methodology. Otherwise, we will list the practice as serving adults only. 2. Secret Shopper Approach: The research team will administer a secret shopper survey and mimic real-world scenarios to test network adequacy. Within this methodology researchers pose as parents wanting to set appointments for their children and have either a private insurance plan or Medicaid. This methodology has been successfully employed by studies such as Steinman et al. (2012), Cama et al. (2017) and Reddy et al. (2022). Studies have shown that the use of mystery shoppers eliminates the hawthorne effect present when healthcare staff are aware they are being monitored (Steinman et al., 2012). The study would therefore mimic a real-world situation when a patient is trying to schedule an appointment with a provider, effectively testing if the provider in fact offers care within the networks that they hold out to serve, while also examining the aforementioned layers of access. 3. Sample size: a. DO (2019)- 12. We are waiting on the most current list from the AOMA. b. MD- 372 active in state who specialize in either ophthalmology or pediatric ophthalmology c. OD- 1293 active (data does not separate between in state and out of state license). We will clean the data by referring to mailing addresses and deleting those practices that are based out of AZ. Timeline: Activities and Deliverables Date Due (Time from contract start date) Draft of Detailed Study Protocol including draft of Electronic and/or Telephone Survey Instrument Completion of Detailed Study Protocol and Data Collection instrument, submitted to EOL for feedback and approval. 30 April Final study protocol and data collection instrument. Completion of Final study protocol and data collection instrument (revised by contractor based on feedback from EOL); Summary of data collection plans and timeline. 30 April Data Collection Completion of data collection confirmed; Initial progress report on response rate and data trends. 30 June Final Report and Presentation Final written report on study results and recommendations; presentation of such to EOL Advisory Board on date agreed upon by both parties. 31 Aug References: Booker QS, Austin JD, Balasubramanian BA. Survey strategies to increase participant response rates in primary care research studies. Fam Pract. 2021;38(5):699-702. doi:10.1093/fampra/cmab070 Cama S, Malowney M, Smith AJB, et al. Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities. Int J Health Serv. 2017;47(4):621-635. doi:10.1177/0020731417707492 Dillman DA, Smyth JD, Melani L. Internet, phone, mail and mixed-mode surveys: The tailored design method. 4th Ed. John Wiley & Sons; 2014 Reddy S, Speer M, Saxon M, Ziegler M, Dedolph Z, Qaasim S. Evaluating network adequacy of oral health services for children on Medicaid in Arizona. AIMS Public Health. 2021;9(1):53-61. Published 2021 Nov 16. doi:10.3934/publichealth.2022005 Steinman KJ, Kelleher K, Dembe AE, Wickizer TM, Hemming T. The use of a "mystery shopper" methodology to evaluate children's access to psychiatric services. J Behav Health Serv Res. 2012;39(3):305-313. doi:10.1007/s11414-012-9275-1 Vaughn SX, Maxey HL, Keen A, Thoele K, Newhouse R. Assessing public behavioral health services data: a mixed method analysis. Subst Abuse Treat Prev Policy. 2020;15(1):85. Published 2020 Nov 11. doi:10.1186/s13011-020-00328-9