Table 1_Socioecological factors captured in autism service disparities research on Medicaid-enrolled patients: a rapid evidence review.docx

There continue to be disparities in access to quality services that vary from the individual to the policy level. Medicaid is particularly relevant to accessing autism services, since obtaining a diagnosis often confers eligibility, regardless of income requirements, making it a major insurer in this population. Therefore, studies using Medicaid claims data to examine autism service access and utilization may provide unique insights into the demographics being studied and the factors influencing service equity. This rapid evidence review followed the Cochrane Rapid Review Methods Group recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to conduct a literature search across five databases (i.e., ERIC, SCOPUS, PubMed, CINAHL Plus, PsycINFO) to locate articles describing studies of autism services utilization conducted in the United States using Medicaid claims data. Studies had to use Medicaid claims, include an autistic population, be peer-reviewed, original empirical research, and examine variances or disparities in autism services. Case studies or series were excluded. Inclusion criteria were assessed using the Covidence review management tool; 60 articles met all criteria and were included. Information was extracted regarding each study, including characteristics of the study and the included participants, including factors analyzed for variation in service utilization. Results show that existing autism disparities research primarily represents the experiences of school-aged children and young adults (ages 6–21 years), pharmacological and therapeutic services, and individual-level factors, limiting the generalizability of existing research on autism service use.

优质服务的可及性仍存在差距，且该差距贯穿从个体到政策的全维度。医疗补助计划（Medicaid）与自闭症服务可及性高度相关：只要获得自闭症诊断即可获得参保资格，不受收入条件限制，因此该计划是该群体的主要医保承保方。因此，借助医疗补助计划理赔数据开展自闭症服务可及性与使用情况研究，可为研究群体的人口统计学特征以及影响服务公平性的相关因素提供独特视角。本快速证据综述遵循考克兰快速综述方法小组（Cochrane Rapid Review Methods Group）指南与系统评价与元分析首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA）规范，在ERIC、SCOPUS、PubMed、CINAHL Plus、PsycINFO共5个数据库中开展文献检索，旨在筛选出以美国人群为研究对象、采用医疗补助计划理赔数据分析自闭症服务使用情况的相关文章。纳入标准为：研究需采用医疗补助计划理赔数据、研究对象为自闭症群体、经同行评议的原创实证研究，且聚焦自闭症服务的差异或公平性差距；个案研究及案例系列研究被排除在外。文献纳入标准通过Covidence综述管理工具（Covidence）进行评估，最终共有60篇文献符合全部纳入标准并被纳入本综述。研究人员对纳入的每篇文献进行了信息提取，内容涵盖研究本身的特征、纳入研究的参与者特征，以及服务使用差异相关的分析因素。结果显示，当前自闭症服务公平性差距相关研究主要聚焦学龄儿童与青年群体（6~21岁）、药物与治疗服务以及个体层面的影响因素，这限制了现有自闭症服务使用研究的外推性。