Children With Special Health Care Needs Screener Research Articles

An Expanded Approach to the Ascertainment of Children and Youth With Special Health Care Needs.

To describe the prevalence, characteristics, and health-related outcomes of children with diagnosed health conditions and functional difficulties who do not meet criteria for having a special health care need based on the traditional scoring of the Children with Special Health Care Needs (CSHCN) Screener. Data come from the 2016 to 2021 National Survey of Children's Health (n = 225 443). Child characteristics and health-related outcomes were compared among 4 mutually exclusive groups defined by CSHCN Screener criteria and the presence of both conditions and difficulties. Among children who do not qualify as children and youth with special health care needs (CYSHCN) on the CSHCN Screener, 6.8% had ≥1 condition and ≥1 difficulty. These children were more likely than CYSHCN to be younger, female, Hispanic, uninsured, privately insured, living in a household with low educational attainment, have families with more children and a primary household language other than English. After adjustment, non-CYSHCN with ≥1 conditions and ≥1 difficulty were less likely than CYSHCN, but significantly more likely than other non-CYSHCN, to have ≥2 emergency department visits, have unmet health care needs, not meet flourishing criteria, live in families that experienced child health-related employment impacts and frustration accessing services. Including these children in the calculation of CYSHCN prevalence increases the national estimate from 19.1% to 24.6%. Approximately 4 million children have both a diagnosed health condition and functional difficulties but are not identified as CYSHCN. An expanded approach to identify CYSHCN may better align program and policy with population needs.

Children With Special Health Care Needs: How Special Are Their Health Care Needs?

To assess use and needs for general practitioner, specialist, emergency department, hospital inpatient, and hospital outpatient services for children with special health care needs (CSHCN). To assess the level of CSHCN's needs compared with other children. Health service use and needs for children aged 4 to 15 years were assessed using the nationally representative Longitudinal Study of Australian Children survey with 25,011 observations. Odds ratios of service use and unmet needs for CSHCN compared to other children were estimated. CSHCN were further grouped as those 1) needing only additional medication, 2) needing only additional medical care, or 3) needing both as defined by the CSHCN screener questions. The prevalence of those meeting criteria for CSHCN was 16.1%. In the past 12 months, 77.7% of CSHCN used any general practitioner care and 46.4%, 21.7%, 12.4%, and 15.0%, respectively, used specialty care, emergency department, hospital inpatient, and outpatient services. Approximately half of CSHCN were identified as having special needs due to needing additional medication. Their service use and unmet needs are only slightly elevated. Another group of CSHCN who need both more medication and medical care comprises less than one third of all CSHCN. These children have the highest odds of using specialty care (odds ratio 12.3, P < .001), and of having unmet specialty care need (odds ratio 7.4, P < .001) compared to children without special needs. Our findings highlight the importance of ensuring specialty care for CSHCN, especially the one third with most elevated needs. This estimate might guide future care planning.

CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs.

Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education. Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's health care needs over time. We dichotomized confidence at "very confident" versus all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care. We collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs 39%, P < .05), including children with complex needs (17% vs 10%, P < .05). The odds of feeling "very confident" (AOR [95% CI]) was lower with increasing CSHCN score (0.61[0.51-0.72]) and was lower for resident versus attending encounters (0.39 [0.16-0.95]). Confidence was higher if the provider had previously seen that patient (2.07 [1.15-3.72]), and for well (2.50 [1.35-4.64]) or sick visits (3.18 [1.46-6.94]) (vs follow-up). Differences between residents and attending pediatricians regarding the relationship between confidence and visit characteristics for subsets of CSHCN are reported. All providers felt less confident caring for CSHCN; however, for certain needs, resident confidence did not increase with level of training. The data suggest potential educational/programmatic opportunities.

Identifying children with Special Health Care Needs in Alexandria, Egypt

Identifying children with Special Health Care Needs in Alexandria, Egypt

The Influence of Care Coordination on Patients With Special Health Care Needs in a Pediatric Residency Continuity Clinic.

This study evaluates the influence of comprehensive health care coordination for children with special health care needs (CSHCN) in a resident continuity clinic. CSHCN patients were identified from 2 resident continuity panels. Patients were eligible with a score of 2 or greater on the CSHCN screener. Interventions included extended appointment times, a binder, and direct phone access to the social worker who facilitated follow-up appointment scheduling. Data measured included completed and no-show visits for primary care and subspecialty appointments, hospitalization and emergency department visits, use of binders, and parent satisfaction surveys. Patients with a baseline CSHCN screener score ≥4 were 15.6 times more likely to keep their appointment after enrollment (P = .0035). Mental health no-show visits decreased significantly (P < .0001). The utilization of components of comprehensive team-based care coordination, even with limited resources, can improve the delivery of health care for children with complex medical needs and mental health disorders in a resident-based clinic.

Identifying children with Special Health Care Needs in Alexandria, Egypt.

In developing countries, obtaining reliable prevalence rates for children with special health care needs (CSHCN) is challenging. One of the tools used to identify CSHCN is the CSHCN Screener (not available in Arabic). The aim is to test the feasibility of using an Arabic version of CSHCN screener in identifying CSHCN in the Egyptian setup and to estimate their prevalence in Alexandria. A community-based survey was conducted among a representative sample of children using a multistage cluster sampling technique. A pre-designed interviewing questionnaire and the Arabic translation of CSHCN screener were used. The prevalence of CSHCN was 12.2% and 91.8% of them had the three domains of health care needs. The most prevalent conditions requiring special health care were sensory and cognitive impairments and impaired mobility. Type of family was the only significant factor associated with special health care needs. It is concluded that the screener can easily be used and help in identifying the majority of children that need to be the focus of the National health care services. It is recommended that the school health services add the screener to assist depicting the existing gaps in the health care system.

Using the Children with Special Health Care Needs Screener with Immigrant Families: An Analysis of the National Survey of Children's Health.

Children in immigrant families are less likely to screen positive with the Children with Special Health Care Needs Screener (CSHCN-S). This may indicate that children in immigrant families are healthier or require fewer health services than non-immigrant peers. Alternatively, the screener may under-identify special healthcare needs in this population. Using the 2011-2012 National Survey of Children's Health, we examined the prevalence of a positive CSHCN-S among children from first, second, and third generation households with an equivalent number of currently diagnosed chronic conditions (0, 1, 2+). Multivariate analyses controlled for sociodemographic factors. Among children with an equivalent number of chronic conditions, fewer children from first and second generation households screened positive with the CSHCN-S relative to children from third generation households. This association remained after adjusting for covariates. The CSHCN Screener may under-identify children from immigrant households, allowing for missed opportunities to allocate health resources.

Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey

To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN). We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home. The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51). SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.

Indicators of poorly controlled asthma and health-related quality of life among school-age children in the United States.

Poorly controlled asthma has far-reaching effects on school-age children and their parents, but little is known about the national impact on health-related quality of life (HRQoL). To examine HRQoL associated with asthma and indicators of poorly controlled asthma in the United States. This was a cross-sectional analysis of HRQoL among school-age children (age range, 6-17 years) with asthma in the nationally representative 2007-2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included the following: exacerbation in the previous 12 months, use of more than three canisters of short-acting beta agonist in 3 months, and annual asthma-specific emergency department or inpatient visits. Health status and HRQoL instruments included the following: the Columbia Impairment Scale (CIS), Child Health Questionnaire (CHQ), Children with Special Health Care Needs Screener (CSHCN), and self-perceived physical and mental health. Ordered logistic regression was used for ordered categorical variables, and logistic regression was used for binary variables. All regressions controlled for sociodemographics and other covariates. There were 44,320 school-age children in the MEPS, of whom 5890 had asthma. School-age children with indicators of poorly controlled asthma had higher odds of feeling unhappy and/or sad or nervous and/or afraid, and of having problems with sports and/or hobbies and schoolwork on the CIS. Results from the CHQ showed that parents of school-age children with asthma and indicators of poorly controlled asthma had higher odds of worrying about their child's health and future. Results from the CSHCN showed that school-age children with asthma and indicators of poorly controlled asthma were more likely to have special health care needs. School-age children with asthma and indicators of poorly controlled asthma had higher odds of having poor perceived physical health. This nationally representative study provided novel information on the burden of poorly controlled asthma on emotional problems, school-related and activity limitations, general health status, and worry among school-age children and their families as measured by validated instruments.

Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD.

(1) To describe parents' report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. In pooled 2002-2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4-17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD-both with and without a co-morbid mental health condition-and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). Parents' responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health management.

Predicting high-cost pediatric patients: derivation and validation of a population-based model.

Health care administrators often lack feasible methods to prospectively identify new pediatric patients with high health care needs, precluding the ability to proactively target appropriate population health management programs to these children. To develop and validate a predictive model identifying high-cost pediatric patients using parent-reported health (PRH) measures that can be easily collected in clinical and administrative settings. Retrospective cohort study using 2-year panel data from the 2001 to 2011 rounds of the Medical Expenditure Panel Survey. A total of 24,163 children aged 5-17 with family incomes below 400% of the federal poverty line were included in this study. Predictive performance, including the c-statistic, sensitivity, specificity, and predictive values, of multivariate logistic regression models predicting top-decile health care expenditures over a 1-year period. Seven independent domains of PRH measures were tested for predictive capacity relative to basic sociodemographic information: the Children with Special Health Care Needs (CSHCN) Screener; subjectively rated health status; prior year health care utilization; behavioral problems; asthma diagnosis; access to health care; and parental health status and access to care. The CSHCN screener and prior year utilization domains exhibited the highest incremental predictive gains over the baseline model. A model including sociodemographic characteristics, the CSHCN screener, and prior year utilization had a c-statistic of 0.73 (95% confidence interval, 0.70-0.74), surpassing the commonly used threshold to establish sufficient predictive capacity (c-statistic>0.70). The proposed prediction tool, comprising a simple series of PRH measures, accurately stratifies pediatric populations by their risk of incurring high health care costs.

Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes

ObjectiveTo assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN). MethodsWe used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013 as part of a congressionally mandated evaluation of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement Initiative's CSHCN screener. We compared the health care experiences of established CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately insured recent CHIP enrollees, controlling for observable characteristics. ResultsParents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey states, about one-fourth of CHIP enrollees had a special health care need. Compared to being uninsured, parents of CSHCN who were established CHIP enrollees reported greater access to and use of medical and dental care, less difficulty meeting their child's health care needs, fewer unmet needs, and better dental health status for their child. Compared to having private insurance, parents of CSHCN who were established CHIP enrollees reported similar levels of access to and use of medical and dental care and unmet needs, and less difficulty meeting their child's health care needs. ConclusionsCHIP has significant benefits for eligible CSHCN and their families compared to being uninsured and appears to have some benefits compared to private insurance.

Strategies to identify and stratify children with special health care needs in outpatient general pediatrics settings.

Developing improved systems of care for children with special health care needs (CSHCN) requires accurate identification and stratification of this population. This study was designed to assess the ability of a brief screener to identify and stratify CSHCN in a primary care clinic to focus future quality improvement initiatives and allocate resources. All families presenting for health maintenance visits or acute care appointments at an academic primary care clinic between September 5, 2012 and September 28, 2012 were asked to complete the CSHCN Screener(©). This panel of patients was compared to registries previously created by: (1) retrospective chart reviews using published lists of International Statistical Classification of Diseases and Related Health Problems (ICD9) codes for CSHCN and (2) direct physician referral to a clinic case manager providing care coordination services to CSHCN. Screeners identified 246 CSHCN (16.8 % of unique completed screeners). Scores ranged from 0 to 5; higher scores indicate higher levels of complexity. Patients with positive screens had a mean score of 2.4. Patients previously identified by retrospective ICD9 search who completed a screener had a mean score of 1.6 with nearly one-half having negative screens. Patients previously identified by physician referral who completed a screener had a mean score of 2.7 with nearly one-half having scores of 4 or 5. The CSHCN Screener(©) can be utilized in an academic primary care clinic to prospectively identify CSHCN and potentially offers a more clinically meaningful method of identification given its inherent ability to stratify this population based on complexity of medical needs.

The effect of special health care needs and health status on school functioning

BackgroundPast studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association. ObjectivesTo compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes. MethodsThe analysis was based on 59,440 children aged 6–17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days. ResultsOverall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health. ConclusionsThe CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning.

Correlates of Mothers’ Perception of Their Communities’ Social Capital: A Community-Based Study

Psychosocial issues have been recognized as important factors in children's health for decades. This study documents the relation among several important psychosocial variables (e.g., mothers' depressive symptoms) and a new instrument that assesses parents' perception of their communities' social capital. Mothers were recruited from their children's primary care (PC) pediatricians' offices within the Southwestern Ohio Ambulatory Research Network or from a children's hospital developmental clinic (DC). Mothers completed a questionnaire that included the Social Capital Scale (SCS), Children with Special Health Care Needs Screener (CSHCNS), Pediatric Quality of Life Inventory, Maternal Social Support Index and the Center for Epidemiologic Studies Depression Scale (CES-D). Mothers were sorted into three subgroups based on site of recruitment (PC or DC) and results of the CSHCNS. The sample (N=620) was also sorted into terciles based on SCS scores. Mean SCS was about 73 for each of the three subgroups. Compared to mothers in the highest SCS tercile, mothers in the lowest SCS tercile reported lower education, lower income and higher CES-D median scores. The SCS subscale "sense of belonging" had an inverse correlation with CES-D scores (r=-.248, p<0.001). Mothers from primary care and sub-specialty clinics had similar perceptions about their communities' social capital. Compared to mothers in the highest one third of SCS scores, mothers in the lowest one third were more likely to report less education and income as well as more depressive symptoms. A decreased sense of belonging in their communities was also correlated with more depressive symptoms. The SCS is a new useful tool for investigators and clinicians who work with children and their families.

Online Schools and Children With Special Health and Educational Needs: Comparison With Performance in Traditional Schools

BackgroundIn the United States, primary and secondary online schools are institutions that deliver online curricula for children enrolled in kindergarten through 12th grade (K-12). These institutions commonly provide opportunities for online instruction in conjunction with local schools for students who may need remediation, have advanced needs, encounter unqualified local instructors, or experience scheduling conflicts. Internet-based online schooling may potentially help children from populations known to have educational and health disadvantages, such as those from certain racial or ethnic backgrounds, those of low socioeconomic status, and children with special health care needs (CSHCN).ObjectiveTo describe the basic and applied demographics of US online-school users and to compare student achievement in traditional versus online schooling environments.MethodsWe performed a brief parental survey in three states examining basic demographics and educational history of the child and parents, the child’s health status as measured by the CSHCN Screener, and their experiences and educational achievement with online schools and class(es). Results were compared with state public-school demographics and statistical analyses controlled for state-specific independence.ResultsWe analyzed responses from 1971 parents with a response rate of 14.7% (1971/13,384). Parents of online-school participants were more likely to report having a bachelor’s degree or higher than were parents of students statewide in traditional schools, and more of their children were white and female. Most notably, the prevalence of CSHCN was high (476/1971, 24.6%) in online schooling. Children who were male, black, or had special health care needs reported significantly lower grades in both traditional and online schools. However, when we controlled for age, gender, race, and parental education, parents of CSHCN or black children reported significantly lower grades in online than in traditional schooling (adjusted odds ratio [aOR] 1.45, 95% confidence interval [CI] 1.29–1.62 for CSHCN, P < .001; aOR 2.73, 95% CI 2.11–3.53 for black children, P < .001.) In contrast, parents with a bachelor’s degree or higher reported significantly higher online-school grades than traditional-school grades for their children (aOR 1.45, 95% CI 1.15–1.82, P < .001).ConclusionsThe demographics of children attending online schools do not mirror those of the state-specific school populations. CSHCN seem to opt into online schools at a higher rate. While parents report equivalent educational achievement in online and traditional classrooms, controlling for known achievement risks suggests that CSHCN and black children have lower performance in online than in traditional schools. Given the millions of students now in online schools, future studies must test whether direct assistance in online schools, such as taking individualized education plans into consideration, will narrow known disparities in educational success. Only then can online schools emerge as a true educational alternative for at-risk populations.

Shared Decision-Making and Health Care Expenditures Among Children With Special Health Care Needs

To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN). We identified CSHCN <18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years. Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were $2131. Over the 2 study years, increasing SDM was associated with a decrease of $339 (95% confidence interval: $21, $660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits. We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.

A comparison of health-related quality of life between children with versus without special health care needs, and children requiring versus not requiring psychiatric services

The purpose of the present study was to compare health-related quality of life (HRQoL) between children with special health care needs (CSHCN) and those without. In particular, CSHCN who require psychiatric services and those who do not were compared. A representative community sample of 3,325 children (10-14years old) was recruited from the Canton of Zurich. Via either computer-assisted telephone interviews or a written questionnaire, special health care needs were assessed using the five-item parent-reported CSHCN Screener. Subsequent to screening, a written questionnaire was sent to a sub-sample of 974 children to acquire more detailed information, both from the children and their parents, about their health and health care utilization, and to assess HRQoL (KIDSCREEN-27) and emotional and behavioral problems (SDQ). A total of 626 children responded to the questionnaire. Multiple linear regression models were used to examine the association between HRQoL and subject group, controlling for other covariates. Among 2,586 children whose parents participated in the screening stage, roughly 18% were identified as CSHCN, with 6.2% requiring psychiatric services. The subsequent survey revealed that those CSHCN who required psychiatric services had the lowest HRQoL scores and highest SDQ scores. CSHCN who utilized psychiatric services were particularly prone to low HRQoL, especially among lower income families. The influence of noticeable emotional and behavioral problems on HRQoL should be afforded more attention, both in clinical practice and empirical studies involving children with special health care needs.

Utility of a Summative Scale Based on the Children with Special Health Care Needs (CSHCN) Screener to Identify CSHCN with Special Dental Care Needs

Our objective was to determine if a summative scale reflecting the number of positive criteria on the Children with Special Health Care Needs (CSHCN) Screener is useful in identifying subgroups of CSHCN at risk for poorer oral health and unmet dental care needs and who should be considered to have special dental care needs. Data were analyzed for a population-based sample of 91,642 US children <18 years from the 2007 National Survey of Children's Health. The independent variable of interest was the summative number of positive CSHCN Screener criteria. Dependent variables were parent-perceived condition of child's teeth, toothache, cavities, broken teeth, bleeding gums in the previous 6 months, and unmet dental care needs in the past 12 months. Descriptive and multivariable logistic regression analyses were performed for each outcome using the survey command in Stata to account for the sampling design. A summative scale based on the number of positive CSHCN Screener criteria was independently associated with various parent-perceived poorer oral health outcomes in children. CSHCN who met 4 or 5 screener criteria had 4 and 4.5 times, respectively, the odds of having fair-poor condition of teeth and bleeding gums relative to non-CSHCN. They also had 87% higher odds for parent-perceived toothache and 2 and 2.5 times the odds of having recent broken teeth and unmet dental care needs relative to non-CSHCN, respectively. There was no dose-dependent association between summative number of positive CSHCN Screener criteria and reported cavities in children. Application of a summative score based on the CSHCN Screener has utility in identifying the CSHCN subgroup with special dental care needs.

Family-Centered Care Can Decrease Hospitalization &amp; ED Use

Research Article| October 01 2011 Family-Centered Care Can Decrease Hospitalization & ED Use AAP Grand Rounds (2011) 26 (4): 45. https://doi.org/10.1542/gr.26-4-45 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Family-Centered Care Can Decrease Hospitalization & ED Use. AAP Grand Rounds October 2011; 26 (4): 45. https://doi.org/10.1542/gr.26-4-45 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: family-centered care, quality of care, parent report measures, emergency service, hospital Source: Raphael JL, Mei M, Brousseau DC, et al. Associations between quality of primary care and health care use among children with special health care needs. Arch Pediatr Adolesc Med. 2011; 165(5): 399– 404; doi: https://doi.org/10.1001/archpediatrics.2011.33Google Scholar Researchers from Baylor College of Medicine in Houston, TX, and the Medical College of Wisconsin conducted a secondary analysis of the 2004–2005 and 2005–2006 Medical Expenditure Panel Surveys (MEPS) to determine the relationship between parent-reported quality of care and emergency department (ED) visits and hospitalizations in children with special health care needs (CSHCN). MEPS is a large-scale, prospective two-year survey of individuals and families, administered by the Agency for Healthcare Research and Quality (AHRQ). MEPS collects data on health care utilization, expenditures, and insurance coverage. Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions are used to assess parental experiences with care. The authors identified CSHCN using the CSHCN Screener tool. Question groupings into quality of care domains and composite scores for parental survey responses were provided by AHRQ. The authors then dichotomized the composite scores, which were averages of Likert scale responses, into high quality versus low quality. Regression analyses were used to describe the associations between scores and the primary outcomes – the number of reported ED visits and hospitalizations. The eligible population totaled 1,591 CSHCN, of whom 85% were between 4 and 17 years of age. Over 97% of the children were insured. Family-centeredness, timeliness, and realized access were the domains of care rated as high quality by 68.3%, 51.5%, and 80.4% of the parents, respectively. Low quality family-centeredness was associated with increased subsequent nonurgent ED visits (incident rate ratio [IRR] 2.24; 95% CI, 1.32–3.80), but there was no association found between any quality domain and subsequent urgent ED visits. For hospitalizations, low quality family-centered care and realized access were significantly associated with more subsequent hospitalizations in privately insured children (IRR 3.87; 95% CI, 1.23–12.13). There were no associations between reported quality of care and hospitalizations in publicly insured children. The authors conclude that parent-reported low quality family-centered care correlates with increased ED utilization and hospitalization in CSHCN. This work builds upon one author’s prior research that demonstrated a link between low quality family-centeredness and nonurgent ED visits in a general population of children.1 Strengths of the approach used in this study include the nationally representative sample and longitudinal survey (MEPS) and a validated questionnaire (CAHPS) to assess family experiences of care. Although the patient population and parental reports are likely generalizable, the associations with ED visits and hospitalizations were modified by variables such as insurance status and urgency of care that will need further exploration. An accompanying editorial appropriately points out that these results do not yet inform practice change and “more granular measurement tools” will likely be needed if we are to tease out the specific interactions that drive improved health outcomes.2 Nonetheless, this work adds to a small but growing body of... You do not currently have access to this content.