Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View

被引：24

作者：

Coller, Ryan J. ^{[1
]}

Lerner, Carlos F. ^{[2
]}

Eickhoff, Jens C. ^{[3
]}

Klitzner, Thomas S. ^{[2
]}

Sklansky, Daniel J. ^{[1
]}

Ehlenbach, Mary ^{[1
]}

Chung, Paul J. ^{[2
,4
,5
,6
]}

机构：

[1] Univ Wisconsin, Dept Pediat, Sch Med & Publ Hlth, 600 Highland Ave, Madison, WI 53792 USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Dept Pediat, Los Angeles, CA 90095 USA

[3] Univ Wisconsin, Sch Med & Publ Hlth, Dept Biostat & Med Informat, Madison, WI USA

[4] Univ Calif Los Angeles, Childrens Discovery & Innovat Inst, Mattel Childrens Hosp, Los Angeles, CA USA

[5] Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Hlth Policy & Management, Los Angeles, CA USA

[6] RAND Corp, RAND Hlth, Santa Monica, CA USA

来源：

HEALTH SERVICES RESEARCH | 2016年 / 51卷 / 04期

关键词：

Children's health; special health care needs; latent class analysis; NATIONAL PROFILE; WASHINGTON-STATE; ASSOCIATION; CONTINUITY; RISK; POPULATION; EMERGENCY; SEVERITY; NUMBER; IMPACT;

D O I：

10.1111/1475-6773.12416

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective. To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes. Data Source. Secondary analysis of 2009-2010 National Survey of CSHCN. Study Design. Latent class analysis grouped individuals into substantively meaningful classes empirically derived from measures of pediatric medical complexity. Outcomes were compared among latent classes with weighted logistic or negative binomial regression. Principal Findings. LCA identified four unique CSHCN subgroups: broad functional impairment (physical, cognitive, and mental health) with extensive health care (Class 1), broad functional impairment alone (Class 2), predominant physical impairment requiring family-delivered care (Class 3), and physical impairment alone (Class 4). CSHCN from Class 1 had the highest ED visit rates (IRR 3.3, p < .001) and hospitalization odds (AOR: 12.0, p < .001) and lowest odds of a medical home (AOR: 0.17, p < .001). CSHCN in Class 3, despite experiencing more shared decision making and medical home attributes, had more ED visits and missed school than CSHCN in Class 2 (p < .001); the latter, however, experienced more cost-related difficulties, care delays, and parents having to stop work (p < .001). Conclusions. Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts.

引用

页码：1644 / 1669

页数：26

共 47 条

[1]

[Anonymous], 2010, Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences

[2]

[Anonymous], 2009, MEAS MED HOM CHILDR

[3]

Berry J., 2013, LANDSCAPE MED CARE C

[4] Taking Stock of the CSHCN Screener: A Review of Common Questions and Current Reflections [J].

Bethel, Christina D. ;

Blumberg, Stephen J. ;

Stein, Ruth E. K. ;

Strickland, Bonnie ;

Robertson, Julie ;

Newacheck, Paul W. .

ACADEMIC PEDIATRICS, 2015, 15 (02) :165-176

[5]

Bethell CD, 2002, AMBUL PEDIATR, V2, P38, DOI 10.1367/1539-4409(2002)002<0038:ICWSHC>2.0.CO

[6]

[7]

Blumberg Stephen J, 2003, Vital Health Stat 1, P1

[8]

Blumberg Stephen J, 2008, Vital Health Stat 1, P1

[9] Differentiating Subgroups of Children with Special Health Care Needs by Health Status and Complexity of Health Care Needs [J].

Bramlett, Matthew D. ;

Read, Debra ;

Bethell, Christina ;

Blumberg, Stephen J. .

MATERNAL AND CHILD HEALTH JOURNAL, 2009, 13 (02) :151-163

[10] Economic impact on families caring for children with special health care needs in New Hampshire: The effect of socioeconomic and health-related factors [J].

Bumbalo, J ;

Ustinich, L ;

Ramcharran, D ;

Schwalberg, R .

MATERNAL AND CHILD HEALTH JOURNAL, 2005, 9 (02) :S3-S11

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