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A national assessment of children with special health care needs: prevalence of special needs and use of health care services among children in the military health system.
Pediatrics. 2004 Aug; 114(2):384-93.Ped

Abstract

OBJECTIVE

Children are frequently perceived to be healthy, low-risk individuals with a majority of clinical services devoted to health maintenance and preventive clinical services. However, a subset of children have unique needs that require specialized care to achieve optimal health outcomes. The purpose of this research was to use survey tools that have been developed to identify children with special health care needs (CSHCN) to measure prevalence and resource needs of these children in the military health system (MHS).

METHODS

The US Department of Defense manages the MHS, which is one of the largest integrated health care systems in the world and provides care to almost 2,000000 children. We incorporated the CSHCN survey screener and assessment questions into the annual health care survey of beneficiaries who are eligible for benefits within the MHS. In addition, we used claims information available from inpatient and outpatient services. We used parent reports from the survey to estimate the prevalence of CSHCN. Incorporating claims data and restricting our analyses to those who were enrolled continuously in a military health maintenance organization (TRICARE Prime), we described utilization of different types of health care resources and compared CSHCN with their healthy counterparts. Finally, we examined alternative types of special needs and performed regression analyses to identify the major determinants of health needs and resource utilization to guide system management and policy development.

RESULTS

CSHCN compose 23% of the TRICARE Prime enrollees who are younger than 18 years and whose parents responded to the survey. The needs of a majority of these children consist of prescription medications and services targeting medical, mental health, and educational needs. CSHCN experience 5 times as many admissions and 10 times as many days in hospitals compared with children without special needs. CSHCN are responsible for nearly half of outpatient visits for enrolled children and more than three quarters of inpatient days. Service utilization varies dramatically by type of special need and other demographic variables.

CONCLUSION

CSHCN represent a major challenge to organized systems of care and our society. Because they represent a group of children who are particularly at risk with potential for improved health outcomes, efforts to improve quality, coordinate care, and optimize efficiency should focus on this target population.

Authors+Show Affiliations

Center for Healthcare Management Studies, Office of the Assistant Secretary of Defense, Health Affairs, TRICARE Management Activity, Falls Church, Virginia 22041, USA. thomas.williams@tma.osd.milNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15286221

Citation

Williams, Thomas V., et al. "A National Assessment of Children With Special Health Care Needs: Prevalence of Special Needs and Use of Health Care Services Among Children in the Military Health System." Pediatrics, vol. 114, no. 2, 2004, pp. 384-93.
Williams TV, Schone EM, Archibald ND, et al. A national assessment of children with special health care needs: prevalence of special needs and use of health care services among children in the military health system. Pediatrics. 2004;114(2):384-93.
Williams, T. V., Schone, E. M., Archibald, N. D., & Thompson, J. W. (2004). A national assessment of children with special health care needs: prevalence of special needs and use of health care services among children in the military health system. Pediatrics, 114(2), 384-93.
Williams TV, et al. A National Assessment of Children With Special Health Care Needs: Prevalence of Special Needs and Use of Health Care Services Among Children in the Military Health System. Pediatrics. 2004;114(2):384-93. PubMed PMID: 15286221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A national assessment of children with special health care needs: prevalence of special needs and use of health care services among children in the military health system. AU - Williams,Thomas V, AU - Schone,Eric M, AU - Archibald,Nancy D, AU - Thompson,Joseph W, PY - 2004/8/3/pubmed PY - 2004/12/28/medline PY - 2004/8/3/entrez SP - 384 EP - 93 JF - Pediatrics JO - Pediatrics VL - 114 IS - 2 N2 - OBJECTIVE: Children are frequently perceived to be healthy, low-risk individuals with a majority of clinical services devoted to health maintenance and preventive clinical services. However, a subset of children have unique needs that require specialized care to achieve optimal health outcomes. The purpose of this research was to use survey tools that have been developed to identify children with special health care needs (CSHCN) to measure prevalence and resource needs of these children in the military health system (MHS). METHODS: The US Department of Defense manages the MHS, which is one of the largest integrated health care systems in the world and provides care to almost 2,000000 children. We incorporated the CSHCN survey screener and assessment questions into the annual health care survey of beneficiaries who are eligible for benefits within the MHS. In addition, we used claims information available from inpatient and outpatient services. We used parent reports from the survey to estimate the prevalence of CSHCN. Incorporating claims data and restricting our analyses to those who were enrolled continuously in a military health maintenance organization (TRICARE Prime), we described utilization of different types of health care resources and compared CSHCN with their healthy counterparts. Finally, we examined alternative types of special needs and performed regression analyses to identify the major determinants of health needs and resource utilization to guide system management and policy development. RESULTS: CSHCN compose 23% of the TRICARE Prime enrollees who are younger than 18 years and whose parents responded to the survey. The needs of a majority of these children consist of prescription medications and services targeting medical, mental health, and educational needs. CSHCN experience 5 times as many admissions and 10 times as many days in hospitals compared with children without special needs. CSHCN are responsible for nearly half of outpatient visits for enrolled children and more than three quarters of inpatient days. Service utilization varies dramatically by type of special need and other demographic variables. CONCLUSION: CSHCN represent a major challenge to organized systems of care and our society. Because they represent a group of children who are particularly at risk with potential for improved health outcomes, efforts to improve quality, coordinate care, and optimize efficiency should focus on this target population. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/15286221/A_national_assessment_of_children_with_special_health_care_needs:_prevalence_of_special_needs_and_use_of_health_care_services_among_children_in_the_military_health_system_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=15286221 DB - PRIME DP - Unbound Medicine ER -