Skip to main content

Advertisement

SpringerLink
Log in

Strategies to Identify and Stratify Children with Special Health Care Needs in Outpatient General Pediatrics Settings

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1 Pt 1), 137–140. 1998/08/26.

    Article  CAS  PubMed  Google Scholar 

  2. Strickland, B. B., Singh, G. K., Kogan, M. D., Mann, M. Y., van Dyck, P. C., & Newacheck, P. W. (2009). Access to the medical home: New findings from the 2005–2006 National Survey of Children with Special Health Care Needs. Pediatrics, 123(6), e996–e1004. 2009/06/02.

    Article  PubMed  Google Scholar 

  3. National Survey of Children’s Health (NSCH 2011/12) Data Resource Center for Child and Adolescent Health 2012 [10/04/2013] http://www.childhealthdata.org/browse/survey/results?q=2507&r=1&g=471

  4. van Dyck, P. C., Kogan, M. D., McPherson, M. G., Weissman, G. R., & Newacheck, P. W. (2004). Prevalence and characteristics of children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 158(9), 884–890. 2004/09/08.

    Article  PubMed  Google Scholar 

  5. Newacheck, P. W., & Kim, S. E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159(1), 10–17. 2005/01/05.

    Article  PubMed  Google Scholar 

  6. Perrin, J. M., Bloom, S. R., & Gortmaker, S. L. (2007). The increase of childhood chronic conditions in the United States. JAMA, The Journal of the American Medical Association, 297(24), 2755–2759.

    Article  CAS  Google Scholar 

  7. Neff, J. M., & Anderson, G. (1995). Protecting children with chronic illness in a competitive marketplace. JAMA, The Journal of the American Medical Association, 274(23), 1866–1869. 1995/12/20.

    Article  CAS  Google Scholar 

  8. Oswald, D. P., Bodurtha, J. N., Willis, J. H., & Moore, M. B. (2007). Underinsurance and key health outcomes for children with special health care needs. Pediatrics, 119(2), e341–e347. 2007/01/11.

    Article  PubMed  Google Scholar 

  9. Cohen, E., Berry, J. G., Camacho, X., Anderson, G., Wodchis, W., & Guttmann, A. (2012). Patterns and costs of health care use of children with medical complexity. Pediatrics, 130(6), e1463–e1470. 2012/11/28.

    Article  PubMed  Google Scholar 

  10. Cooley, W. C., McAllister, J. W., Sherrieb, K., & Kuhlthau, K. (2009). Improved outcomes associated with medical home implementation in pediatric primary care. Pediatrics, 124(1), 358–364. 2009/07/01.

    Article  PubMed  Google Scholar 

  11. Klitzner, T. S., Rabbitt, L. A., & Chang, R. K. (2010). Benefits of care coordination for children with complex disease: a pilot medical home project in a resident teaching clinic. Journal of Pediatrics, 156(6), 1006–1010. 2010/03/13.

    Article  PubMed  Google Scholar 

  12. Kuhlthau, K. A., & Perrin, J. M. (2001). Child health status and parental employment. Archives of Pediatrics and Adolescent Medicine, 155(12), 1346–1350. 2001/12/26.

    Article  CAS  PubMed  Google Scholar 

  13. Derigne, L., & Porterfield, S. (2010). Employment change and the role of the medical home for married and single-mother families with children with special health care needs. Social Science and Medicine, 70(4), 631–641. 2009/11/27.

    Article  PubMed  Google Scholar 

  14. Approaches to Identifying Children and Adults with Special Health Care Needs: A Resource Manual for State Medicaid Agencies and Managed Care Organizations. Centers for Medicare and Medicaid Services; 2002 [11/20/2013] http://cahmi.org/ViewDocument.aspx?DocumentID=120.

  15. Bethell, C. D., Read, D., Neff, J., Blumberg, S. J., Stein, R. E., Sharp, V., et al. (2002). Comparison of the children with special health care needs screener to the questionnaire for identifying children with chronic conditions—revised. Ambulatory Pediatrics : The Official Journal of the Ambulatory Pediatric Association., 2(1), 49–57.

    Article  Google Scholar 

  16. Bethell, C. D., Read, D., Stein, R. E., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics : The Official Journal of the Ambulatory Pediatric Association, 2(1), 38–48. 2002/03/13.

    Article  Google Scholar 

  17. Carle, A. C., Blumberg, S. J., & Poblenz, C. (2011). Internal psychometric properties of the Children with Special Health Care Needs Screener. Academic Pediatrics, 11(2), 128–135.

    Article  PubMed  Google Scholar 

  18. Bramlett, M. D., Read, D., Bethell, C., & Blumberg, S. J. (2009). Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal and Child Health Journal, 13(2), 151–163. 2008/04/04.

    Article  PubMed  Google Scholar 

  19. Kogan, M. D., Strickland, B. B., & Newacheck, P. W. (2009). Building systems of care: Findings from the National Survey of Children With Special Health Care Needs. Pediatrics, 124(Suppl. 4), S333–S336. 2010/01/09.

    Article  PubMed  Google Scholar 

  20. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. 2008/10/22.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Feudtner, C., Hays, R. M., Haynes, G., Geyer, J. R., Neff, J. M., & Koepsell, T. D. (2001). Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics, 107(6), E99. 2001/06/05.

    Article  CAS  PubMed  Google Scholar 

  22. Neuzil, K. M., Wright, P. F., Mitchel, E. F, Jr., & Griffin, M. R. (2000). The burden of influenza illness in children with asthma and other chronic medical conditions. Journal of Pediatrics, 137(6), 856–864. 2000/12/13.

    Article  CAS  PubMed  Google Scholar 

  23. Daley, M. F., Barrow, J., Pearson, K., Crane, L. A., Gao, D., Stevenson, J. M., et al. (2004). Identification and recall of children with chronic medical conditions for influenza vaccination. Pediatrics, 113(1 Pt 1), e26–e33. 2004/01/02.

    Article  PubMed  Google Scholar 

  24. Farmer, J. E., Marien, W. E., & Frasier, L. (2003). Quality improvements in primary care for children with special health care needs: Use of a brief screening measure. Childrens Health Care, 32(4), 273–285.

    Article  Google Scholar 

  25. Stein, R. E., Bauman, L. J., Westbrook, L. E., Coupey, S. M., & Ireys, H. T. (1993). Framework for identifying children who have chronic conditions: The case for a new definition. Journal of Pediatrics, 122(3), 342–347. 1993/03/01.

    Article  CAS  PubMed  Google Scholar 

  26. Westbrook, L. E., Silver, E. J., & Stein, R. E. (1998). Implications for estimates of disability in children: A comparison of definitional components. Pediatrics, 101(6), 1025–1030. 1998/06/02.

    Article  CAS  PubMed  Google Scholar 

  27. 2009/10 NS-CSHCN: Prevalence of specific difficulties among CSHCN with each condition. Data Resource Center for Child & Adolescent Health; 2012 [11/27/13] http://childhealthdata.org/docs/cshcn/functional-difficulties-by-condition_2009-10.pdf.

  28. McAllister, J. W., Presler, E., & Cooley, W. C. (2007). Practice-based care coordination: A medical home essential. Pediatrics, 120(3), e723–e733. 2007/09/04.

    Article  PubMed  Google Scholar 

  29. Peter, S., Chaney, G., Zappia, T., Van Veldhuisen, C., Pereira, S., & Santamaria, N. (2011). Care coordination for children with complex care needs significantly reduces hospital utilization. Journal for Specialists in Pediatric Nursing, 16(4), 305–312. 2011/09/29.

    Article  PubMed  Google Scholar 

  30. Liptak, G. S., Burns, C. M., Davidson, P. W., & McAnarney, E. R. (1998). Effects of providing comprehensive ambulatory services to children with chronic conditions. Archives of Pediatrics and Adolescent Medicine, 152(10), 1003–1008. 1998/10/28.

    Article  CAS  PubMed  Google Scholar 

  31. Berry, J. G., Agrawal, R., Cohen, E., Kuo, D. Z. (2013). The landscape of medical care for children with medical complexity. Children’s Hospital Association. http://www.childrenshospitals.net/AM/Template.cfm?Section=Home3&Template=/CM/ContentDisplay.cfm&ContentID=67046.

  32. Berry, J. G., Hall, M., Hall, D. E., Kuo, D. Z., Cohen, E., Agrawal, R., et al. (2013). Inpatient growth and resource use in 28 children’s hospitals: A longitudinal, multi-institutional study. JAMA Pediatrics, 167(2), 170–177. 2012/12/26.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Neff, J. M., Clifton, H., Park, K. J., Goldenberg, C., Popalisky, J., Stout, J. W., et al. (2010). Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data. Academic Pediatrics, 10(6), 417–423. 2010/11/16.

    Article  PubMed  Google Scholar 

  34. Neff, J. M., Sharp, V. L., Muldoon, J., Graham, J., Popalisky, J., & Gay, J. C. (2002). Identifying and classifying children with chronic conditions using administrative data with the clinical risk group classification system. Ambulatory Pediatrics : The official Journal of the Ambulatory Pediatric Association, 2(1), 71–79. 2002/03/13.

    Article  Google Scholar 

  35. Read, D., Bethell, C., Blumberg, S. J., Abreu, M., & Molina, C. (2007). An evaluation of the linguistic and cultural validity of the Spanish language version of the children with special health care needs screener. Maternal and Child Health Journal, 11(6), 568–585.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Christina Bethell for permitting use of the CSHCN Screener© and for her willingness to provide guidance regarding its implementation in an ambulatory setting. Salary support and protected scholarly time was provided to the principal investigator through the Katherine Dodd Faculty Scholars Program of the Vanderbilt University Department of Pediatrics. Funding for the development of the REDCap database was provided to the study site’s institution via NIH Grant # UL1TR000445.

Conflict of interest

The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of General Pediatrics, Department of Pediatrics, Monroe Carell Junior Children’s Hospital, Vanderbilt University School of Medicine, 2200 Children’s Way, DOT 8242, Nashville, TN, 37232-9225, USA

    Alaina M. Davis

  2. Division of General Pediatrics, Department of Pediatrics, Monroe Carell Junior Children’s Hospital, Vanderbilt University School of Medicine, 2200 Children’s Way, DOT 8239, Nashville, TN, 37232-9225, USA

    Sara E. McFadden

  3. Division of General Pediatrics, Department of Pediatrics, Monroe Carell Junior Children’s Hospital, Vanderbilt University School of Medicine, 2200 Children’s Way, DOT 8232, Nashville, TN, 37232-9225, USA

    Barron L. Patterson & Shari L. Barkin

Authors
  1. Alaina M. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara E. McFadden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barron L. Patterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shari L. Barkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alaina M. Davis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Davis, A.M., McFadden, S.E., Patterson, B.L. et al. Strategies to Identify and Stratify Children with Special Health Care Needs in Outpatient General Pediatrics Settings. Matern Child Health J 19, 1384–1392 (2015). https://doi.org/10.1007/s10995-014-1644-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1644-3

Keywords

Search

Navigation