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.
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.
复制标题
对有特殊医疗保健需求的儿童进行的国家评估：军事卫生系统中儿童的特殊需求和医疗保健服务的使用情况。
DOI：
10.1542/peds.114.2.384
复制
发表时间：
2004
期刊：
影响因子：
8
通讯作者：
Joseph W. Thompson
中科院分区：
文献类型：
--
作者：
T. V. Williams;E. Schone;N. Archibald;Joseph W. Thompson
目的
儿童通常被认为是健康、低风险的个体，大多数临床服务致力于健康维护和预防性临床服务。然而，有一部分儿童有着特殊的需求，需要专门的护理才能实现最佳的健康结果。本研究的目的是使用已开发的调查工具，以确定儿童与特殊卫生保健需要（CSHCN），以衡量这些儿童在军事卫生系统（MHS）的患病率和资源需求。
方法
美国国防部管理MHS，这是世界上最大的综合医疗保健系统之一，为近200万儿童提供护理。我们将CSHCN调查筛选器和评估问题纳入MHS内有资格获得福利的受益人的年度医疗保健调查。此外，我们使用了住院和门诊服务提供的索赔信息。我们使用调查的父母报告来估计CSHCN的患病率。通过对索赔数据的分析，并将我们的分析限制在那些连续参加军事健康维护组织（TRICARE Prime）的人，我们描述了不同类型的医疗保健资源的利用情况，并将CSHCN与健康同行进行了比较。最后，我们研究了其他类型的特殊需求，并进行了回归分析，以确定卫生需求和资源利用的主要决定因素，以指导系统管理和政策制定。
结果
CSHCN占TRICARE Prime注册者的23%，他们年龄小于18岁，父母对调查作出了回应。这些儿童中的大多数的需求包括处方药和针对医疗、心理健康和教育需求的服务。与没有特殊需要的儿童相比，CSHCN的入院人数是他们的5倍，住院天数是他们的10倍。CSHCN负责登记儿童近一半的门诊和超过四分之三的住院日。服务利用率因特殊需要的类型和其他人口变量而有很大差异。
结论
CSHCN是对有组织的护理系统和我们社会的一个重大挑战。因为他们代表了一群特别有可能改善健康结果的儿童，所以提高质量、协调护理和优化效率的努力应该集中在这一目标人群上。
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.