Road to the Future: Priorities for Child Health Services Research

Building a Children's Health Service and System Research Strategy: development and integration in an Australian paediatric healthcare setting

BACKGROUND

Health services and systems research (HSSR) strategies dedicated to paediatric health care and service delivery are limited. Strategies are available but are outdated and yet to be optimised for use in a paediatric health system. We aim to describe the development and integration of a Children's Health Service and System Research Strategy (CHSSR-S) in Children's Health Queensland (CHQ), a large specialist quaternary hospital and health service caring for children and young people in Queensland and northern New South Wales, Australia.

METHODS

The CHSSR-S was developed using an inductive, bottom-up, participatory systems approach across three phases: (1) Identifying local HSSR capacity; (2) Development; (3) Integration. A HSSR "Champion" was appointed to lead all phases. Clinical, research and system-based stakeholders (n = 14) were individually identified, contacted and participated in dedicated meetings and a workshop to iteratively design the CHSSR-S. A health system-wide CHSSR-S governance committee was established to drive phase three. Health system integration was achieved by multicomponent, action-based strategies.

RESULTS

The final CHSSR-S comprised ten Research Priorities and three Research Enablers, and was successfully integrated within CHQ via a range of platforms. Research Priorities included: (1) Population Health; (2) Adolescent and Young Adult (AYA) Cancer; (3) Indigenous Health; (4); Mental Health; (5) Nutrition and Obesity; (6) Rare Neurodevelopmental Disorders; (7) Sepsis; (8) Screening, surveillance and monitoring; (9) Innovation; and (10) Electronic Medical Record (EMR). Research Priorities were supported by three Research Enablers: (1) Data; (2); Evaluation and Health Economics; and (3) Policy.

CONCLUSIONS

The CHSSR-S is the first known paediatric HSSR strategy developed and integrated within a large dedicated paediatric health system. The CHSSR-S may be used to guide global paediatric healthcare systems to prioritise HSSR in their local setting to optimise health service delivery and patient outcomes.

Gaps in health insurance coverage and emergency department use among children with asthma

Background: Gaps in health insurance coverage may complicate asthma management and increase emergency department (ED) use. Using two nationally-representative surveys, we characterize the prevalence of coverage gaps among children with asthma, and describe their association with ED visits in this population. Methods: De-identified data were obtained from the 2016 National Survey of Children's Health (NSCH) and National Health Interview Survey (NHIS). Among children with asthma, we classified coverage over the past year as: (1) continuous private, (2) continuous public, (3) gap in coverage, and (4) continuously uninsured. The primary outcome was all-cause ED visits in the past year (both surveys). Secondary outcomes included unmet health care needs (NSCH), asthma-related ED visits or hospitalizations (NHIS) and asthma exacerbations (NHIS). Results: The analysis included 3739 (NSCH) and 854 (NHIS) children with asthma, representing a population of 5.5 million children in the US. Estimated prevalence of coverage gaps was 5% in the NSCH and 3% in the NHIS. On multivariable ordinal logistic regression using NSCH data, coverage gaps were associated with increased all-cause ED use (OR = 2.5; 95% CI: 1.3, 4.7, p = 0.005), compared to continuous private coverage. Further analysis confirmed higher odds of unmet health care needs, asthma exacerbations, and asthma-related ED visits among children with coverage gaps. Conclusions: Children with asthma who experience insurance coverage gaps have increased ED use, possibly related to poorer access to appropriate health care. Protecting insurance coverage continuity may reduce ED use and improve clinical outcomes in this population.