1
|
Selmani A, Coenen M, Voss S, Jung-Sievers C. Health indices for the evaluation and monitoring of health in children and adolescents in prevention and health promotion: a scoping review. BMC Public Health 2021; 21:2309. [PMID: 34930195 PMCID: PMC8686583 DOI: 10.1186/s12889-021-12335-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health indicators are used in different settings to monitor health outcomes. Child and adolescent health is arguably one of the most important areas for the application of indices and indicators in prevention and health promotion. Although single health indicators may be better suited to display the complexity of the health status and its determinants, a selected set of indicators will still offer a complex picture. Therefore, it is argued that a group of indicators combined into an index may offer a pragmatic tool that is easier to use in order to inform stakeholders. METHODS A scoping review was conducted to identify and describe health indices that monitor and evaluate health of children and adolescents and to appraise the quality and value of the identified indices that may guide the further applications of these indices in particular settings. The three bibliographic databases MEDLINE, EMBASE and PsycINFO were searched and a double screening of titles and abstracts as well as double screening of full texts was performed. Indices contained in these studies were analysed in terms of focus and composition and evaluated in terms of quality criteria. RESULTS The scoping review identified 36 eligible studies with 18 health indices in six thematic categories. Of the identified indices, seven indices focus on anthropometrical variables, three indices focus on special aspects of newborns and five indices focus on oral health. One index assesses "healthy lifestyle" and one "functional ability" whereas one index a combination of different aspects. Most indices are calculated by using primary health data. CONCLUSIONS Alone or in combination with single sets of indicators, indices in six major thematic domains may be used as pragmatic tools for monitoring children's and adolescents´ health and the evaluation of interventions in health promotion and prevention settings.
Collapse
Affiliation(s)
- Albulena Selmani
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
2
|
Wallander JL, Berry S, Carr PA, Peterson ER, Waldie KE, Marks E, D'Souza S, Morton SMB. Patterns of risk exposure in first 1,000 days of life and health, behavior, and education-related problems at age 4.5: evidence from Growing Up in New Zealand, a longitudinal cohort study. BMC Pediatr 2021; 21:285. [PMID: 34140013 PMCID: PMC8212450 DOI: 10.1186/s12887-021-02652-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/08/2021] [Indexed: 01/01/2023] Open
Abstract
Background Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. Those exposed to multiple risk factors are more likely to exhibit problems in development than those exposed to a single or no risk factor. We examined the longitudinal associations between persistence and timing of exposure to cumulative risk (CR) on three occasions by age 2 and problems in development at age 4.5 in health, behavior, and education-related domains. Methods Data are from Growing Up in New Zealand (NZ), a prospective longitudinal study of a birth cohort first assessed during their last trimester in 2009–10 and followed at ages 9 months and 2 and 4.5 years. All women with an expected delivery date in a 12-month period who resided within a defined region were invited to participate, with no additional eligibility criteria. Exposure was measured for 12 sociodemographic and maternal health risk factors at third trimester and ages 9 months and 2 years, from which developmental trajectories were constructed capturing persistence and timing of CR exposure. Ten developmental outcomes were measured at age 4.5 to classify problems in overall health status, obesity, and injuries; internalizing and externalizing behavior problems; and letter naming, counting forward and backward, and expectations for starting school and completing education. Results Analyses of data from 6156 children (49% female, 33% Non-European ethnicity) who participated in the 4.5-age assessment uniformly showed associations between exposure to more than consistently zero CR across early development and higher prevalence of being classified with problems for 9 of 10 outcomes. Persistent exposure to a CR ≥ 4 was generally associated with a higher prevalence of problems for 7 of 10 outcomes, whereas the timing of first exposure to CR ≥ 4 showed a less consistent association with problem outcomes. Conclusions These findings are concerning because over 50% of NZ children are exposed to at least one of these risk factors at some point in early development. Routine screening of most of these risk factors during pregnancy is feasible and can identify priority candidates for intervention.
Collapse
Affiliation(s)
- Jan L Wallander
- Psychological Sciences and Health Sciences Research Institute, University of California, 5400 North Lake Rd., Merced, CA, 95343, USA.
| | | | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Elizabeth R Peterson
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Emma Marks
- School of Population Health and Centre for Longitudinal Research He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- COMPASS Research Centre, Faculty of Arts, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- School of Population Health and Centre for Longitudinal Research He Ara ki Mua, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Changes in Caregiver Health in the Years Surrounding the Birth of a Child With Health Problems: Administrative Data From British Columbia. Med Care 2019; 57:369-376. [PMID: 30908379 DOI: 10.1097/mlr.0000000000001098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caregivers of children with health problems (CHPs; usually mothers) experience more physical and psychological health problems than those of children without health problems (non-CHPs). Primarily cross-sectional and survey-driven, this literature has not yet explored whether these health differences existed before the birth of the CHPs, or are exacerbated postbirth. METHODS Using linked administrative health data on all mother-child dyads for children born in the year 2000 in British Columbia, Canada, we examined maternal health before, during, and after the birth of CHPs, and compared it between mothers of CHPs and non-CHPs with piecewise growth curve modeling. RESULTS Compared with mothers of non-CHPs, mothers of CHPs had more physician visits (8.09 vs. 11.07), more medication types (1.81 vs. 2.60), and were more likely to be diagnosed with selected health conditions (30.9% vs. 42.5%) 4 years before the birth of the child. Over the 7-year postbirth period, the health of the 2 groups of mothers further diverged: while mothers of CHPs showed increases on physician visits and types of medication, mothers of non-CHPs did not experience any changes in physician visits and had less steep increases for types of medication. CONCLUSIONS Health issues associated with having a child with a health problem may begin well before the birth of the child, but also appear to be exacerbated postbirth. The health challenges of caregivers of CHPs may be multifactorial, involving both preexisting conditions and the stresses associated with caring for a child with health problems.
Collapse
|
4
|
Brehaut JC, Guèvremont A, Arim RG, Garner RE, Miller AR, McGrail KM, Brownell M, Lach LM, Rosenbaum PL, Kohen DE. Using Canadian administrative health data to examine the health of caregivers of children with and without health problems: A demonstration of feasibility. Int J Popul Data Sci 2019; 4:584. [PMID: 32935023 PMCID: PMC7479927 DOI: 10.23889/ijpds.v4i1.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Caregivers of children with health problems experience poorer health than the caregivers of healthy children. To date, population-based studies on this issue have primarily used survey data. Objectives We demonstrate that administrative health data may be used to study these issues, and explore how non-categorical indicators of child health in administrative data can enable population-level study of caregiver health. Methods Dyads from Population Data British Columbia (BC) databases, encompassing nearly all mothers in BC with children aged 6-10 years in 2006, were grouped using a non-categorical definition based on diagnoses and service use. Regression models examined whether four maternal health outcomes varied according to indicators of child health. Results 162,847 mother-child dyads were grouped according to the following indicators: Child High Service Use (18%) vs. Not (82%), Diagnosis of Major and/or Chronic Condition (12%) vs. Not (88%), and Both High Service Use and Diagnosis (5%) vs. Neither (75%). For all maternal health and service use outcomes (number of physician visits, chronic condition, mood or anxiety disorder, hospitalization), differences were demonstrated by child health indicators. Conclusions Mothers of children with health problems had poorer health themselves, as indicated by administrative data groupings. This work not only demonstrates the research potential of using routinely collected health administrative data to study caregiver and child health, but also the importance of addressing maternal health when treating children with health problems.
Collapse
Affiliation(s)
- Jamie C Brehaut
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Room 1284 Centre for Practice-Changing Research; Box 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Anne Guèvremont
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Rubab G Arim
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Rochelle E Garner
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Anton R Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z9, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Lucyna M Lach
- School of Social Work, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada
| | - Peter L Rosenbaum
- Department of Paediatrics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Dafna E Kohen
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| |
Collapse
|
5
|
Wallander JL, Fradkin C, Elliott MN, Cuccaro PM, Tortolero Emery S, Schuster MA. Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study. Qual Life Res 2019; 28:1761-1771. [PMID: 30927145 DOI: 10.1007/s11136-019-02157-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence. METHODS A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQL™ short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth's overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home. RESULTS Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments. CONCLUSIONS Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health.
Collapse
Affiliation(s)
- Jan L Wallander
- Psychological Sciences and Health Sciences Research Institute, SSHA, University of California, 5200 N. Lake Rd, Merced, CA, 95343, USA.
| | - Chris Fradkin
- Psychological Sciences and Health Sciences Research Institute, SSHA, University of California, 5200 N. Lake Rd, Merced, CA, 95343, USA.,Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula M Cuccaro
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, USA
| | - Susan Tortolero Emery
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, USA
| | - Mark A Schuster
- Kaiser Permanente School of Medicine, Pasadena, CA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| |
Collapse
|
6
|
Cohen E, Berry JG, Sanders L, Schor EL, Wise PH. Status Complexicus? The Emergence of Pediatric Complex Care. Pediatrics 2018; 141:S202-S211. [PMID: 29496971 DOI: 10.1542/peds.2017-1284e] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/24/2022] Open
Abstract
Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.
Collapse
Affiliation(s)
- Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; .,Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jay G Berry
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Lee Sanders
- Center for Policy, Outcomes and Prevention (CPOP) and.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and
| | - Edward L Schor
- Lucile Packard Foundation for Children's Health, Palo Alto, California
| | - Paul H Wise
- Center for Policy, Outcomes and Prevention (CPOP) and.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and
| |
Collapse
|
7
|
Arim RG, Miller AR, Guèvremont A, Lach LM, Brehaut JC, Kohen DE. Children with neurodevelopmental disorders and disabilities: a population-based study of healthcare service utilization using administrative data. Dev Med Child Neurol 2017; 59:1284-1290. [PMID: 28905997 DOI: 10.1111/dmcn.13557] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to identify children with neurodevelopmental disorders and disabilities (NDD/D) and compare their healthcare service utilization to children without NDD/D using provincial linked administrative data. METHOD The sample included children aged 6 to 10 years (n=183 041), who were registered with the British Columbia Medical Services Plan. Diagnostic information was used for the identification and classification of NDD/D in six functional domains. Healthcare service utilization included outcomes based on physician claims, prescription medication use, and hospitalization. RESULTS Overall, 8.3% of children were identified with NDD/D. Children with NDD/D had higher healthcare service utilization rates than those without NDD/D. Effect sizes were: very large for the number of days a prescription medication was dispensed; large for the number of prescriptions; medium for the number of physician visits, different specialists visited, number of different prescription medications, and ever hospitalized; and small for the number of laboratory visits, X-ray visits, and number of days hospitalized. INTERPRETATION The findings have policy implications for service and resource planning. Given the high use of psychostimulants, specialized services for both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D. Future studies may examine patterns of physician behaviours and costs attributable to healthcare service utilization for children with NDD/D. WHAT THIS PAPER ADDS Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without. Based on provincial population-based linked administrative health data, a sizeable number of children are living with NDD/D. Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D.
Collapse
Affiliation(s)
- Rubab G Arim
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Anton R Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Guèvremont
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Lucyna M Lach
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dafna E Kohen
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| |
Collapse
|
8
|
Yamaoka Y, Tamiya N, Izumida N, Kawamura A, Takahashi H, Noguchi H. The relationship between raising a child with a disability and the mental health of mothers compared to raising a child without disability in japan. SSM Popul Health 2016; 2:542-548. [PMID: 29349170 PMCID: PMC5757745 DOI: 10.1016/j.ssmph.2016.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
Objective Previous studies conducted in Japan targeted only mothers who cared for children with disabilities, and lacked reference subjects, such as mothers of children without disabilities. The aim of this study was to examine the association between raising one or two children with a disability and maternal psychological distress compared to mothers of children without a disability, and to assess differences among partnered mothers living with grandparent(s), partnered mothers without grandparent(s), and single mothers. Methods This study utilized data from the Comprehensive Survey of Living Conditions (CSLC) in 2010. We merged the data of the children (aged six and over), mothers, and fathers. This study obtained 33,739 study subjects as a triad of a child (33,110 children without disabilities and 629 children with disabilities), mother, and father. The Japanese version of Kessler 6 (K6) was used to assess the psychological distress of mothers. Multivariate logistic regression was performed to assess the independent association of a child with a disability on maternal psychological distress after controlling for the basic characteristics of the children, mothers, and households. Results This study reported that raising one or two children with disabilities was significantly related to maternal psychological distress (odds ratio: 1.72 for one child, 2.85 for two children) compared to mothers of children without disability. After stratifying the analyses by family structure, significant associations remained among mothers in two-parent families but not for mothers in three-generation families and single mothers due to a small number of children with disabilities in these families. Conclusions This study reported the significant association between raising a child with a disability and maternal psychological distress in comparison to mothers of children without disabilities. Attention should be paid to not only single mothers, but also partnered mothers in two-parent families who have a child with a disability. It is important for health professionals to focus on the mental health of every mother of a child with a disability and to assess their needs for psychological support. This study examined the association between raising a child with a disability and maternal psychological distress. We compared differences among mothers of child with or without disability using a population-based survey. Raising one or two children with a disability had a significant association with maternal psychological distress. Significant associations remained among mothers in only two-parent families. It is important for health professionals to focus on mental health of every mother of child with a disability.
Collapse
Affiliation(s)
- Yui Yamaoka
- Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
| | - Nobuyuki Izumida
- Department of Empirical Social Security Research, National Institute of Population and Social Security Research, Chiyoda-ku, Tokyo, Japan
| | - Akira Kawamura
- Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
| | - Hideto Takahashi
- Office of Information Management and Statistics, Radiation Medical Science Center for the Fukushima Health Management Survey, Faculty of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
9
|
Uebel H, Wright IM, Burns L, Hilder L, Bajuk B, Breen C, Abdel-Latif ME, Feller JM, Falconer J, Clews S, Eastwood J, Oei JL. Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome. Pediatrics 2015; 136:e811-20. [PMID: 26371197 DOI: 10.1542/peds.2014-2767] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. METHODS Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1,018,421 live born infants without an NAS diagnosis. RESULTS Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poisoning (3.6, 2.6-4.8), and mental/behavioral (2.6, 2.1-3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0-7.0), have no antenatal care (6.6, 5.9-7.4), and be socioeconomically deprived (1.6, 1.5-1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4-6.1) and mental and behavioral disorders (2.3, 1.9-2.9), even after accounting for prematurity, maternal age, and Indigenous status. CONCLUSIONS Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.
Collapse
Affiliation(s)
- Hannah Uebel
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia
| | - Ian M Wright
- Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, Australia; Department of Paediatrics, The Wollongong Hospital, Wollongong, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, and
| | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, Australia
| | | | | | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australia; Faculty of Medicine, Australian National University, Deakin, Australia
| | - John M Feller
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Children's Hospital, Randwick, Australia
| | | | | | - John Eastwood
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Local Health District, Australia; School of Public Health, University of Sydney, Camperdown, Australia; and
| | - Ju Lee Oei
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Department of Newborn Care, Royal Hospital for Women, Randwick, Australia
| |
Collapse
|
10
|
Bethell CD, Blumberg SJ, Stein REK, Strickland B, Robertson J, Newacheck PW. Taking stock of the CSHCN screener: a review of common questions and current reflections. Acad Pediatr 2015; 15:165-76. [PMID: 25486969 PMCID: PMC4778422 DOI: 10.1016/j.acap.2014.10.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/29/2014] [Accepted: 10/12/2014] [Indexed: 11/24/2022]
Abstract
Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and related services beyond those routinely used by children. Common questions about the CS include those related to its development and uses; its conceptual framework and potential for under- or overidentification; its ability to stratify CSHCN by complexity of service needs and daily life impacts; and its potential application in clinical settings and comparisons with other identification approaches. This review recaps the development, design, and findings from the use of the CS and synthesizes findings from studies conducted over the past 13 years as well as updated findings on the CS to briefly address the 12 most common questions asked about this tool through technical assistance provided regarding the CS since 2001. Across a range of analyses, the CS consistently identifies a subset of children with chronic conditions who need or use more than a routine type or amount of medical- and health-related services and who share common needs for health care, including care coordination, access to specialized and community-based services, and enhanced family engagement. Scoring algorithms exist to stratify CSHCN by complexity of needs and higher costs of care. Combining CS data with clinical diagnostic code algorithms may enhance capacity to further identify meaningful subgroups. Clinical application is most suited for identifying and characterizing populations of patients and assessing quality and system improvement impacts for children with a broad range of chronic conditions. Other clinical applications require further implementation research. Use of the CS in clinical settings is limited because integration of standardized patient-reported health information is not yet common practice in most settings or in electronic health records. The CS continues to demonstrate validity as a non-condition-specific, population-based tool that addresses many of the limits of condition or diagnosis checklists, including the relatively low prevalence of many individual conditions and substantial within-diagnosis variations and across-diagnoses similarities in health service needs, functioning, and quality of care.
Collapse
Affiliation(s)
- Christina D Bethell
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md.
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, USDHHS, Hyattsville, MD
| | - Ruth E K Stein
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY
| | - Bonnie Strickland
- Maternal and Child Health Bureau, Health Resources and Services Administration, USDHHS, Dockville, MD
| | - Julie Robertson
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Paul W Newacheck
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Calif
| |
Collapse
|
11
|
Hillemeier MM, Lanza ST, Landale NS, Oropesa RS. Measuring early childhood health and health disparities: a new approach. Matern Child Health J 2014; 17:1852-61. [PMID: 23225206 DOI: 10.1007/s10995-012-1205-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Efforts to improve the health of U.S. children and reduce disparities have been hampered by lack of a rigorous way to summarize the multi-dimensional nature of children's health. This research employed a novel statistical approach to measurement to provide an integrated, comprehensive perspective on early childhood health and disparities. Nationally-representative data (n = 8,800) came from the Early Childhood Longitudinal Study, Birth Cohort. Latent class analysis was used to classify health at 48 months, incorporating health conditions, functioning, and aspects of physical, cognitive, and emotional development. Health disparities by gender, poverty, race/ethnicity, and birthweight were examined. Over half of all children were classified as healthy using multidimensional latent class methodology; others fell into one of seven less optimal health statuses. The analyses highlighted pervasive disparities in health, with poor children at increased risk of being classified into the most disadvantaged health status consisting of chronic conditions and a cluster of developmental problems including low cognitive achievement, poor social skills, and behavior problems. Children with very low birthweight had the highest rate of being in the most disadvantaged health status (25.2 %), but moderately low birthweight children were also at elevated risk (7.9 vs. 3.4 % among non-low birthweight children). Latent class analysis provides a uniquely comprehensive picture of child health and health disparities that identifies clusters of problems experienced by some groups. The findings underscore the importance of continued efforts to reduce preterm birth, and to ameliorate poverty's effects on children's health through access to high-quality healthcare and other services.
Collapse
Affiliation(s)
- Marianne M Hillemeier
- Department of Health Policy and Administration, Pennsylvania State University, 504S Ford Building, University Park, PA, 16802, USA,
| | | | | | | |
Collapse
|
12
|
Fradkin C, Wallander JL, Yamakawa Y, Schwebel DC, Chienl A, Le YCL, Li DH, Elliott M, Schuster M. Quality of Life Among Asian American Youth. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2014; 5:13-21. [PMID: 27087894 PMCID: PMC4831066 DOI: 10.1037/a0029822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The aims of the present study were to examine whether Asian American youth experience disparities in quality of life (QL) compared with Hispanic, African American, and white youth in the general population and to what extent socioeconomic status (SES) mediates any disparities among these racial/ethnic groups. Data were obtained from the Healthy Passages study, in which 4,972 Asian American (148; 3%), Hispanic (1,813; 36%), African American (1,755; 35%), and white (1,256; 25%) fifth-graders were enrolled in a population-based, cross-sectional survey conducted in three U.S. metropolitan areas. Youth reported their own QL using the PedsQL and supplemental scales. Parents reported youth's overall health status as well as parent's education and household income level. Asian American youth experienced worse status than white youth for three of 10 QL and well-being measures, better status than Hispanic youth on six measures, and better status than African American youth on three measures. However, the observed advantages for Asian American youth over Hispanic and African American youth disappeared when the marked SES differences that are also present among these racial/ethnic groups were taken into account. In contrast, the differences between Asian American and white youth remained after adjusting for SES. These findings suggest that the disparities in QL that favor white youth over Asian American youth exist independent of SES and warrant further examination. In contrast, the QL differences that favor Asian American over Hispanic and African American youth may be partly explained by SES. Interpretations are limited by the heterogeneity existing among Asian Americans.
Collapse
Affiliation(s)
- Chris Fradkin
- Psychological Sciences, Center of Excellence on Health Disparities, and Health Sciences Research Institute, University of California, Merced
| | - Jan L Wallander
- Psychological Sciences, Center of Excellence on Health Disparities, and Health Sciences Research Institute, University of California, Merced
| | - Yoshimi Yamakawa
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Alyna Chienl
- Division of General Pediatrics, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School
| | - Yen-Chi L Le
- University of Texas School of Public Health, Houston
| | - Dennis H Li
- University of Texas School of Public Health, Houston
| | | | - Mark Schuster
- Division of General Pediatrics, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, and RAND Corporation
| |
Collapse
|
13
|
Garbarski D. The interplay between child and maternal health: reciprocal relationships and cumulative disadvantage during childhood and adolescence. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:91-106. [PMID: 24578398 PMCID: PMC4318683 DOI: 10.1177/0022146513513225] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While many studies use parental socioeconomic status and health to predict children's health, this study examines the interplay over time between child and maternal health across childhood and adolescence. Using data from women in the National Longitudinal Study of Youth 1979 cohort and their children (N = 2,225), autoregressive cross-lagged models demonstrate a reciprocal relationship between child activity limitations and maternal health limitations in direct effects of child activity limitations on maternal health limitations two years later and vice versa-net of a range of health-relevant time-varying and time-invariant covariates. Furthermore, there are indirect effects of child activity limitations on subsequent maternal health limitations and indirect effects of maternal health limitations on subsequent child activity limitations via intervening health statuses. This study examines how the interplay between child and maternal health unfolds over time and describes how these interdependent statuses jointly experience health disadvantages.
Collapse
|
14
|
Wallander JL, Kerbawy S, Toomey S, Lowry R, Elliott MN, Escobar-Chaves SL, Franzini L, Schuster MA. Is obesity associated with reduced health-related quality of life in Latino, Black and White children in the community? Int J Obes (Lond) 2013; 37:920-5. [PMID: 23478424 PMCID: PMC3705583 DOI: 10.1038/ijo.2013.31] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/10/2013] [Accepted: 01/28/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Few studies have examined the impact of obesity on health-related quality of life (HRQOL) in non-clinical community samples of children, and methodological limitations have hindered drawing firm conclusions, especially whether the impact is similar across racial/ethnic groups. The present aims were to examine at what levels of non-normal weight, school-aged children experience lower HRQOL and whether this differs among racial/ethnic groups, when controlling for socioeconomic status (SES) differences. DESIGN Cross-sectional community cohort survey. SUBJECTS AND METHODS Data are from the Healthy Passages, reporting on 4824 Latino, black and white 5th graders in a population-based survey conducted in three United States metropolitan areas. Children's weight status was classified from measured weight and height into underweight (1%), normal weight (52%), overweight (19%), obese (13%) and extremely obese (14%). Children reported their own HRQOL using the Pediatric Quality of Life Inventory and additional scales addressing global self-worth, physical appearance and body satisfaction. Parents reported children's overall health status. RESULTS Each increment in higher non-healthy weight class-overweight to obese to extremely obese-was associated with significantly lower scores in more domains of psychosocial HRQOL compared with that in normal weight. However, only extremely obese children reported significantly lower physical HRQOL. Differences among weight classes remained when adjusting for SES and were independent of race/ethnicity. Underweight children generally reported HRQOL that was not significantly different from normal weight children. CONCLUSIONS Overweight, obese and extremely obese 5th graders on average experience worse HRQOL than normal weight children, especially in psychosocial domains including self-worth and peer relationships, regardless of race/ethnicity. If messages can be conveyed in a sensitive and supportive manner, the desire to improve HRQOL could provide additional motivation for children and their parents in addressing unhealthy weight.
Collapse
Affiliation(s)
- J L Wallander
- Department of Psychological Sciences, Center of Excellence on Health Disparities, Health Sciences Research Institute, University of California, Merced, Merced, CA 95343, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Reuben CA, Pastor PN. The effect of special health care needs and health status on school functioning. Disabil Health J 2013; 6:325-32. [PMID: 24060255 DOI: 10.1016/j.dhjo.2013.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/07/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association. OBJECTIVES To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes. METHODS The analysis was based on 59,440 children aged 6-17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days. RESULTS Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health. CONCLUSIONS The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning.
Collapse
Affiliation(s)
- Cynthia A Reuben
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA
| | | |
Collapse
|
16
|
Garbarski D, Witt WP. Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health. JOURNAL OF FAMILY ISSUES 2013; 34:484-509. [PMID: 23788824 PMCID: PMC3685194 DOI: 10.1177/0192513x12443052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal physical and mental health outcomes. We hypothesize that poor child health may also increase the risk of poor maternal health outcomes through an interaction between child health and factors associated with health outcomes, such as marital status, marital quality, and socioeconomic status. Using data on women in the National Longitudinal Study of Youth 1979 cohort (N = 2,279), we find evidence that the effects of certain maternal marital quality and socioeconomic factors on maternal physical and mental health depend on child health status and vice versa.
Collapse
Affiliation(s)
- Dana Garbarski
- Department of Sociology, University of Wisconsin-Madison Department of Population Health Sciences, University of Wisconsin-Madison University of Wisconsin Survey Center, University of Wisconsin-Madison 8128 Sewell Social Science Building 1180 Observatory Drive Madison, WI 53706 (Phone: (608) 262-2182; Fax (608) 262-8400; )
| | - Whitney P. Witt
- Department of Population Health Sciences, University of Wisconsin-Madison 707 WARF Building, Office 503 610 Walnut Street Madison, WI 53726 (Phone: (608) 265-6290; Fax (608) 263-2820; )
| |
Collapse
|
17
|
Landale NS, Lanza ST, Hillemeier M, Oropesa R. Health and development among Mexican, black and white preschool children: An integrative approach using latent class analysis. DEMOGRAPHIC RESEARCH 2013; 28:1302-1338. [PMID: 25057259 PMCID: PMC4105264 DOI: 10.4054/demres.2013.28.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Building on an emerging scientific consensus that the concept of child health should encompass chronic conditions, functional abilities, and developmental domains, we delineate the multidimensional health statuses of Mexican, non-Hispanic black, and non-Hispanic white preschool children in the United States. This integrative approach provides the foundation for an in-depth analysis of health disparities. OBJECTIVE The research objectives are: (1) to demonstrate a new methodological approach to identifying the major child health statuses; (2) to document differences in the prevalence of those health statuses among children in the largest ethnoracial groups in the U.S.; and (3) to assess whether key sources of disadvantage account for ethnoracial disparities in children's health. METHODS With data from a nationally representative sample, we use latent class analysis to estimate a set of latent health statuses that capture the nature of health at age four. The latent class membership of children is predicted using multinomial logistic regression. RESULTS Mexican and non-Hispanic black children are more likely than non-Hispanic white children to fall into health statuses distinguished by low cognitive achievement and multiple developmental problems. Mexican children are the most likely to be classified into these problematic health statuses. This pattern persists in multivariate models that incorporate potential explanatory factors, including health at birth, socio-demographic characteristics, home environment, well-child care and center-based child care. CONCLUSIONS Latent class analysis is a useful method for incorporating measures of physical conditions, functional problems, and development into a single analysis in order to identify key dimensions of childhood health and locate ethnoracial health disparities.
Collapse
Affiliation(s)
- Nancy S. Landale
- The Pennsylvania State University, Department of Sociology & Crime, Law and Justice, USA
| | | | - Marianne Hillemeier
- The Pennsylvania State University, Department of Health Policy and Administration, USA
| | - R.S. Oropesa
- The Pennsylvania State University, Department of Sociology & Crime, Law and Justice, USA
| |
Collapse
|
18
|
Wallander JL, Fradkin C, Chien AT, Mrug S, Banspach SW, Davies S, Elliott MN, Franzini L, Schuster MA. Racial/ethnic disparities in health-related quality of life and health in children are largely mediated by family contextual differences. Acad Pediatr 2012; 12:532-8. [PMID: 22884796 DOI: 10.1016/j.acap.2012.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL), and overall health status among African-American, Hispanic, and white 5th graders in the general population and (2) the extent to which socioeconomic status (SES) and other family contextual variables mediate any disparities. METHODS A total of 4824 African-American, Hispanic, and white fifth-graders participating in a population-based, cross-sectional survey conducted in 3 U.S. metropolitan areas reported their own HRQOL by using the Pediatric Quality of Life Inventory Version 4.0 and supplemental personal and social well-being scales. Parents reported these children's overall health status. SES was indexed by parent education and household income. Other family contextual variables included family structure and degree to which English is spoken at home. RESULTS Marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring white children and especially disfavoring Hispanic children. Most of these disparities were no longer significant after adjusting for SES and other family contextual differences that were observed among these racial/ethnic groups. Only disparities in parent-reported overall health status and self-reported global self-worth remained. CONCLUSIONS Racial/ethnic disparities in children's health status are substantial but may be mediated by corresponding disparities in SES and other family contextual variables. Race/ethnicity and family context are related to one another and should be considered jointly in efforts to reduce health disparities in children.
Collapse
Affiliation(s)
- Jan L Wallander
- Psychological Sciences, Center of Excellence on Health Disparities, University of California, Merced, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kuo DZ, Cohen E, Agrawal R, Berry JG, Casey PH. A national profile of caregiver challenges among more medically complex children with special health care needs. ACTA ACUST UNITED AC 2011; 165:1020-6. [PMID: 22065182 DOI: 10.1001/archpediatrics.2011.172] [Citation(s) in RCA: 365] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront. DESIGN Secondary analysis of the 2005-2006 National Survey of Children With Special Health Care Needs (unweighted n = 40 723). SETTING United States-based population. PARTICIPANTS National sample of CSHCN. MAIN EXPOSURE More complex CSHCN were defined by incorporating components of child health and family need, including medical technology dependence and care by 2 or more subspecialists. MAIN OUTCOME MEASURES Caregiver challenges were defined by family-reported care burden (including hours providing care coordination and home care), medical care use (on the basis of health care encounters in the last 12 months), and unmet needs (defined by 15 individual medical care needs and a single nonmedical service need). RESULTS Among CSHCN, 3.2% (weighted n = 324 323) met criteria for more complex children, representing 0.4% of all children in the United States. Caregivers of more complex CSHCN reported a median of 2 (interquartile range, 1-6) hours per week on care coordination and 11 to 20 (interquartile range, 3->21) hours per week on direct home care. More than half (56.8%) reported financial problems, 54.1% reported that a family member stopped working because of the child's health, 48.8% reported at least 1 unmet medical service need, and 33.1% reported difficulty in accessing nonmedical services. CONCLUSIONS Extraordinary and diverse needs are common among family caregivers of more complex CSHCN. Enhanced care coordination support, respite care, and direct home care may begin to address the substantial economic burden and the multiple unmet needs that many of these families face.
Collapse
Affiliation(s)
- Dennis Z Kuo
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
| | | | | | | | | |
Collapse
|
20
|
Kuo DZ, Cohen E, Agrawal R, Berry JG, Casey PH. A national profile of caregiver challenges among more medically complex children with special health care needs. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2011. [PMID: 22065182 DOI: 10.1001/archpediatrics.2011.172.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront. DESIGN Secondary analysis of the 2005-2006 National Survey of Children With Special Health Care Needs (unweighted n = 40 723). SETTING United States-based population. PARTICIPANTS National sample of CSHCN. MAIN EXPOSURE More complex CSHCN were defined by incorporating components of child health and family need, including medical technology dependence and care by 2 or more subspecialists. MAIN OUTCOME MEASURES Caregiver challenges were defined by family-reported care burden (including hours providing care coordination and home care), medical care use (on the basis of health care encounters in the last 12 months), and unmet needs (defined by 15 individual medical care needs and a single nonmedical service need). RESULTS Among CSHCN, 3.2% (weighted n = 324 323) met criteria for more complex children, representing 0.4% of all children in the United States. Caregivers of more complex CSHCN reported a median of 2 (interquartile range, 1-6) hours per week on care coordination and 11 to 20 (interquartile range, 3->21) hours per week on direct home care. More than half (56.8%) reported financial problems, 54.1% reported that a family member stopped working because of the child's health, 48.8% reported at least 1 unmet medical service need, and 33.1% reported difficulty in accessing nonmedical services. CONCLUSIONS Extraordinary and diverse needs are common among family caregivers of more complex CSHCN. Enhanced care coordination support, respite care, and direct home care may begin to address the substantial economic burden and the multiple unmet needs that many of these families face.
Collapse
Affiliation(s)
- Dennis Z Kuo
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
| | | | | | | | | |
Collapse
|
21
|
Brehaut JC, Garner RE, Miller AR, Lach LM, Klassen AF, Rosenbaum PL, Kohen DE. Changes over time in the health of caregivers of children with health problems: growth-curve findings from a 10-year Canadian population-based study. Am J Public Health 2011; 101:2308-16. [PMID: 22021302 DOI: 10.2105/ajph.2011.300298] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used Canadian population-based data to examine changes in the health of caregivers of children with complex health problems compared with caregivers of healthy children over a 10-year time period. METHODS The National Longitudinal Survey of Children and Youth collected data biennially from 9401 children and their caregivers in 6 waves from 1994-1995 to 2004-2005. We conducted growth-curve analyses of these data to model self-reported general health and depressive symptoms for 4 groups of caregivers: caregivers of healthy children, and caregivers of children with 1, 2, or at least 3 of 4 conceptually distinct indicators of child health problems. We modeled covariates for children (age, gender, only-child status) and caregivers (age, gender, education, income, marital status). RESULTS After we controlled for covariates, caregiver health outcomes worsened incrementally with increasing complexity of child health problems. Change in self-reported general health and depressive symptoms over the 10-year period was consistent across all groups of caregivers. CONCLUSIONS Poorer health among caregivers of children with health problems can persist for many years and is associated with complexity of child health problems. Attention to parental health should form a component of health care services for children with health problems.
Collapse
Affiliation(s)
- Jamie C Brehaut
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|
22
|
Witt WP, Litzelman K, Mandic CG, Wisk LE, Hampton JM, Creswell PD, Gottlieb CA, Gangnon RE. Healthcare-Related Financial Burden among Families in the U.S.: The Role of Childhood Activity Limitations and Income. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2011; 32:308-326. [PMID: 21552342 PMCID: PMC3088430 DOI: 10.1007/s10834-011-9253-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996-2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0-17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p<0.05), and were 54% more likely to experience relative burden (p<0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.
Collapse
Affiliation(s)
- Whitney P Witt
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Bethell CD, Kogan MD, Strickland BB, Schor EL, Robertson J, Newacheck PW. A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Acad Pediatr 2011; 11:S22-33. [PMID: 21570014 DOI: 10.1016/j.acap.2010.08.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/19/2010] [Accepted: 08/27/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA). OBJECTIVES The aim of this study was to evaluate national and state prevalence of health problems and special health care needs in US children; to estimate health care quality related to adequacy and consistency of insurance coverage, access to specialist, mental health and preventive medical and dental care, developmental screening, and whether children meet criteria for having a medical home, including care coordination and family centeredness; and to assess differences in health and health care quality for children by insurance type, special health care needs status, race/ethnicity, and/or state of residence. METHODS National and state level estimates were derived from the 2007 National Survey of Children's Health (N = 91,642; children aged 0-17 years). Variations between children with public versus private sector health insurance, special health care needs, specific conditions, race/ethnicity, and across states were evaluated using multivariate logistic regression and/or standardized statistical tests. RESULTS An estimated 43% of US children (32 million) currently have at least 1 of 20 chronic health conditions assessed, increasing to 54.1% when overweight, obesity, or being at risk for developmental delays are included; 19.2% (14.2 million) have conditions resulting in a special health care need, a 1.6 point increase since 2003. Compared with privately insured children, the prevalence, complexity, and severity of health problems were systematically greater for the 29.1% of all children who are publicly insured children after adjusting for variations in demographic and socioeconomic factors. Forty-five percent of all children in the United States scored positively on a minimal quality composite measure: 1) adequate insurance, 2) preventive care visit, and 3) medical home. A 22.2 point difference existed across states and there were wide variations by health condition (autism, 22.8, to asthma, 39.4). After adjustment for demographic and health status differences, quality of care varied between children with public versus private health insurance on all but the following 3 measures: not receiving needed mental health services, care coordination, and performance on the minimal quality composite. A 4.60 fold (gaps in insurance) to 1.27 fold (preventive dental and medical care visits) difference in quality scores was observed across states. Notable disparities were observed among publicly insured children according to race/ethnicity and across all children by special needs status and household income. CONCLUSIONS Findings emphasize the importance of health care insurance duration and adequacy, health care access, chronic condition management, and other quality of care goals reflected in the 2009 CHIPRA legislation and the ACA. Despite disparities, similarities for public and privately insured children speak to the pervasive nature of availability, coverage, and access issues for mental health services in the United States, as well as the system-wide problem of care coordination and accessing specialist care for all children. Variations across states in key areas amenable to state policy and program management support cross-state learning and improvement efforts.
Collapse
Affiliation(s)
- Christina D Bethell
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, 707 SW Gaines Street, Mailcode CDRCP, Portland, Oregon 97239, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Miller AR, Condin CJ, McKellin WH, Shaw N, Klassen AF, Sheps S. Continuity of care for children with complex chronic health conditions: parents' perspectives. BMC Health Serv Res 2009; 9:242. [PMID: 20025770 PMCID: PMC2805629 DOI: 10.1186/1472-6963-9-242] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 12/21/2009] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. METHODS Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services), with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. RESULTS Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors, institutional structures and practices, provider attitudes, and, on occasion, parent preferences and judgments, were all found to create barriers to "seamless" management and provision of care continuity across providers, settings, and sectors. CONCLUSIONS These findings add new perspectives to the understanding of continuity within chronically ill children's health care. They are relevant to contemporary initiatives to improve continuity of services to children with special health care needs, demonstrate the need for parental support of their important role in maintaining continuity, and suggest avenues for further research.
Collapse
Affiliation(s)
- Anton R Miller
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher J Condin
- Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William H McKellin
- Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicola Shaw
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sam Sheps
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Witt WP, Gottlieb CA, Hampton J, Litzelman K. The impact of childhood activity limitations on parental health, mental health, and workdays lost in the United States. Acad Pediatr 2009; 9:263-9. [PMID: 19487173 PMCID: PMC2743933 DOI: 10.1016/j.acap.2009.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 02/23/2009] [Accepted: 02/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine if and to what extent the onset and persistence of childhood activity limitations (ongoing, resolved, or newly reported) resulted in subsequent adverse health, mental health, and work attendance outcomes among parents in the United States. METHODS A study was conducted using 10 panels (1996-2005) of the Medical Expenditure Panel Survey (MEPS), a household survey of a nationally representative sample of the civilian noninstitutionalized population in the United States. Participants in this study were 18 827 parents and their children aged 0 to 17 years. RESULTS During the 2-year study period, 15.6% of parents reported caring for a child aged 0 to 17 years with a limitation. Parents of children with any activity limitation were significantly more likely to experience subsequent poor health and mental health. Parents of children with ongoing or newly reported limitations had an increased number of lost workdays as compared with parents of children without limitations. Moreover, caring for multiple children with activity limitations was predictive of adverse parental mental health outcomes. Parents of children with ongoing activity limitations had significantly increased odds of poor mental health compared with parents of children with resolved limitations. CONCLUSIONS Caring for a child with activity limitations affects the health, mental health, and work attendance of parents. These findings indicate that child health can importantly influence the health and work behavior of the family and that health care providers should consider a family-centered approach to care.
Collapse
Affiliation(s)
- Whitney P. Witt
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Carissa A. Gottlieb
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - John Hampton
- University of Wisconsin, Paul P. Carbone Comprehensive Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Kristin Litzelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| |
Collapse
|
26
|
Brehaut JC, Kohen DE, Garner RE, Miller AR, Lach LM, Klassen AF, Rosenbaum PL. Health among caregivers of children with health problems: findings from a Canadian population-based study. Am J Public Health 2008; 99:1254-62. [PMID: 19059861 DOI: 10.2105/ajph.2007.129817] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used population-based data to evaluate whether caring for a child with health problems had implications for caregiver health after we controlled for relevant covariates. METHODS We used data on 9401 children and their caregivers from a population-based Canadian study. We performed analyses to compare 3633 healthy children with 2485 children with health problems. Caregiver health outcomes included chronic conditions, activity limitations, self-reported general health, depressive symptoms, social support, family functioning, and marital satisfaction. Covariates included family (single-parent status, number of children, income adequacy), caregiver (gender, age, education, smoking status, biological relationship to child), and child (age, gender) characteristics. RESULTS Logistic regression showed that caregivers of children with health problems had more than twice the odds of reporting chronic conditions, activity limitations, and elevated depressive symptoms, and had greater odds of reporting poorer general health than did caregivers of healthy children. CONCLUSIONS Caregivers of children with health problems had substantially greater odds of health problems than did caregivers of healthy children. The findings are consistent with the movement toward family-centered services recognizing the link between caregivers' health and health of the children for whom they care.
Collapse
Affiliation(s)
- Jamie C Brehaut
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa Hospital, Civic Campus, ASB 2-004, Box 693, 1053 Carling Ave, Ottawa, ON, Canada, K1Y 4E9.
| | | | | | | | | | | | | |
Collapse
|