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Raouafi S, Achiche S, Raison M. Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities. Epidemiol Health 2018; 40:e2018010. [PMID: 29642656 PMCID: PMC6004430 DOI: 10.4178/epih.e2018010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/29/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system. METHODS Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level. RESULTS After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling. CONCLUSIONS More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D.
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Affiliation(s)
- Sana Raouafi
- Institute of Biomedical Engineering, Polytechnic School of Montréal, Montreal, Canada
| | - Sofiane Achiche
- Department of Mechanical Engineering, Machine Design Section, Polytechnic School of Montréal, Montreal, Canada
| | - Maxime Raison
- Department of Mechanical Engineering, Machine Design Section, Polytechnic School of Montréal, Montreal, Canada
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Güeita-Rodríguez J, García-Muro F, Cano-Díez B, Rodríguez-Fernández ÁL, Lambeck J, Palacios-Ceña D. Identification of intervention categories for aquatic physical therapy in pediatrics using the International Classification of Functioning, Disability and Health-Children and Youth: a global expert survey. Braz J Phys Ther 2017; 21:287-295. [PMID: 28579189 PMCID: PMC5537483 DOI: 10.1016/j.bjpt.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To identify intervention categories encountered by physical therapists working in aquatic therapy with disabled children, using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY). METHODS Aquatic physical therapists were asked to describe concepts related to the functioning of disabled children and their contextual factors. Data were collected in three rounds using the Delphi technique. All answers were translated ('linked') to the ICF-CY and analyzed to determine the degree of consensus. RESULTS Answers were linked and organized into four diagnostic groups. Overall, in the four groups, 41 Body Functions, 8 Body Structures, 36 Activities and Participation, and 6 Environmental Factors categories were identified as intervention targets. In addition, 8 Environmental Factors that influence aquatic physical therapy were identified. CONCLUSIONS This study highlights the variety of intervention categories available to aquatic physical therapists when treating children in the water.
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Affiliation(s)
- Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Francisco García-Muro
- Department of Nursing and Physical Therapy, School of Medicine, CEU-San Pablo University, Madrid, Spain
| | - Beatriz Cano-Díez
- Department of Nursing and Physical Therapy, School of Medicine, CEU-San Pablo University, Madrid, Spain
| | | | - Johan Lambeck
- Department of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Pulcini CD, Perrin JM, Houtrow AJ, Sargent J, Shui A, Kuhlthau K. Examining Trends and Coexisting Conditions Among Children Qualifying for SSI Under ADHD, ASD, and ID. Acad Pediatr 2015; 15:439-43. [PMID: 26142070 DOI: 10.1016/j.acap.2015.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the prevalence trends and coexisting conditions in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in the pediatric Supplemental Security Income (SSI) population and general population. METHODS The Social Security Administration (SSA) provided data on primary and secondary diagnoses of children qualifying for SSI for years 2000 to 2011. We compared SSA data with 2000-2011 National Health Interview Survey data on the prevalence of mental health diagnoses among children in the general population living between 0 and 199% of the federal poverty line. We utilized linear regression analysis to test the statistical significance of differences in the trends of the conditions' prevalence. RESULTS Over this time period, the SSI population experienced increases in ADHD (5.8%) and ASD (7.2%) and a decrease in ID (-10.3%). Comparison with change in the general population indicated no significant difference in ADHD but significant differences in ASD and ID. Relative percentage changes reflect similar changes. The SSI population qualifying for SSI with ADHD (70.8%) had higher rates of coexisting conditions than the general population (66.1%), but lower rates of coexisting conditions for ASD and ID. CONCLUSIONS ADHD is on the rise among children receiving SSI and in the general population. This suggests that the rise of ADHD in the SSI population is expected and does not represent a misallocation of resources. Changes described among the SSI population in ASD and ID may allude to diagnostic/coding trends and/or true changes in prevalence. Limitations arise from the comparability of the 2 data sets.
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Affiliation(s)
- Christian D Pulcini
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
| | - James M Perrin
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Amy J Houtrow
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Departments of Physical Medicine and Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - John Sargent
- Tufts Medical Center, Boston, Mass; Departments of Pediatrics and Psychiatry, Tufts Floating Hospital for Children, Tufts University School of Medicine, Boston, MA
| | - Amy Shui
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Karen Kuhlthau
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
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Houtrow AJ, Larson K, Olson LM, Newacheck PW, Halfon N. Changing trends of childhood disability, 2001-2011. Pediatrics 2014; 134:530-8. [PMID: 25136051 PMCID: PMC4144000 DOI: 10.1542/peds.2014-0594] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the past half century the prevalence of childhood disability increased dramatically, coupled with notable increases in the prevalence of mental health and neurodevelopmental conditions. This study provides a detailed assessment of recent trends in childhood disability in relation to health conditions and sociodemographic factors. METHODS Secondary data analysis of National Health Interview Survey (NHIS) datasets 2001-2002, 2004-2005, 2007-2008, and 2010-2011 (N = 198888) was conducted to calculate the prevalence, rate of change, severity, and sociodemographic disparities of parent-reported childhood disability. RESULTS The prevalence of childhood disability has continued to increase, growing by 15.6% between 2001-2002 and 2010-2011. Nearly 6 million children were considered disabled in 2010-2011. Children living in poverty experienced the highest rates of disability, 102.6 cases per 1000 population in 2010-2011, but unexpectedly, children living in households with incomes ≥ 400% above the federal poverty level experienced the largest increase (28.4%) over this 10-year period. The percentage of disability cases related to any physical health condition declined 11.8% during the decade, whereas cases related to any neurodevelopmental or mental health condition increased by 20.9%. CONCLUSIONS Over the past decade, parent-reported childhood disability steadily increased. As childhood disability due to physical conditions declined, there was a large increase in disabilities due to neurodevelopmental or mental health problems. For the first time since the NHIS began tracking childhood disability in 1957, the rise in reported prevalence is disproportionately occurring among socially advantaged families. This unexpected finding highlights the need to better understand the social, medical, and environmental factors influencing parent reports of childhood disability.
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Affiliation(s)
- Amy J Houtrow
- Departments of Physical Medicine and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Kandyce Larson
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Lynn M Olson
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Paul W Newacheck
- Department of Pediatrics, University of California at San Francisco, San Francisco, California; and
| | - Neal Halfon
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, California
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Felix JF, Voortman T, van den Hooven EH, Sajjad A, Leermakers ET, Tharner A, Jong JCKD, Duijts L, Verhulst FC, de Jongste JC, Tiemeier H, Hofman A, Rivadeneira F, Moll HA, Raat H, Jaddoe VW, Franco OH. Health in children: A conceptual framework for use in healthy ageing research. Maturitas 2014; 77:47-51. [DOI: 10.1016/j.maturitas.2013.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 12/22/2022]
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Dey M, Landolt MA, Mohler-Kuo M. Health-related quality of life among children with mental disorders: a systematic review. Qual Life Res 2013; 21:1797-1814. [PMID: 22298200 DOI: 10.1007/s11136-012-0109-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To systematically review studies about the quality of life (QOL) of children with various mental disorders relative to healthy controls and to describe limitations in these studies. METHODS Relevant articles were searched using different databases, by checking reference lists and contacting experts. We included articles that either compared children with mental disorders to healthy controls/norm values or made such a comparison possible. RESULTS Sixteen out of 4,560 articles met the pre-defined inclusion criteria. These studies revealed that the QOL of children with various mental disorders is compromised across multiple domains. The largest effect sizes were found for psychosocial and family-related domains and for the total QOL score, whereas physical domains generally were less affected. The most important limitations in the existing literature include the lack of study samples drawn from the general population, the failure to use self-ratings, not considering item overlap between measuring QOL and assessing for the presence of a particular mental disorder, and not determining whether the children were receiving medication for their mental disorder. CONCLUSIONS Children with mental disorders experience a considerable reduction in QOL across various domains. Research studies that avoid previous limitations are crucial to fill existing knowledge gaps.
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Affiliation(s)
- Michelle Dey
- Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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7
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Ronen GM, Rosenbaum PL. Health outcomes measurement: concepts, guidelines and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:35-41. [PMID: 23622149 DOI: 10.1016/b978-0-444-52891-9.00004-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this chapter we argue that modern thinking about chronic neurological and developmental conditions requires that we recognize all aspects of functioning and quality of life in addition to the biomedical dimensions of these disorders. We find the International Classification of Functioning, Disability, and Health (ICF) a useful framework by which to think about and understand the many dimensions of health; and we appreciate its heuristic value as a stimulus to consider a range of outcomes of these individuals. Quality of Life (QOL) and Health-Related Quality of Life (HRQL) cover the additional perceived dimensions that are so important to patients' personal valuations, aspirations, and satisfaction about health throughout their lifespan, of which we see QOL being the broader construct. In order to measure outcomes at either the individual clinical or research level it is essential to ask clear and specific questions as a prelude to selecting measures that are appropriate in terms of both their content and their measurement properties. We provide some brief guidelines that we hope will be helpful to readers who wish to expand their activities in measuring clinical outcomes.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Canada.
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Stevens K, Palfreyman S. The use of qualitative methods in developing the descriptive systems of preference-based measures of health-related quality of life for use in economic evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:991-998. [PMID: 23244799 DOI: 10.1016/j.jval.2012.08.2204] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 07/07/2012] [Accepted: 08/08/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe how qualitative methods can be used in the development of descriptive systems of preference-based measures (PBMs) of health-related quality of life. METHODS The requirements of the National Institute for Health and Clinical Excellence and other agencies together with the increasing use of patient-reported outcome measures has led to an increase in the demand for PBMs. Recently, interest has grown in developing new PBMs and while previous research on PBMs has mainly focused on the methods of valuation, research into the methods of developing descriptive systems is an emerging field. RESULTS Traditionally, descriptive systems of PBMs were developed by using top-down methods, where content was derived from existing measures, the literature, or health surveys. A contrasting approach is a bottom-up methodology, which takes the views of patients or laypeople on how their life is affected by their health. This approach generally requires the use of qualitative methods. Qualitative methods lend themselves well to the development of PBMs. They also ensure that the measure has appropriate language, content validity, and responsiveness to change. While the use of qualitative methods in the development of non-PBMs is fairly standard, their use in developing PBMs was until recently nonexistent. CONCLUSIONS In this article, we illustrate the use of qualitative methods by presenting two case studies of recently developed PBMs, one generic and one condition specific. We outline the stages involved, discuss the strengths and weaknesses of the approach, and compare with the top-down approach used in the majority of PBMs to date.
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Affiliation(s)
- Katherine Stevens
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Stein REK. A measured approach to child health. Acad Pediatr 2011; 11:240-6. [PMID: 21354383 DOI: 10.1016/j.acap.2010.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/23/2010] [Accepted: 11/27/2010] [Indexed: 11/16/2022]
Abstract
Children's health and its measurement have gained increasing attention in the face of advances in treating disease, and the growing recognition of long-term implications of child health for adult health and the nation's economy. Advances in measurement are aided by new conceptualizations, including a dynamic definition of child health and model of how it evolves. This paper discusses challenges in measurement of child health, the role of large-scale data sets, how to select a measure, 2 promising measurement frontiers, and the role of the Academic Pediatric Association in promoting a measured approach to child health.
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Affiliation(s)
- Ruth E K Stein
- Department of Pediatrics, Preventive Intervention Research Center for Child Health, Albert Einstein College of Medicine and Children's Hospital at Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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10
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Ronen GM, Fayed N, Rosenbaum PL. Outcomes in pediatric neurology: a review of conceptual issues and recommendationsThe 2010 Ronnie Mac Keith Lecture. Dev Med Child Neurol 2011; 53:305-12. [PMID: 21401584 DOI: 10.1111/j.1469-8749.2011.03919.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper discusses how to evaluate whether, and in what ways, treatments affect the lives of children with neurological conditions and their families. We argue that professionals should incorporate perspectives from patients and families to help them make decisions about what 'outcomes' are important, and we discuss how those outcomes might be assessed. A case vignette illustrates the differences and complementarity between the perspectives of clinicians and those of children and their parents. We recommend methods for expanding the range of relevant health outcomes in child neurology to include those that reflect the ways patients and families view their conditions and our interventions. We explore the added value of a 'non-categorical' approach to the choice of outcomes. The International Classification of Functioning, Disability and Health is a useful biopsychosocial framework to 'rule in' relevant aspects of child and family issues to create a dynamic system of possible influences on outcomes. We examine the meaning of 'health', 'health-related quality of life', and 'quality of life' as related but conceptually distinct outcomes. Specific issues are discussed about the construction, validation, and appraisal of outcome measures, as well as practical recommendations on how to select outcome measures in the clinical setting and research.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Carle AC, Blumberg SJ, Poblenz C. Internal psychometric properties of the Children with Special Health Care Needs Screener. Acad Pediatr 2011; 11:128-35. [PMID: 20227936 DOI: 10.1016/j.acap.2009.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 08/28/2009] [Accepted: 11/13/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Insufficient research has established the measurement properties of the Children with Special Health Care Needs (CSHCN) Screener. This leaves unclear whether CSHCN Screener-based estimates reliably identify CSHCN. We used classical and modern test theory to establish the CSHCN Screener's internal psychometric properties. METHODS Data came from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of US children (N = 359,154). RESULTS Cronbach's α, a measure of internal reliability, equaled .76. Confirmatory factor analysis for ordered-categorical measures indicated that a single underlying trait that we label health-condition-complexity underlies CSHCN Screener responses. Item response theory showed that responses provide particularly precise measurement among children experiencing elevated health-condition-complexity trait levels. CONCLUSIONS Findings demonstrate that responses to the CSHCN Screener as used in the NS-CSHCN have good internal psychometric properties and include minimal random measurement error. Epidemiologists, clinicians and others can rely on CSHCN Screener responses to reliably identify CSHCN experiencing 1 or more of the 5 consequences included on the CSHCN Screener.
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Affiliation(s)
- Adam C Carle
- Department of Pediatrics, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio 45229, USA.
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12
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Was sind chronisch kranke Kinder? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:585-91. [DOI: 10.1007/s00103-008-0534-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McCormick MC. Issues in measuring child health. ACTA ACUST UNITED AC 2008; 8:77-84. [PMID: 18355733 DOI: 10.1016/j.ambp.2007.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 11/14/2007] [Accepted: 11/21/2007] [Indexed: 11/25/2022]
Abstract
Assessing child health is critical to a variety of child health, educational, and social programs, as well as to clinical research and practice. However, despite the apparent wealth of measures available in health, education, and legal and social welfare systems, little agreement exists as to what are the most important measures and for what domains of health. Development of improved measures may capitalize on advances in conceptualization of child health, including the dynamic nature of the interplay of child health and development over time. The need for enhanced measures can be illustrated by consideration of various aspects of pediatric care: well-child care, acute illness care, and the management of children with special health care needs. In particular, the strong theoretical perspectives on aspects of development such as cognition and behavioral development need to be informed by the experience of various states of health and their developmental implications. If generalist academicians are to further their research and educational mission, they must engage, and urgently, in the development and measurement of child health.
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Affiliation(s)
- Marie C McCormick
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Nageswaran S, Silver EJ, Stein REK. Association of functional limitation with health care needs and experiences of children with special health care needs. Pediatrics 2008; 121:994-1001. [PMID: 18450905 DOI: 10.1542/peds.2007-1795] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. METHODS We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. RESULTS Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. CONCLUSIONS Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.
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Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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15
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Affiliation(s)
- Ruth E K Stein
- Department of Pediatrics Albert Einstein College of Medicine/Children's Hospital at Montefiore, 111 East 210 Street, Bronx, NY 10467, USA.
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Olson LM, Radecki L, Frintner MP, Weiss KB, Korfmacher J, Siegel RM. At what age can children report dependably on their asthma health status? Pediatrics 2007; 119:e93-102. [PMID: 17200264 DOI: 10.1542/peds.2005-3211] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examined psychometric properties and feasibility issues surrounding child-reported asthma health status data. METHODS In separate interviews, parents and children completed 3 visits. Child questionnaires were interviewer administered. The primary instrument was the Children's Health Survey for Asthma-Child Version, used to compute 3 scales (physical health, activities, and emotional health). The following were assessed: reliability (internal consistency and test-retest reliability), validity (general health status, symptom burden, and lung function), and feasibility (completion time, missing data, and inconsistent responses). RESULTS A total of 414 parent-child pairs completed the study (mean child age: 11.5 years). Reliability estimates for the activities and emotional health scales were > .70 in all but 1 age category; 5 of 9 age groups had acceptable internal consistency ratings (> or = .70) for the physical health scale. Cronbach's alpha tended to increase with child age. In general, test-retest correlations between forms and intraclass correlation coefficients were strong for all ages but tended to increase with child age. Correlations between forms ranged from .57 (7-year-old subjects, physical health) to .96 (14-year-old subjects, activities). Intraclass correlation coefficients ranged from .76 (13-year-old subjects, emotional health) to .94 (15-16-year-old subjects, physical health). Children with less symptom burden reported higher mean Children's Health Survey for Asthma-Child Version scores (indicating better health status) for each scale, at significant levels for nearly all age groups. Children's Health Survey for Asthma-Child Version completion times decreased from 12.9 minutes at age 7 to 6.9 minutes at age 13. CONCLUSIONS This research indicates that children with asthma as young as 7 may be dependable and valuable reporters of their health. Data quality tends to improve with age.
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Affiliation(s)
- Lynn M Olson
- Department of Research, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007, USA.
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Buescher PA, Whitmire JT, Brunssen S, Kluttz-Hile CE. Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004. Matern Child Health J 2006; 10:461-6. [PMID: 16752093 DOI: 10.1007/s10995-006-0081-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 04/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0-19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. METHODS The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. RESULTS 1,914 children ages 0-19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0-19. CONCLUSIONS This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.
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Affiliation(s)
- Paul A Buescher
- State Center for Health Statistics, North Carolina Division of Public Health, 1908 Mail Service Center, Raleigh, NC 27699-1908, USA.
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