Publication year
2004
Citation Title
A national assessment of children with special health care needs: Prevalence of special needs and use of health care services among children in the military health system.
Journal Name
Pediatrics
Journal Volume
114
Issue Number
2
Page Numbers
384-393
DOI
NULL
Summary
Children in military families experience health challenges just like children in other families. Using data from administrative databases and surveys from parents, researchers investigated the prevalence of special health care needs among children who receive care through the Military Health System (MHS). Across a range of indices, children with special health care needs had higher rates of service utilization than children without special needs.
Key Findings
Children with special health care needs comprised 23% of the TRICARE Prime enrollees who were younger than 18 and whose parents responded to the survey.
Children with special health care needs experienced five times as many admissions and ten times as many days in hospitals compared with children without special needs.
Of the outpatient visits of enrolled children, nearly half were from children with special health care needs and nearly 75% of inpatient days were also from those children.
Implications for Program Leaders
Offer peer support groups for parents of children with special needs so that they can form a social support network that includes others who have had similar experiences
Provide workshops for families with children with special needs to help them develop strategies in managing the demands associated with the special need, including how to manage the stress of many health care appointments
Develop classes for parents of children with special needs to increase skills around advocating for their child and organizing health care information
Implications for Policy Makers
Continue to support programs that aim to assist families with children with special health care needs
Recommend professional development for professionals who work with military families about the experience of families with a child with special needs
Encourage collaboration among providers who care for children with special needs to ensure continuity of care
Methods
Surveys were sent to 35,000 individuals who were eligible to recieve benefits through the MHS.
Children with special health care needs were identified by a five question screener that identified children who needed prescription drugs, medical services, were limited in their activities, and/or received special therapies or counseling.
Data were analyzed to examine the relationship between the use of medical services and demographic characteristics.
Participants
Data were collected regarding 6,180 children who were eligible for MHS coverage who used TRICARE Prime.
Participants had a mean age of 9.52 years old.
Of the participants, 52% were male, 75% were White, and 23% had a special health care need.
Limitations
The classification of a child having a special health care need was determined in part through questions regarding utilization of health care services more often than the typical child, so findings regarding increased health care usage were implied in the definition of a child having a special health care need.
The researchers restricted their study sample to enrolled users of care, but it is possible that some services were obtained outside the MHS and were unrecorded in the databases used.
This study did not evaluate involvement in services not covered by insurance such as alternative therapies.
Avenues for Future Research
Include parents’ reports of their experiences in seeking care to investigate the extent to which care provided through the health care system meets the special needs of their children
Investigate the additional time (e.g., referral reports, treatment plans, and family education) and tasks required in the treatment of children with special health care needs
Examine the ways in which stressors around accessing health care interact with everyday stressors and the stressors inherent in being affiliated with the military
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective. Children are frequently perceived to be healthy, low-risk individuals with a majority of clinical services devoted to health maintenance and preventive clinical services. However, a subset of children have unique needs that require specialized care to achieve optimal health outcomes. The purpose of this research was to use survey tools that have been developed to identify children with special health care needs (CSHCN) to measure prevalence and resource needs of these children in the military health system (MHS). Methods. The US Department of Defense manages the MHS, which is one of the largest integrated health care systems in the world and provides care to almost 2,000,000 children. We incorporated the CSHCN survey screener and assessment questions into the annual health care survey of beneficiaries who are eligible for benefits within the MHS. In addition, we used claims information available from inpatient and outpatient services. We used parent reports from the survey to estimate the prevalence of CSHCN. Incorporating claims data and restricting our analyses to those who were enrolled continuously in a military health maintenance organization (TRICARE Prime), we described utilization of different types of health care resources and compared CSHCN with their healthy counterparts. Finally, we examined alternative types of special needs and performed regression analyses to identify the major determinants of health needs and resource utilization to guide system management and policy development. Results. CSHCN compose 23% of the TRICARE Prime enrollees who are younger than 18 years and whose parents responded to the survey. The needs of a majority of these children consist of prescription medications and services targeting medical, mental health, and educational needs. CSHCN experience 5 times as many admissions and 10 times as many days in hospitals compared with children without special needs. CSHCN are responsible for nearly half of outpatient visits for enrolled children and more than three quarters of inpatient days. Service utilization varies dramatically by type of special need and other demographic variables. Conclusion. CSHCN represent a major challenge to organized systems of care and our society. Because they represent a group of children who are particularly at risk with potential for improved health outcomes, efforts to improve quality, coordinate care, and optimize efficiency should focus on this target population.
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