Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View

Ryan J Coller; Carlos F Lerner; Jens C Eickhoff; Thomas S Klitzner; Daniel J Sklansky; Mary Ehlenbach; Paul J Chung

doi:10.1111/1475-6773.12416

Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View

Health Serv Res. 2016 Aug;51(4):1644-69. doi: 10.1111/1475-6773.12416. Epub 2015 Nov 30.

Authors

Ryan J Coller¹, Carlos F Lerner², Jens C Eickhoff³, Thomas S Klitzner², Daniel J Sklansky¹, Mary Ehlenbach¹, Paul J Chung^{2

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Affiliations

¹ Department of Pediatrics, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, WI.
² Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA.
³ Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
⁴ Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, CA.
⁵ Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.
⁶ RAND Health, The RAND Corporation, Santa Monica, CA.

Abstract

Objective: To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes.

Data source: Secondary analysis of 2009-2010 National Survey of CSHCN.

Study design: Latent class analysis grouped individuals into substantively meaningful classes empirically derived from measures of pediatric medical complexity. Outcomes were compared among latent classes with weighted logistic or negative binomial regression.

Principal findings: LCA identified four unique CSHCN subgroups: broad functional impairment (physical, cognitive, and mental health) with extensive health care (Class 1), broad functional impairment alone (Class 2), predominant physical impairment requiring family-delivered care (Class 3), and physical impairment alone (Class 4). CSHCN from Class 1 had the highest ED visit rates (IRR 3.3, p < .001) and hospitalization odds (AOR: 12.0, p < .001) and lowest odds of a medical home (AOR: 0.17, p < .001). CSHCN in Class 3, despite experiencing more shared decision making and medical home attributes, had more ED visits and missed school than CSHCN in Class 2 (p < .001); the latter, however, experienced more cost-related difficulties, care delays, and parents having to stop work (p < .001).

Conclusions: Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts.

Keywords: Children's health; latent class analysis; special health care needs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child Health Services
Disabled Children / statistics & numerical data*
Female
Health Care Surveys
Health Services Accessibility / statistics & numerical data
Health Services Needs and Demand / classification*
Health Status*
Humans
Male
Mental Health
Severity of Illness Index*
United States