摘要
目的:由于大多数的临床服务致力于维持健康和预防疾病,所以通常视儿童为健康的低危险因素的个体。然而,一部分儿童需要特殊照顾才能达到最佳的健康状态。这项研究的目的在于使用一种已经发展为可以确认哪些儿童需要特殊卫生保健(CSHCN)的调查方法来评估军队卫生体系(MHS)中这些儿童的发病率和医疗资源的需求。方法:美国国防部管理MHS,而MHS可能是全世界最大的综合卫生保健体系之一,为大约200万儿童提供医疗服务。
Objective. Children are frequently perceived to be healthy, lowrisk 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 en-rollees 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 amajor 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.
