Identifying Children with Special Health Care Needs in the National Health Interview Survey: A New Resource for Policy Analysis

The Urban Institute, Washington, DC 20037, USA.
Health Services Research (Impact Factor: 2.78). 03/2004; 39(1):53-71. DOI: 10.1111/j.1475-6773.2004.00215.x
Source: PubMed


To test the feasibility of using the National Health Interview Survey (NHIS) to identify children with chronic illness through a noncategorical approach, as exemplified by the Children with Special Health Care Needs (CSHCN) screener. The ability to use the NHIS to identify CSHCN will permit analyses of the effects of welfare reform and public insurance eligibility expansions during the late 1990s on CSHCN.
The NHIS from 1997, 1999, and 2000. The NHIS is an ongoing household survey representative of the civilian, noninstitutionalized population of the United States.
Survey items were selected from the NHIS and thresholds designated to replicate the content and logic of the CSHCN screener. The screener asks explicit questions concerning an elevated need for, or use of health care services, and about limitations in activity, both caused by a chronic health condition. The algorithm created was applied to the pooled 1999-2000 NHIS to generate national prevalence estimates. Multivariate logistic regression was estimated to determine the effect of having particular demographic characteristics on the likelihood of being identified as CSHCN. Log odds ratios were compared to those from earlier NHIS-based estimates and from a pretest of the CSHCN screener.
An estimated 12 percent of noninstitutionalized children aged 0 through 17 have a chronic condition that results in elevated service use or limitations in normal activity. This estimate is sensitive to inclusion of children with a broader array of less serious or shorter-term conditions. The estimated effects of child characteristics on the likelihood of being identified as having special health needs are similar but not identical to other algorithms that have been used to identify CSHCN.
It is feasible to use existing questions in the NHIS to identify a population of CSHCN that is substantially similar to children identified through other algorithms or through use of a screening instrument imbedded in a household survey. The availability of this algorithm will permit use of the NHIS for important analyses of the effects of welfare reform and public insurance expansions on children with special health care needs.

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Available from: Amy J Davidoff,
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    • "In the context of health problems and disability, meeting specific eligibility criteria may result in access to drugs or treatment [4], access to health insurance [5,6], access to assistive technology [7], admission to a programme [8,9] or access to specialised interventions in education systems [10]. For this purpose, individuals are identified as having special health care needs [11], special support needs in a given setting [12] or belonging to a special group requiring specialised interventions and environments [13]. "
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    • "For the purposes of our study, the information about CSHCN, which we use for risk adjustment, is easily obtained from parents based on the CSHCN Screener and could easily be verified by health care providers. In particular, ''the policy research community has converged in its support for this mechanism [of identifying CSHCN through the CSHCN Screener]'' (Davidoff 2004), which has been adopted by national surveys, including the MEPS. Previous studies have reported that the CSHCN Screener is cost-effective in comparison with other instruments to identify CSHCN (Bethell et al. 2002a, b; Blumberg et al. 2003). "
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    • "Physical and emotional chronic health problems were assessed using the Children with Special Health Care Needs Screener (CSHCN) (Bethell et al. 2002a,b), which was completed by the parents The CSHCN quantifies whether a child meets the criteria for functional limitation and for special healthcare needs. Based on the existing literature (Davidoff 2004), special healthcare needs and functional limitation were expected to result in higher KIDSCREEN Physical Well-being scores. Healthcare utilization was assessed by asking the parents: "
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