Identification of children with special health care needs within a managed care setting

Area of Science:

• Health Services Research
• Pediatric Health
• Healthcare Management

Background:

• Effective identification of Children With Special Health Care Needs (CSHCN) is crucial for targeted service coordination within health plans.
• Existing methods for identifying CSHCN require rigorous evaluation for efficiency and accuracy.

Purpose of the Study:

• To compare the effectiveness of two established methods, the Questionnaire for Identifying Children With Chronic Conditions (QuICCC) and Clinical Risk Grouper (CRG) software, for identifying CSHCN.
• To assess these methods within a health plan population to optimize intensified service coordination.

Main Methods:

• The study involved 517 children; parents completed the QuICCC via telephone.
• The CRG software was applied to the health plan's pediatric database.
• A comprehensive medical record review by a trained reviewer served as the benchmark for accuracy assessment.

Main Results:

• The QuICCC identified 37.1% of surveyed parents reporting CSHCN, while CRG categorized 11% of the pediatric population as CSHCN.
• Medical record review concordance was 53%-61% for QuICCC and 66%-73% for CRG.
• CRG demonstrated higher sensitivity and lower labor intensity compared to QuICCC.

Conclusions:

• The QuICCC is a time- and labor-intensive method with relatively lower sensitivity for identifying CSHCN.
• The CRG software offers a more efficient approach with slightly improved sensitivity.
• Developing effective and efficient strategies for identifying CSHCN remains a significant challenge for health plans.