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Published on: June 20, 2020
Comparing states on outcomes for children with special health care needs
Stephen J Blumberg1, Matthew D Bramlett
1National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 2112, Hyattsville, Maryland 20782, USA. sblumberg@cdc.gov
Insights
New methods for ranking states on children with special health care needs (CSHCN) reveal adjusted scores that account for demographics. This provides a clearer comparison of state performance in CSHCN health and well-being.
Area of Science:
- Pediatric Health Outcomes
- Health Services Research
- State-Level Health Comparisons
Background:
- Assessing the health, healthcare, and well-being of children with special health care needs (CSHCN) across states is complex.
- Existing comparisons may be confounded by demographic differences between states.
- A need exists for methods that allow for equitable state-level comparisons.
Purpose of the Study:
- To develop and evaluate two alternative methods for comparing and ranking states based on CSHCN health, healthcare, and well-being.
- To create composite scores that reflect key indicators for CSHCN.
- To adjust these scores for demographic variations to enable fairer state comparisons.
Main Methods:
- Utilized 15 key indicators from the 2001 National Survey of Children with Special Health Care Needs.
- Developed an initial composite score by averaging standardized state indicator scores.
- Applied linear regression and standardized residuals to create an adjusted composite score, controlling for demographic variables.
Main Results:
- Initial composite scores were influenced by poverty, race, and prevalence of special healthcare needs.
- State rankings shifted significantly (≥10 positions for half of states) when using adjusted scores compared to initial scores.
- Hawaii, Rhode Island, Arizona, Iowa, and North Dakota demonstrated the highest adjusted scores.
Conclusions:
- Adjusted composite scores enable more equitable comparisons of states with differing demographic compositions.
- These adjusted scores can highlight areas where state performance may be overestimated due to favorable demographics.
- The methods enhance awareness of CSHCN concerns by providing a demographically adjusted perspective on state performance.
Objectives:
To develop two alternative methods for comparing and ranking states on the health, health care, and well-being of children with special health care needs (CSHCN).
Methods:
Fifteen key indicators of CSHCN's functional abilities, health insurance coverage, access to care, and the impact of their conditions on their families were identified from the 2001 National Survey of Children with Special Health Care Needs. An initial composite score for each state was created by averaging the state's standardized scores for each of these indicators. Using linear regression analyses and standardized residuals, an adjusted composite score for each state was then created that accounted for demographic variables that differed by state and were related to the initial composite score. States were ranked based on the initial and adjusted composite scores.
Results:
The initial composite scores were related to population differences by poverty status, African-American race, and the prevalence of special health care needs. Compared to ranks based on the initial scores, ranks based on the adjusted scores shifted by 10 or more positions for half the states. Hawaii, Rhode Island, Arizona, Iowa, and North Dakota had the highest ("best") adjusted scores.
Conclusion:
Adjustment to the initial composite scores permits states with different demographic compositions to be compared. The adjusted scores may also help raise awareness of CSHCN's concerns in states where demographic compositions favorable to health outcomes mask the fact that these outcomes are only average (or worse) given the states' demographic compositions.
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