The 130th Annual Meeting of APHA

Abstract #50652

Kathleen A. Sherrieb, RN, MS, MPH, Center for Medical Home Improvement Hood Center for Children and Families, Department of Pediatrics, Dartmouth Medical School, 1 Medical Center Drive, Colburn Hill, Lebanon, NH 03756, 603-653-1491, Kathleen.A.Sherrieb@Hitchcock.ORG, Karen Healy, RN, MHA, Anthem Blue Cross Blue Shield, Blue Cross Ave., Manchester, NH 03756, and Ardis L. Olson, MD, Department of Pediatrics, Dartmouth Medical School, Hood Center for Children and Families, 1 Medical Center Drive, Lebanon, NH 03756.

Studies indicate that 6%-35% of children have a need for special health care services. Furthermore, 5% of that subgroup use more than 35% of the health care resources designated for pediatric care. Structuring these services for this group requires they have access to a full range of services, along with access to routine preventive and primary care afforded the larger pediatric population. This population, because of the use of multiple and diverse services, requires intensive care coordination to arrange, organize and advocate for their needs. As part of a project designed to develop partnerships among families, pediatric providers, and MCO to ensure that coordinated, comprehensive care is provided for CSHCN, a survey was conducted through the MCO to identify the population of CSHCN, determine unique family service needs and whether they are being met. Of the 18,000 children 18 years and younger in the MCO plan in 2000, 21% were identified with a chronic condition through use of a diagnosis/utilization algorithm. Surveys were returned by 1,373 (35.3%) families. Results of the survey indicate that the parents' perception of their child's illness and its complexity was a good indicator for illness burden on the family, need for medical and non-medical services needs, need for professional assistance in coordinating care, and satisfaction with MCO and primary care services. Families who identified that their child had a chronic condition and a developmental delay or a functional limitation had higher unmet needs including care coordination, and were generally less satisfied with current care delivery.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Describe a method that can be used by private insurers to identify the subgroup of children with special health care needs in their plan.
• Discuss trends among need for this population and their families based on chronic condition complexity.
• Apply the findings from this survey to enhance services for children with special health care needs who have complex conditions and needs.

Keywords: Children With Special Needs, Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.