Assessing the prevalence of children with special health care needs in an integrated community health care system

Introduction: Children with special health care needs (CSHCN) require long-term and often intensive care coordination and health services. Indentifying this patient population within a large integrated health care system is important in facilitating the allocation of resources, improving health outcomes, and aiding in the design of required care systems. Objectives: To operationally define CSHCN and identify this patient population within the Denver Health medical system. Methods: 21 non-exclusive diagnostic and administrative categories served to define CSHCN. From this definition, a structured query language program was developed to compile a list of patients from administrative and clinical databases meeting one or more of these categories, and who were attending (one or more visits in the last 18 months) a community-based or school-based health center of the Denver Health medical system. Results: Approximately 5,600 patients met one or more CSHCN-defining categories, representing 10.8% of all pediatric patients. Median age was 6.6 years; 51.2% were male, with 75.2% Hispanic, 10.6% black, 7.9% white, and 6.3% other. The primary language was English for 55.2%; Spanish 42.2%. Among clinics, the proportion of pediatric patients who were CSHCN varied from 7% to 19%. Over half (62%) of CSHCN were defined with the categories: provider designated; hearing disability; and/or three or more specialty clinic visits. Conclusions: Using operational definitions to query electronic health databases, a list of CSHCN patients was identified. Future efforts will focus on improving the maintenance of the list and developing workflows and metrics for helping providers address the health services needs of CSHCN.