229256 Reliability of Functional Status Measurement (ADLs) for Children with Special Health Care Needs (CSHCN) Living in the Community

Sunday, November 7, 2010

Charles Phillips, D , Department of Health Policy and Management, Texas A&M University Health Science Center, College Station, TX
Ashweeta Patnaik, MPH , Public Policy Research Institute, Texas A&M University, College Station, TX
James Dyer, PhD , Public Policy Research Institute, Texas A&M University, College Station, TX
Emily Naiser, MPH , Public Policy Research Institute, Texas A&M University, College Station, TX
Joshua Johnson, MS , Department of Health Policy and Management, Texas A&M Health Science Center, School of Rural Public Health, College Station, TX
Constance Fournier, PhD , Department of Educational Psychology, Texas A&M University, College Station, TX
Timothy R. Elliott, PhD, ABPP , Department of Educational Psychology, Texas A&M University, College Station, TX
Understanding the personal care needs of children with special health care needs (CSHCN) living in the community demands a reliable picture of their ability to perform activities of daily living (ADLs). This research investigated what factors affect inter-rater reliability when two assessors attempt to record the functional abilities of CSHCN living in the community. The data are dual assessment information on 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single southwestern state. These data were collected in 2007 in dual assessments performed by master's trained social workers or registered nurses using a standardized, multidimensional assessment instrument. The results indicated that the level of disagreement on functional status is not affected by assessors or the environment. It is strongly affected by the child's underlying level of ADL impairment. Assessments of those children who were the most or least impaired exhibit the greatest agreement. It was when assessors faced children with moderate to moderately severe impairment that one finds the greatest disagreement. Also, specific ADLs where the greatest and least agreement were observed varied by level of impairment. This analysis emphasized the importance of the measurement of functional status for CSHCN. For a wide range of programs and services, precise measures of function are increasingly important.

Learning Areas:
Program planning
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1. Evaluate the importance of different potential sources of variance in rater differences in their scoring of CSHCN on ADL function for purposes of defining need for personal care services. 2. Identfiy those CSHCN who are at risk of measurement error in the assessment of ADL function

Keywords: Child Health, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I manage the data collection for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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