Forrest Christopher B, Riley Anne W, Vivier Patrick M, Gordon Nancy P, Starfield Barbara
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Med Care. 2004 Mar;42(3):232-8. doi: 10.1097/01.mlr.0000115196.02425.05.
The objective of this study was to examine the relationship between healthcare use and children's healthcare needs as assessed from the perspectives of children themselves, parents, and healthcare practitioners.
We conducted a prospective cohort study in which service use was monitored for the 12 months before and after administration of a health survey.
We studied 384 parents and children aged 6 to 11 years enrolled for 2 years in a northern California health maintenance organization or a Medicaid managed care program in Rhode Island.
Child and parent perspectives on needs were determined using the Child Health and Illness Profile, Child Edition (CHIP-CE). Plan administrative data were used to develop a treated morbidity index, which was based on diagnosis codes recorded by practitioners during the year before the survey and to obtain prospective measures of service use.
For both child- and parent-respondents, low satisfaction and comfort scale scores from the CHIP-CE were significant predictors of number of visits. CHIP-CE domain scales unrelated to future use were risk avoidance, resilience, and achievement. Multivariable regression using CHIP-CE information collected from children explained more variation in total physician visits than models that used parent-respondent data. The treated morbidity index was a weaker predictor of physician visits than the CHIP-CE scale scores. None of the domain scales were significant predictors of any emergency department use or any specialist use; however, the treated morbidity index was associated with any specialist use.
A child's sense of well-being and burden of symptoms predict future use. Perceived healthcare needs, as assessed by the CHIP-CE, is a better predictor of children's service use than evaluated needs as assessed by physician-diagnosed disorders. Our results support the validity of using the responses of children aged 6 to 11 years as a measure of need for future health care.
本研究的目的是从儿童自身、父母和医疗从业者的角度，探讨医疗保健利用与儿童医疗保健需求之间的关系。
我们进行了一项前瞻性队列研究，在进行健康调查之前和之后的12个月内监测服务利用情况。
我们研究了384名年龄在6至11岁之间的父母和儿童，他们在加利福尼亚州北部的一个健康维护组织或罗德岛的一个医疗补助管理式医疗项目中登记了2年。
使用儿童健康与疾病概况儿童版（CHIP-CE）确定儿童和父母对需求的看法。利用计划管理数据制定治疗发病率指数，该指数基于调查前一年从业者记录的诊断代码，并获取服务利用的前瞻性测量数据。
对于儿童和父母受访者而言，CHIP-CE的低满意度和舒适度量表得分是就诊次数的显著预测因素。与未来利用无关的CHIP-CE领域量表包括风险规避、恢复力和成就。使用从儿童收集的CHIP-CE信息进行的多变量回归比使用父母受访者数据的模型解释了更多的总就诊次数变化。治疗发病率指数对就诊次数的预测能力比CHIP-CE量表得分弱。没有一个领域量表是任何急诊科利用或任何专科就诊的显著预测因素；然而，治疗发病率指数与任何专科就诊有关。
儿童的幸福感和症状负担可预测未来的医疗利用。通过CHIP-CE评估的感知医疗保健需求比通过医生诊断的疾病评估的评估需求更能预测儿童的服务利用。我们的结果支持将6至11岁儿童的回答用作未来医疗保健需求衡量标准的有效性。
