Hill Kristen S, Freeman Linda C, Yucel Recai M, Kuhlthau Karen A
Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, 50 Staniford Street, Suite 901, Boston, MA 02114, USA.
Matern Child Health J. 2008 Sep;12(5):650-61. doi: 10.1007/s10995-007-0283-3. Epub 2007 Sep 25.
We partnered with a Massachusetts family workgroup to analyze state level data that would be most useful to consumers and advocates in Massachusetts.
Massachusetts' and US data from the 2001 National Survey of Children with Special Health Care Needs (NSCSHCN) were analyzed. We examined types of need and prevalence of unmet need for all CSHCN and for more severely affected CSHCN. We also correlated unmet need to child and family characteristics using multivariate logistic regression.
In Massachusetts, 17% of CSHCN and 37% of children more severely affected did not receive needed care. CSHCN who were uninsured anytime during the previous year were nearly 5 times more likely to experience an unmet need (OR = 4.95, CI: 1.69-14.51). Children with more functional limitations (OR = 3.15; CI: 1.59-6.24) and unstable health care needs (OR = 3.26; CI: 1.33-8.00) were also more likely to experience an unmet need. Receiving coordinated care in a medical home (OR = 0.46; CI: 0.23-0.90) was associated with reduced reports of unmet need.
With input from families of CSHCN, researchers can direct their analyses to answering the questions and concerns most meaningful to families. We estimate that 1 in 6 CSHCN in Massachusetts did not receive needed care, with more than 1 in 3 CSHCN with a more severe condition experiencing an unmet need. Enabling factors were predictors of unmet need suggesting solutions such as expanding insurance coverage and improving services systems for CSHCN.
我们与马萨诸塞州的一个家庭工作组合作，分析对该州消费者和倡导者最有用的州级数据。
分析了2001年全国特殊医疗需求儿童调查（NSCSHCN）中马萨诸塞州和美国的数据。我们研究了所有特殊医疗需求儿童（CSHCN）以及受影响更严重的CSHCN的需求类型和未满足需求的患病率。我们还使用多变量逻辑回归将未满足需求与儿童和家庭特征进行关联。
在马萨诸塞州，17%的CSHCN和37%受影响更严重的儿童没有得到所需的护理。上一年任何时候未参保的CSHCN经历未满足需求的可能性几乎高出4倍（OR = 4.95，CI：1.69 - 14.51）。功能受限更多的儿童（OR = 3.15；CI：1.59 - 6.24）和医疗需求不稳定的儿童（OR = 3.26；CI：1.33 - 8.00）也更有可能经历未满足需求。在医疗之家接受协调护理（OR = 0.46；CI：0.23 - 0.90）与未满足需求报告的减少有关。
在特殊医疗需求儿童家庭的参与下，研究人员可以将分析方向指向回答对家庭最有意义的问题和关切。我们估计，马萨诸塞州每6名CSHCN中就有1名没有得到所需的护理，超过三分之一病情更严重的CSHCN经历了未满足需求。促成因素是未满足需求的预测因素，这表明了一些解决方案，如扩大保险覆盖范围和改善CSHCN的服务系统。
