Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Hyattsville, MD 20782, USA.
Pediatrics. 2009 Dec;124 Suppl 4:S361-7. doi: 10.1542/peds.2009-1255F.
Using structural equation modeling, we sought to assess the system of services for children with special health care needs (CSHCN) and their families by using 14 key indicators of functional abilities of CSHCN, health insurance coverage, access to care, and the impact of their conditions on their families.
With data from the 2001 and 2005-2006 National Surveys of Children With Special Health Care Needs, we used confirmatory factor analysis for ordered-categorical measures to model the relationship between an indirectly observed (ie, latent) variable and the key indicators and evaluate changes in this relationship over time.
For both survey periods, a single-factor model fit well. The latent construct was defined as the well-being of the health care environment for CSHCN and their families. Family financial problems caused by the child's condition, unmet needs for family support services, and negative impact on employment were most strongly related to the latent well-being construct. The lowest levels of the well-being construct were associated with families that had unmet needs for support services, CSHCN who lacked a usual place for care, and families that spent > or = 11 hours/week providing or coordinating care. CSHCN and their families with family-centered care and with adequate health insurance were likely to have average or better levels of the well-being construct. Mean levels of the well-being construct were unchanged over time.
The 14 key indicators can be used to reliably assess a single latent construct. The relative ordering of the indicators' thresholds (a model parameter) may be useful for guiding pediatricians' evaluations of the health care environment for CSHCN and their families. Researchers may use the scores available from the latent-variable model to assess outcomes related to the health care environment and the system of services for CSHCN and their families.
采用结构方程模型，通过对儿童特殊健康需求（CSHCN）及其家庭的 14 项关键功能能力指标、健康保险覆盖情况、获得医疗服务的机会，以及其健康状况对家庭的影响进行评估，对儿童特殊健康需求的服务系统进行研究。
我们利用 2001 年和 2005-2006 年全国儿童特殊健康需求调查的数据，采用有序分类测量的验证性因子分析方法对间接观测（即潜在）变量与关键指标之间的关系进行建模，并评估这一关系随时间的变化情况。
在两个调查时期，单因素模型拟合度都较好。潜在构念被定义为 CSHCN 及其家庭的医疗保健环境的健康状况。因儿童病情导致的家庭经济问题、对家庭支持服务的需求未得到满足，以及对就业的负面影响与潜在的健康状况构建联系最为紧密。健康状况构建的最低水平与那些需要支持服务但未得到满足的家庭、缺乏常规护理地点的 CSHCN 以及每周花费>或=11 小时提供或协调护理的家庭有关。具有以家庭为中心的护理且有足够健康保险的 CSHCN 及其家庭可能会具有中等或更好的健康状况构建水平。健康状况构建的平均水平在整个研究期间没有变化。
这 14 项关键指标可用于可靠地评估单一潜在构念。指标阈值（模型参数）的相对顺序可能有助于指导儿科医生对 CSHCN 及其家庭的医疗保健环境进行评估。研究人员可以使用潜在变量模型中的得分来评估与儿童特殊健康需求的服务系统及儿童特殊健康需求的医疗保健环境相关的结果。
