Department of Pediatrics, University of Florida, College of Medicine, Gainesville, FL 32608, USA.
Pediatrics. 2009 Dec;124 Suppl 4:S420-7. doi: 10.1542/peds.2009-1255N.
Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown.
To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies.
We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N = 40723). Additional state data included Medicaid and State Children's Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Florida's SCHIP comprehensive care program (CMS-Duval ["Ped-I-Care"]) for CSHCN (N = 300).
Nationally, 59.8% of parents were satisfied with their child's health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas family-centered care reflects more on provider encounters.
Insurance type affects both satisfaction and family-centered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care.
与有典型需求的儿童相比，有特殊医疗需求的儿童（CSHCN）的健康结果和满意度更差。尽管个体特征会影响满意度和以家庭为中心的护理，但健康保险和州儿童健康政策的额外影响尚不清楚。
确定在调整个体特征后，根据保险类型和州儿童健康政策，CSHCN 的满意度和以家庭为中心的护理是否存在差异。
我们使用 2006 年全国有特殊医疗需求儿童调查（N=40723）的人口统计学、保险和满意度数据进行描述性和多变量分析。其他州的数据包括医疗补助和州儿童健康保险计划（SCHIP）的特点以及儿科医生的供应。我们使用佛罗里达州 SCHIP 综合护理计划（CMS-Duval [Ped-I-Care]）的调查数据补充了全国调查结果，该计划针对 CSHCN（N=300）。
在全国范围内，59.8%的父母对孩子的医疗服务表示满意，三分之二（65.7%）接受了以家庭为中心的护理。在调整个体预测因素后，未参保和有公共保险的儿童满意度较低（优势比[OR]：0.45 和 0.83），以家庭为中心的护理较少（OR：0.43 和 0.80），而私人保险的儿童则较多。值得注意的是，满意度随着州医疗补助支出的增加而增加。与 SCHIP 全国满意度（54.2%）相比，来自 Ped-I-Care 的调查数据显示出更高的满意度（91.7%），以家庭为中心的护理率相似（65.6%）。这些结果表明，满意度更多地基于对卫生系统的体验，而以家庭为中心的护理则更多地反映了与提供者的接触。
保险类型影响 CSHCN 的满意度和以家庭为中心的护理，某些州级医疗保健特征影响满意度。未来的研究应集中在卫生保健系统的干预措施上，以提高满意度和以家庭为中心的护理患者的体验。
