Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC 27599-7445, USA.
Matern Child Health J. 2011 Aug;15(6):713-21. doi: 10.1007/s10995-010-0642-3.
To examine the relationship between measures of state economic, political, health services, and Title V capacity and individual level measures of the well-being of CSHCN. We selected five measures of Title V capacity from the Title V Information System and 13 state capacity measures from a variety of data sources, and eight indicators of intermediate health outcomes from the National Survey of Children with Special Health Care Needs. To assess the associations between Title V capacity and health services outcomes, we used stepwise regression to identify significant capacity measures while accounting for the survey design and clustering of observations by state. To assess the associations between economic, political and health systems capacity and health outcomes we fit weighted logistic regression models for each outcome, using a stepwise procedure to reduce the models. Using statistically significant capacity measures from the stepwise models, we fit reduced random effects logistic regression models to account for clustering of observations by state. Few measures of Title V and state capacity were associated with health services outcomes. For health systems measures, a higher percentage of uninsured children was associated with decreased odds of receipt of early intervention services, decreased odds of receipt of professional care coordination, and increased odds of delayed or missed care. Parents in states with higher per capita Medicaid expenditures on children were more likely to report receipt of special education services. Only two state capacity measures were associated explicitly with Title V: states with higher generalist physician to population ratios were associated with a greater likelihood of parent report of having heard of Title V and states with higher per capita gross state product were less likely to be associated with a report of using Title V services, conditional on having heard of Title V. The state level measure of family participation in Title V governance was negatively associated with receipt of care coordination and having used Title V services. The measures of state economic, political, health systems, and Title V capacity that we have analyzed are only weakly associated with the well-being of children with special health care needs. If Congress and other policymakers increase the expectations of the states in assuring that the needs of CSHCN and their families are addressed, it is essential to be cognizant of the capacities of the states to undertake that role.
为了研究州级经济、政治、医疗服务和 Title V 能力指标与儿童特殊健康照护需求（CSHCN）个体水平的健康状况之间的关系。我们从 Title V 信息系统中选择了 5 项 Title V 能力指标，从各种数据源中选择了 13 项州级能力指标，并从国家特殊健康需求儿童调查中选择了 8 项中级健康结果指标。为了评估 Title V 能力与卫生服务结果之间的关联，我们使用逐步回归来识别具有显著能力的指标，同时考虑了调查设计和州级观测的聚类。为了评估经济、政治和卫生系统能力与健康结果之间的关联，我们为每个结果拟合加权逻辑回归模型，使用逐步过程来简化模型。使用逐步模型中具有统计学意义的能力指标，我们拟合简化的随机效应逻辑回归模型，以说明州级观测的聚类。Title V 和州级能力的很少指标与卫生服务结果相关。对于卫生系统措施，未参保儿童比例较高与早期干预服务获得机会减少、专业医疗协调服务获得机会减少和护理延误或遗漏机会增加相关。州儿童人均医疗补助支出较高的父母更有可能报告获得特殊教育服务。只有两项州级能力指标与 Title V 明确相关：普通医生与人口比例较高的州更有可能报告家长听说过 Title V，人均国内生产总值较高的州不太可能与听说过 Title V 有关，但使用 Title V 服务的可能性较低，这是有条件的。家庭参与 Title V 治理的州级指标与医疗协调获得和使用 Title V 服务呈负相关。我们分析的州级经济、政治、卫生系统和 Title V 能力指标与特殊健康需求儿童的健康状况仅存在微弱关联。如果国会和其他政策制定者提高各州确保满足 CSHCN 及其家庭需求的期望，那么了解各州承担这一角色的能力至关重要。
