Zuckerman Katharine E, Lindly Olivia J, Bethell Christina D, Kuhlthau Karen
Child and Adolescent Health Measurement Initiative, Oregon Health & Science University, Portland, Ore; Division of General Pediatrics, Oregon Health & Science University, Portland, Ore.
Child and Adolescent Health Measurement Initiative, Oregon Health & Science University, Portland, Ore; Department of Public Health, Oregon State University, Corvallis, Ore.
Acad Pediatr. 2014 Jul-Aug;14(4):398-407. doi: 10.1016/j.acap.2014.03.011.
To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN + ASD), CSHCN with functional limitations (CSHCN + FL), and CSHCN lacking these conditions (other CSHCN); to test whether high health care quality was associated with reduced family impacts among CSHCN + ASD.
Data from the 2009-2010 National Survey of CSHCN were used to compare 3025 CSHCN + ASD, 6505 CSHCN + FL, and 28,296 other CSHCN. Weighted multivariate logistic regression analyses examined 6 age-relevant, federally defined health care quality indicators and 5 family financial and employment impact indicators. Two composite measures were additionally used: 1) receipt of care that met all age-relevant quality indicators; and 2) had ≥ 2 of the 5 adverse family impacts.
Across all health care quality indicators, CSHCN + ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN + ASD had worse health care quality than other CSHCN, including CSHCN + FL. CSHCN + ASD also had high rates of adverse family impact, with over half experiencing ≥ 2 adverse impacts. Rates of adverse family impact were higher in CSHCN + ASD than other CSHCN, including CSHCN + FL. Among CSHCN + ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN + ASD whose health care did not meet federal quality standards.
CSHCN + ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN + FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN + ASD.
比较患有自闭症谱系障碍的特殊医疗需求儿童（CSHCN + ASD）、有功能限制的特殊医疗需求儿童（CSHCN + FL）和无这些状况的特殊医疗需求儿童（其他CSHCN）的医疗保健质量、家庭就业及经济影响；检验高质量医疗保健是否与CSHCN + ASD家庭影响的减轻相关。
使用2009 - 2010年全国特殊医疗需求儿童调查数据，对3025名CSHCN + ASD、6505名CSHCN + FL和28296名其他CSHCN进行比较。加权多变量逻辑回归分析考察了6项与年龄相关的、联邦定义的医疗保健质量指标和5项家庭经济及就业影响指标。另外还使用了两项综合指标：1）接受符合所有与年龄相关质量指标的护理；2）有5项不良家庭影响中的≥2项。
在所有医疗保健质量指标方面，CSHCN + ASD表现不佳，只有7.4%符合所有与年龄相关的指标。CSHCN + ASD的医疗保健质量比其他CSHCN更差，包括CSHCN + FL。CSHCN + ASD出现不良家庭影响的比例也很高，超过一半的人经历了≥2种不良影响。CSHCN + ASD的不良家庭影响发生率高于其他CSHCN，包括CSHCN + FL。在CSHCN + ASD中，其医疗保健符合联邦质量标准的儿童比医疗保健不符合联邦质量标准的CSHCN + ASD儿童更不容易出现多种不良家庭影响。
与其他CSHCN相比，即使是与CSHCN + FL相比，CSHCN + ASD更易经历低质量医疗保健和家庭影响。接受符合联邦质量标准的护理可能会减轻CSHCN + ASD家庭的不良影响。
