Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md.
National Center for Health Statistics, Centers for Disease Control and Prevention, USDHHS, Hyattsville, MD.
Acad Pediatr. 2015 Mar-Apr;15(2):165-76. doi: 10.1016/j.acap.2014.10.003. Epub 2014 Dec 5.
Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and related services beyond those routinely used by children. Common questions about the CS include those related to its development and uses; its conceptual framework and potential for under- or overidentification; its ability to stratify CSHCN by complexity of service needs and daily life impacts; and its potential application in clinical settings and comparisons with other identification approaches. This review recaps the development, design, and findings from the use of the CS and synthesizes findings from studies conducted over the past 13 years as well as updated findings on the CS to briefly address the 12 most common questions asked about this tool through technical assistance provided regarding the CS since 2001. Across a range of analyses, the CS consistently identifies a subset of children with chronic conditions who need or use more than a routine type or amount of medical- and health-related services and who share common needs for health care, including care coordination, access to specialized and community-based services, and enhanced family engagement. Scoring algorithms exist to stratify CSHCN by complexity of needs and higher costs of care. Combining CS data with clinical diagnostic code algorithms may enhance capacity to further identify meaningful subgroups. Clinical application is most suited for identifying and characterizing populations of patients and assessing quality and system improvement impacts for children with a broad range of chronic conditions. Other clinical applications require further implementation research. Use of the CS in clinical settings is limited because integration of standardized patient-reported health information is not yet common practice in most settings or in electronic health records. The CS continues to demonstrate validity as a non-condition-specific, population-based tool that addresses many of the limits of condition or diagnosis checklists, including the relatively low prevalence of many individual conditions and substantial within-diagnosis variations and across-diagnoses similarities in health service needs, functioning, and quality of care.
自 2000 年以来，《特殊健康需求儿童筛查表》（CS）已在全国范围内被各州和地方广泛使用，作为一种标准化的、简短的基于调查的方法，用于识别患有慢性身体、精神、行为或其他疾病的儿童群体，这些儿童还需要超出一般儿童常规使用的类型和数量的健康和相关服务。有关 CS 的常见问题包括其发展和使用；其概念框架和潜在的低估或高估识别；其按服务需求和日常生活影响的复杂性对 CSHCN 进行分层的能力；以及其在临床环境中的潜在应用以及与其他识别方法的比较。本综述总结了 CS 的开发、设计和使用情况，并综合了过去 13 年进行的研究结果，以及关于 CS 的最新结果，简要回答了自 2001 年以来通过关于 CS 的技术援助提出的关于该工具的 12 个最常见问题。在一系列分析中，CS 始终能识别出一组患有慢性疾病的儿童，他们需要或使用超过常规类型或数量的医疗和健康相关服务，并且他们共同需要医疗保健，包括协调护理、获得专门和社区服务以及增强家庭参与。存在评分算法来按需求的复杂性和更高的护理成本对 CSHCN 进行分层。将 CS 数据与临床诊断代码算法相结合，可能会增强进一步识别有意义的亚组的能力。临床应用最适合识别和描述患者群体，并评估具有广泛慢性疾病的儿童的质量和系统改进影响。其他临床应用需要进一步的实施研究。CS 在临床环境中的使用受到限制，因为在大多数环境中或在电子健康记录中，尚未普遍采用标准化的患者报告健康信息的整合。CS 继续作为一种非特定疾病的基于人群的工具表现出有效性，该工具解决了许多疾病或诊断清单的局限性，包括许多个体疾病的相对低患病率，以及在健康服务需求、功能和护理质量方面的显著诊断内差异和跨诊断相似性。
