Identification of Children With Special Health Care Needs Within a Managed Care Setting | Pediatrics | JAMA Pediatrics | JAMA Network
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March 2003

Identification of Children With Special Health Care Needs Within a Managed Care Setting

Author Affiliations

From the HealthPartners Research Foundation, Bloomington, Minn (Dr Rolnick and Mss Flores and Paulsen); and Minnesota Department of Health (Ms Thorson), St Paul.

Arch Pediatr Adolesc Med. 2003;157(3):273-278. doi:10.1001/archpedi.157.3.273

Objective  To assess 2 established methods of identifying children with special health care needs (CSHCN) within a health plan population for intensified service coordination.

Methods  The tools tested were the Questionnaire for Identifying Children With Chronic Conditions (QuICCC) and the Clinical Risk Grouper (CRG) software. The QuICCC was administered by telephone to the parents of 517 children. The CRG software tool was then applied to the health plan database. The accuracy of identifying the target population was assessed by a single trained reviewer by comparison with the comprehensive medical record.

Results  According to the QuICCC, 37.1% of the parents surveyed had CSHCN. According to the CRG, 11% of the health plan's pediatric population was categorized as CSHCN. The medical record review agreed with overall QuICCC findings in 53% to 61% of cases and overall CRG findings in 66% to 73% of cases.

Conclusions  Administering the QuICCC was a time- and labor-intensive endeavor with a relatively low overall level of sensitivity. The CRG was less labor intensive with slightly higher sensitivity. Identifying the target population in an effective and efficient manner remains a challenge for health plans.