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Taking Stock of the CSHCN Screener: A Review of Common Questions and Current Reflections

机译：总结CSHCN筛选器：常见问题和最新思考的回顾

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摘要

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.
机译：自2000年以来，有特殊保健需求的儿童（CSHCN）筛查器（CS）已在全国，各国和地方广泛使用，作为一种基于标准化和简短调查的方法，用于识别患有慢性身体，心理，行为习惯的儿童人群或其他条件，并且他们还需要超出儿童常规使用的健康和相关服务的类型和数量。有关CS的常见问题包括与CS的开发和使用有关的问题;其概念框架以及识别不足或识别过度的潜力;通过服务需求的复杂性和日常生活影响将CSHCN分层的能力;及其在临床环境中的潜在应用以及与其他鉴定方法的比较。这篇综述总结了使用CS的开发，设计和发现，并总结了过去13年中进行的研究得出的发现以及关于CS的最新发现，以通过技术援助简要解决有关此工具的12个最常见问题自2001年以来一直提供有关CS的信息。通过一系列分析，CS持续识别出一部分慢性病儿童，他们需要或使用的不是常规类型或数量的与医疗和健康相关的服务，而且他们具有共同的健康需求照料，包括照料协调，获得专业和基于社区的服务以及增强家庭参与度。存在评分算法，可以根据需求的复杂性和较高的护理费用对CSHCN进行分层。将CS数据与临床诊断代码算法结合在一起可以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表征患者人群，并评估其对各种慢性疾病儿童的质量和系统改善的影响。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，因为在大多数情况下或在电子健康记录中，尚未整合标准化的患者报告的健康信息。 CS继续证明其作为一种非特定疾病，基于人群的工具的有效性，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患病率相对较低以及大量的内部诊断差异和跨诊断相似性在医疗服务需求，功能和护理质量方面。

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