Population health is a conceptual approach to identifying the determinants of health status affecting a particular group.1,2
To utilize population health concepts is to take a step beyond the individual-level focus of mainstream medicine by addressing a broad range of factors that impact the health of an entire population group.3
A good population health management program is cognizant of the many elements which affect the wellbeing of a particular population and has access to programs that target health needs of that population.
According to the American Academy of Pediatrics,4
the medical home is “a partnership approach with families to provide primary health care that is accessible, family centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.” In order to perform the functions of a medical home, physicians would do well to understand and use population health management concepts. With use of these concepts, for example through disease management, individuals with complex medical needs would have better access to health care, increased satisfaction with care, and ultimately improved health of a specific population.5,6
Children with Special Health Care Needs (CSHCN) are one particularly important pediatric population that can benefit from application of population health management concepts. The Health Resources and Services Administration, Maternal and Child Health Bureau defines children with special health care needs as “those who have a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”7
The 2009/10 National Survey of Children with Special Health Care Needs (NS-CSHCN) conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics showed that Hawai‘i's prevalence of CSHCN is 45,700 (12.3%), while the national prevalence is 11.2 million (15.1%).8
Additionally, nationwide over 1 in 5 households with children have at least one child with a special health care need.8
This statistic translates into almost 9 million households. The 2009/10 survey also showed that in Hawai‘i, 29.0% of CSHCN did not receive care coordination within a medical home, 33.2% did not receive family-centered care, and 22.4% of CSHCN families were not partners in care decision making at all levels.8
The Child and Adolescent Health Measurement Initiative, in collaboration with the National Committee for Quality Assurance, has developed a questionnaire called the Children with Special Health Care Needs (CSHCN) Screener©, hence forth referred to as “screener.” The screener helps a family identify their child's need for extra services due to existing chronic conditions.9
Children's health care needs status is assessed by asking questions about prescription medications, need or use of services, functional limitations, specialized therapies, and counseling. (A copy of the screening instrument is provided in Appendix A.) The screener is used in several surveys, including the Medical Expenditure Panel Survey, the National Survey of Children's Health, and the National Survey of Children with Special Health Care Needs (NS-CSHCN).8,10
This tool gives physicians the opportunity to engage in a more comprehensive needs assessment based on a family's perception. The screener enables physicians to identify CSHCN in their practice as a population and to examine whether comprehensive care is provided for the CSHCN population.
The screener is important because the overall health of a child is influenced by multiple factors and it may be difficult to identify all of these factors during a single office visit with their health care provider. The CSHCN population shares many common health-related needs and issues. In addition, they often experience more than one condition at a time. Focusing on single conditions is both limiting and often impractical due to the large number of relatively low prevalence childhood chronic conditions.10
Population health management programs begin with the identification of the population at risk. The screener is recommended by the American Academy of Pediatrics as one of three screening tools that can be used to identify CSHCN.11
The screener was selected as the screening tool in this study because the screener is the only nationwide tool that allows comparison of Hawai‘i's profile with NS-CSHCN's data. Results from a study in 2002 indicate that the screener requires minimal time to administer, is acceptable for use as both an interview-based and self-administered survey, and provides a comprehensive yet simple method for identifying CSHCN.12
Thus, it would appear that the screener would be an ideal tool for pediatricians to begin that identification process which could then lead them to improve population health management skills.
The 2009/10 NS-CSHCN8
showing that 29% of Hawai‘i's CSHCN do not receive comprehensive, coordinated care in a medical home setting has room for improvement. Possible reasons for this issue include: physicians lacking an understanding of population health management, and/or physicians not having a mechanism to identify their children with special health care needs. To elucidate these questions, a survey was administered to a select group of pediatricians in Hawai‘i to find out how many of them had knowledge of population health management, how many practiced population health management, and how many utilized the screener in their office.