What factors are associated with state performance on provision of transition services to CSHCN?
OBJECTIVE
To examine whether individual, condition-related, and system-related characteristics are associated with state performance (high, medium, low) on the provision of transition services to children with special health care needs (CSHCN).


METHODS
We conducted descriptive, bivariate, and multivariable analyses of 16876 children aged 12 to 17 years by using data from the 2005-2006 National Survey of Children With Special Health Care Needs. Polytomous logistic regression was used to compare the characteristics of CSHCN residing within high-, medium-, and low-performance states, with low-performance states serving as the reference group.


RESULTS
Compared with non-Hispanic white CSHCN, Hispanic (adjusted odds ratio [aOR]: 0.25 [95% confidence interval (CI): 0.17-0.37]) and non-Hispanic black (aOR: 0.44 [95% CI: 0.30-0.62]) CSHCN were less likely to reside in a high-performance than in a low-performance state. Compared with CSHCN who had a medical home or adequate insurance coverage, CSHCN who did not have a medical home or adequate insurance coverage were less likely to reside in a high-performance than in a low-performance state (aOR: 0.73 [95% CI: 0.57-0.95]; aOR: 0.73 [95% CI: 0.58-0.93], respectively).


CONCLUSIONS
Key factors found to be important in a state's performance on provision of transition services to CSHCN were race/ethnicity and having a medical home and adequate insurance coverage. Efforts to support the Maternal and Child Health Bureau's integration of system-level factors in quality-improvement activities, particularly establishing a medical home and attaining and maintaining adequate insurance, are likely to help states improve their performance on provision of transition services.
Kane
Debra J
DJ
Iowa Department of Public Health, Bureau of Family Health, 321 E 12th St, 5th Floor, Des Moines, IA 50319-0075, USA. dkane@idph.state.ia.us
Kasehagen
Laurin
L
Punyko
Judy
J
Carle
Adam C
AC
Penziner
Andy
A
Thorson
Sarah
S
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000193:education / Q000706:statistics & numerical data*; D004521:Educational Measurement / Q000706:statistics & numerical data*; D005190:Family / Q000208:ethnology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D040361:Healthy People Programs / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D016015:Logistic Models; D015233:Models, Statistical; D015999:Multivariate Analysis; D020380:Needs Assessment / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology