title: Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View.
abstract: To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes.
  
  
  
  Secondary analysis of 2009-2010 National Survey of CSHCN.
  
  
  
  Latent class analysis grouped individuals into substantively meaningful classes empirically derived from measures of pediatric medical complexity. Outcomes were compared among latent classes with weighted logistic or negative binomial regression.
  
  
  
  LCA identified four unique CSHCN subgroups: broad functional impairment (physical, cognitive, and mental health) with extensive health care (Class 1), broad functional impairment alone (Class 2), predominant physical impairment requiring family-delivered care (Class 3), and physical impairment alone (Class 4). CSHCN from Class 1 had the highest ED visit rates (IRR 3.3, p < .001) and hospitalization odds (AOR: 12.0, p < .001) and lowest odds of a medical home (AOR: 0.17, p < .001). CSHCN in Class 3, despite experiencing more shared decision making and medical home attributes, had more ED visits and missed school than CSHCN in Class 2 (p < .001); the latter, however, experienced more cost-related difficulties, care delays, and parents having to stop work (p < .001).
  
  
  
  Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts.
authors.affiliation: Department of Pediatrics, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, WI.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Coller
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Lerner
authors.affiliation: Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
authors.forename: Jens C
authors.initials: JC
authors.lastname: Eickhoff
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
authors.affiliation: Department of Pediatrics, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, WI.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sklansky
authors.affiliation: Department of Pediatrics, University of Wisconsin, Madison, School of Medicine and Public Health, Madison, WI.
authors.forename: Mary
authors.initials: M
authors.lastname: Ehlenbach
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA.|Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, CA.|Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.|RAND Health, The RAND Corporation, Santa Monica, CA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000145:classification*; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D012720:Severity of Illness Index; D014481:United States
keywords: Children's health; latent class analysis; special health care needs