Child Health in Oregon
Identifying risks in children and providing early intervention is critical to keeping children on a trajectory to becoming healthy young adults.
Over the past half-century, immunizations have drastically reduced childhood deaths and the prevalence of disease among children1. In 2011, 83% of parents in Oregon report their child as having good or excellent health 2. However, as the risk of childhood disease has decreased other health risks remain. 38% of children in Oregon have parents with one or more concerns about their child's physical, behavioral or social development, according to the 2007 National Survey of Children’s Health survey (2011/2012 results were not available for this measure). According to the 2011/12 National Survey of Children’s Health, 26% of Oregon children age 10-17 years old are overweight or obese, 23% of Oregon children have one or more chronic conditions, and 13% Of Oregon children have special health care needs. Oregon parents report that 10% of their children have been injured during the previous 12 months. Parents also reported that 24% had a child who missed six or more days of school in the past 12 months, which is reflected in employee and school absenteeism.
Identifying risks in children and providing early intervention is critical to keeping children on a trajectory to becoming healthy young adults. As providers treat less disease and more developmental, behavioral and social conditions, it’s important for providers to know their population of patients in order to proactively manage their care. In 2011, the Children’s Health Foundation (CHF [a sister organization to the Children’s Health Alliance]) launched an extensive search for a child health population model.
After a comprehensive review of other well recognized approaches to identify children and youth with special health care need and an extensive chart review done by a reputable Pediatrician Hospital for children. CHF estimates that 1-2% of all pediatric patients have a severe or very complicated set of medical and psychosocial conditions, 18-20% of patients have one chronic health condition that is not well controlled or more than one chronic health condition, and an additional 10% have one well-controlled health condition. There is an additional set of patients, not easily identified by diagnosis-based tools, that is “at-risk” for chronic conditions and/or high health care utilization, both in the near term, and in the future.
CHF/CHA Pediatric Population Management
CHF has developed a methodology and a tool for pediatricians to identify their patient populations based on the amount of support the child and family needs for optimal self-management and overall health. Considerations include medical complexity, patient functioning and family factors. Each of these elements contributes to the type and amount of medical and health management support that children/families need from their provider and pediatric practice care team.
In early 2013, CHA providers began documenting their understanding of support needs and medical complexity in collaboration with the child’s parent at well child visits. As of September of 2013, CHA pediatricians evaluated over 27,000 and entered them into a population health registry. The two embedded tables show the value of data aggregation. Table One charts the most prevalent conditions among the patients of CHA providers. Table Two correlates patients’ overall support needs with their support factors and chronic conditions.
Initially, CHA practices may focus interventions and/or services on the top 1-2% of patients who are the top care utilizers or most complex, or have chronic condition(s). Relevant patient care information and population management data will be obtained from medical records and payer data which will be enhanced as it is made available. Care management competencies will initially focus on proactive team-based management of these patients and will expand into collaboration with specialists and community partners. Population monitoring interventions will be largely data driven and will involve payer and claims information.
CHA providers will continue to perform these evaluations as CHA aggregates this data. Analysis of this information enables improved patient-centered care, optimization of practice resources, and influence over payment and policy reform.
1. National Network for Immunization Information, www.immunizationinfo.org/parents
2. Child and Adolescent Health Measurement Initiative, www.CAHMI.org/NCSH
3. Tri-State Physician Hospital Organization, Keith Mandel, MD, Vice President of Medical Affairs.