Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports ( ), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems. 1. Introduction Children with special health care needs (CSHCN) are at increased risk for poor health outcomes [1]. The CSHCN population is growing, the need for services is increasing, and the capacity to provide CSHCN services is decreasing due to public sector financial constraints [2]. It is critical to demonstrate the needs of this vulnerable population and evaluate the effectiveness and value of CSHCN programs [2, 3]. Public health nurses (PHNs) in Washington State serving CSHCN sought to describe CSHCN client needs and evaluate CSHCN programs using a standardized terminology, the Omaha System [4]. They selected the Omaha System because many of the local Washington State public health jurisdictions used electronic health records and the Omaha System for clinical documentation. Standardized terminologies have potential to advance the development of practice standards and assessment guidelines and overall quality improvement policies and procedures [5–7]. This work builds on previous efforts to describe care and evaluate outcomes in other states and programs [8]. The Maternal Child Health Bureau (MCHB) defines CSHCN as “those who have or are at increased risk for a chronic
References
[1]
United States Department of Health and Human Services, Health Resources and Services Administration: Maternal and Child Health Bureau, Children with Special Health Care Needs MCHB agenda, 2012, http://mchb.hrsa.gov/AZ/azdescriptions.html.
[2]
B. B. Strickland, P. C. Van Dyck, M. D. Kogan et al., “Assessing and ensuring a comprehensive system of services for children with special health care needs: a public health approach,” American Journal of Public Health, vol. 101, no. 2, pp. 224–231, 2011.
[3]
S. L. Parish, P. T. Shattuck, and R. A. Rose, “Financial burden of raising CSHCN: association with state policy choices,” Pediatrics, vol. 124, supplement 4, pp. S435–S442, 2009.
[4]
K. S. Martin, The Omaha System: A Key to Practice, Documentation, and Information Management, Health Connections Press, Omaha, Neb, USA, 2nd edition, 2005.
[5]
K. A. Monsen, C. Neely, G. Oftedahl, M. J. Kerr, M. Cella, and O. Farri, “Translating Institute for Clinical Systems Improvement standards into practice through the electronic health record using the Omaha System,” Journal of Biomedical Informatics, vol. 45, pp. 719–725, 2012.
[6]
K. A. Monsen, D. J. Foster, T. Gomez, J. K. Poulsen, J. Mast, B. L. Westra, et al., “Evidence-based standardized care plans for use internationally to improve home care practice and population health,” Applied Clinical Informatics, vol. 2, pp. 373–384, 2011.
[7]
B. L. Westra, C. W. Delaney, D. Konicek, and G. Keenan, “Nursing standards to support the electronic health record,” Nursing Outlook, vol. 56, no. 5, pp. 258–266.e1, 2008.
[8]
K. A. Monsen, J. A. Fulkerson, A. B. Lytton, L. L. Taft, L. D. Schwichtenberg, and K. S. Martin, “Comparing maternal child health problems and outcomes across public health nursing agencies,” Maternal and Child Health Journal, vol. 14, no. 3, pp. 412–421, 2010.
[9]
S. J. Blumberg and A. C. Carle, “The well-being of the health care environment for CSHCN and their families: a latent variable approach,” Pediatrics, vol. 124, supplement 4, pp. S361–S367, 2009.
[10]
R. N. Roberts, D. D. Behl, and A. L. Akers, “Building a system of care for children with special healthcare needs,” Infants and Young Children, vol. 17, no. 3, pp. 213–222, 2004.
[11]
S. De Fries, V. Sharp, M. Nardella, and R. Peters, “A data driven process in Washington State to improve systems of care for Children With Special Health Care Needs: The National Survey of CSHCN,” Maternal and Child Health Journal, vol. 9, supplement 2, pp. S117–S120, 2005.
[12]
Institute of Medicine, For the Public'a Health: The Role of Meaaurement in Action and Accountability, National Academies Press, Washington, DC, USA, 2011.
[13]
K. A. Monsen, B. Bekemeier, R. P. Newhouse, and F. D. Scutchfield, “Development of a public health nursing data infrastructure,” Public Health Nursing, vol. 29, pp. 343–351, 2012.
[14]
Children with special health care needs program, 2012, http://www.doh.wa.gov/YouandYourFamily/InfantsChildrenandTeens/HealthandSafety/ChildrenwithSpecialHealthCareNeeds.aspx.
[15]
S. Elsbernd, L. Barnhart, J. Stock, K. A. Monsen, and C. Prock, “Washington State public health nurse use of the Omaha system in serving children with special health care needs,” in Proceedings of the Omaha System International Conference, Eagan, Minn, USA, 2011.
[16]
ANA recognized terminologies and data element sets, 2012, http://www.nursingworld.org/npii/terminologies.htm.
[17]
Minnesota Omaha System Users Group, 2012, http://omahasystemmn.org.
[18]
Omaha System Partnership for Knowledge Discovery and Health Care Quality, 2012, http://omahasystempartnership.org/.
[19]
K. A. Monsen, D. M. Radosevich, M. J. Kerr, and J. A. Fulkerson, “Public health nurses tailor interventions for families at risk,” Public Health Nursing, vol. 28, no. 2, pp. 119–128, 2011.
[20]
K. A. Monsen, A. Chatterjee, and B. L. Westra, “Relationships between client characteristics, nursing interventions, and client outcomes in family home visiting”. In Review.
[21]
K. A. Monsen, D. B. McNaughton, K. Savik, and O. Farri, “Problem stabilization: a metric for problem improvement in home visiting clients,” Applied Clinical Informatics, vol. 2, pp. 437–446, 2011.
[22]
S. J. Blumberg and M. D. Bramlett, “Comparing states on outcomes for children with special health care needs,” Maternal and Child Health Journal, vol. 9, supplement 2, pp. S121–S128, 2005.
[23]
Local health department budget cuts in the news, 2012, http://www.naccho.org/press/coverage/budgetcuts/index.cfm.
