Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View

Health Serv Res. 2016 Aug;51(4):1644-69. doi: 10.1111/1475-6773.12416. Epub 2015 Nov 30.


Objective: To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes.

Data source: Secondary analysis of 2009-2010 National Survey of CSHCN.

Study design: 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.

Principal findings: 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).

Conclusions: Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts.

Keywords: Children's health; latent class analysis; special health care needs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child Health Services
  • Disabled Children / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand / classification*
  • Health Status*
  • Humans
  • Male
  • Mental Health
  • Severity of Illness Index*
  • United States