Identification of children with special health care needs within a managed care setting

Objective: To assess 2 established methods of identifying children with special health care needs (CSHCN) within a health plan population for intensified service coordination. Methods: The tools tested were the Questionnaire for Identifying Children With Chronic Conditions (QuICCC) and the Clinical Risk Grouper (CRG) software. The QuICCC was administered by telephone to the parents of 517 children. The CRG software tool was then applied to the health plan database. The accuracy of identifying the target, population was assessed by a single trained reviewer by comparison with the comprehensive medical record. Results: According to the QuICCC, 37.1% of the parents surveyed had CSHCN. According to the CRG, 11% of the health plan's pediatric population was categorized as CSHCN. The medical record review agreed with overall QuICCC findings in 53% to 61% of cases and overall CRG findings in 66% to 73% of cases. Conclusions: Administering the QuICCC was a time- and labor-intensive endeavor with a relatively low overall level of sensitivity. The CRG was less labor intensive with slightly higher sensitivity. Identifying the target population in an effective and efficient manner remains a challenge for health plans.