Comparing States on Outcomes for Children with Special Health Care Needs

Objectives: To develop two alternative methods for comparing and ranking states on the health, health care, and well-being of children with special health care needs (CSHCN). Methods: Fifteen key indicators of CSHCN’s functional abilities, health insurance coverage, access to care, and the impact of their conditions on their families were identified from the 2001 National Survey of Children with Special Health Care Needs. An initial composite score for each state was created by averaging the state’s standardized scores for each of these indicators. Using linear regression analyses and standardized residuals, an adjusted composite score for each state was then created that accounted for demographic variables that differed by state and were related to the initial composite score. States were ranked based on the initial and adjusted composite scores. Results: The initial composite scores were related to population differences by poverty status, African-American race, and the prevalence of special health care needs. Compared to ranks based on the initial scores, ranks based on the adjusted scores shifted by 10 or more positions for half the states. Hawaii, Rhode Island, Arizona, Iowa, and North Dakota had the highest (“best”) adjusted scores. Conclusion: Adjustment to the initial composite scores permits states with different demographic compositions to be compared. The adjusted scores may also help raise awareness of CSHCN’s concerns in states where demographic compositions favorable to health outcomes mask the fact that these outcomes are only average (or worse) given the states’ demographic compositions.