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The CAHPS Item Set for Children with Chronic Conditions includes a five-item screener that is used during the analysis of the data to determine which responses to the questionnaire reflect the experiences of children with chronic conditions.

The Problem: Children with Chronic Conditions Are Hard to Find

To identify children with special health needs, it is not sufficient to look for categories of children, i.e., those with specific conditions or diseases.

• First, the prevalence of any given chronic condition among children is relatively low.
• Second, there are a large number of applicable diagnoses, many of which are very rare.
• Third, identification strategies that rely on diagnoses have been known to miss children who should qualify as having chronic conditions. Reasons for this problem include coding errors, misdiagnoses, lack of access to care, and the global or developmental nature of some childhood problems.
• Finally, there are many definitions of children with chronic conditions (or special health care needs), and each results in a different set of conditions and/or codes to operationalize the definition.

CAHPS Methodology: Focus on Consequences

This item set addresses this problem by classifying children as having a chronic condition if they report one or more of the consequences associated with such conditions. The screener is designed to identify children who meet three criteria.

• Criteria #1: The child currently experiences a specific consequence.
• Criteria #2: The consequence results from a medical, behavioral, or other health condition.
• Criteria #3: The duration or expected duration of the condition is at least 12 months.

What Does the Screener Ask?

The screener consists of five main questions, each of which has three parts. The questions cover the following five health consequences:

• ·Use or need of prescription medication.
• ·Above average use or need of medical, mental health, or education services.
• ·Function limitations compared with others of the same age.
• ·Use or need of specialized therapies (e.g., occupational therapy, physical therapy, speech).
• ·Treatment or counseling for emotional, behavioral, or developmental problems.

If the answer to the first part of the question is "yes," the respondent moves on to the second part to say whether the consequence is due to any kind of health condition. If so, the respondent continues to the third part, which asks whether the condition has lasted or is expected to last for at least 12 months. (The one exception to this pattern is the last screener question, which has only two parts.) A child who meets all three criteria for one or more of the five main questions would qualify as having a chronic condition. On average, 16 to 20 percent of the general population of children meets these criteria. When you analyze the data, the number of children who meet the screener criteria will be the denominator for calculations of quality measures for children with chronic conditions.