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| American Academy of Pediatrics Division of Health Policy Research EXECUTIVE SUMMARY
Health Services for Children With and Without
Special Needs: This report presents findings from Periodic Survey #44 on the provision of various health care (medical home) services to children in pediatric practices. The survey was initiated by the Children with Special Needs Project Advisory Committee (CSN-PAC) and the Committee on Children with Disabilities (COCWD) to explore pediatricians' provision of the elements of a medical home to all children - those with special needs and those with no special needs. The survey also explored the effect of various practice characteristics, including practice location, setting and participation in managed care, on the provision of these services. These data were collected to help identify areas of focus for educational programs and policy initiatives to improve pediatricians' ability to provide medical homes to all children. The survey was conducted from January to May 2000; after six mailings a total of 925 completed questionnaires were received for a response rate of 56.7%. These analyses are based on responses from 803 pediatricians who provide direct patient care. Office Services Available to All Children Nearly all pediatricians (94.5%) say their patients always have telephone access to someone in their practice 24 hours a day, 7 days a week. Sixty-nine percent say someone from their practice is always available in an emergency to see a child in the middle of the night or on weekends and 59.2% say Saturday morning appointments are always available. Less than half of pediatricians say weekday evening appointments are always available (42.6%) and payment options are available (46.5%). The most frequently named barrier to providing these services is the lack of medical staff in pediatric practices. The frequency with which pediatricians say their practice is accessible varies by practice location and setting; however there is little variation when findings are examined by the proportion of patients in managed care. Insurance Plan Coverage Among All Children Pediatricians estimate that nearly two-thirds of their patients are covered by a managed care health insurance plan (about 65%). Pediatricians estimate about 70% of their insured patients have insurance that restricts prior authorization for hospitalization or referrals to specialists. More than one-third of patients (about 37%) is estimated to have insurance that restricts the number of services or referrals an individual patient is allowed. Considerably fewer children are estimated to have insurance that assigns a pediatric medical subspecialists or surgical specialist, or an adult specialist or subspecialist, as a child's primary care provider. There are no significant differences between the estimates for children with special needs and those with no special needs. Patients With Special Needs Pediatricians estimate that 26.9% of their patients in their primary practice setting have special needs. The majority of these patients (70.9%) are categorized as high prevalence, low severity. Twenty percent are low prevalence, high severity and 9.5% are categorized as technology-dependent. Care Coordination Services Provided to Children With and Without Special Needs Pediatricians were asked about the frequency with which care coordination services are provided to children with special needs and to children with no special needs. The proportion of pediatricians who say they always provide such services is fairly similar for both groups, although there are several services for which responses vary significantly between groups.
The frequency with which most care coordination services are provided to children in both groups varies by pediatricians' practice location and setting; however, the proportion of patients in managed care has no effect. Barriers to Providing Care Coordination Services While barriers to providing these services vary somewhat by type of service, overall, the most frequently cited barriers to providing care coordination services to all children are the lack of time and the lack of medical staff to provide such services. Family Centered Services Provided to Children With and Without Special Needs Pediatricians were also asked how often family centered services are
provided to children with special needs and to children with no special
needs. Overall, the proportion of pediatricians who say they always provide
such services is similar for both groups.
Fewer pediatricians report their practice provides an interpreter for families for whom English is a second language (34.9%, 32.3%, n.s.), has a systematic method of obtaining feedback from patients/parents (23.2%, 20.9%, n.s.), and translates written materials into the families' primary language (16.8%,15.4%, n.s.). The frequency with which pediatricians report providing many family centered services varies somewhat by proportion of patients in managed care, pediatricians' practice location and setting. Barriers to Providing Family Centered Care Services While barriers to providing family centered health care services to all children vary by service, overall, the most frequently cited barriers include: lack of time, lack of medical staff to provide the service, lack of administrative support, and lack of community/government agency services in these areas.
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