RESUMO
Efforts to identify children with ongoing health conditions generally rely on lists of diagnoses. However, there has been a growing trend to use a noncategorical, or generic, approach in which such children are identified by the consequences of their condition. Recent legislation and the Supreme Court decision in Sullivan v Zebley adopt this broader concept and mandate that a noncategorical approach be used in determining eligibility for services and benefits. Traditional condition lists are less desirable because (1) every disorder to which children are subject cannot be included, (2) diagnoses may be applied inconsistently by clinicians and across settings, (3) condition labels alone do not convey the extent of morbidity for individuals, (4) there is a bias toward identifying only those children who have access to the medical care system, and (5) there is often a gap between emergence of symptoms or consequences and diagnosis. We developed a noncategorical framework for identifying children with ongoing health conditions that responds to the federal mandate and uses consequences of disorders, rather than diagnostic labels. It can be applied to meet the objectives of services, research, policy, reimbursement, or program eligibility; is consistent across diagnoses; is descriptive of the impact of morbidity; is adaptable to meet specific purposes; and can be modified by imposing different severity levels. Our screening tool will soon be available for practical use.
Assuntos
Doença Crônica/classificação , Definição da Elegibilidade , Necessidades e Demandas de Serviços de Saúde , Adolescente , Criança , Serviços de Saúde da Criança/legislação & jurisprudência , Pré-Escolar , Doença Crônica/economia , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Lactente , Programas de Rastreamento/métodos , Política Pública , Índice de Gravidade de Doença , Estados UnidosRESUMO
A pediatric home care program is described which has operated as an ambulatory special care unit in an urban hospital center since 1970. The program provides care for seriously or chronically ill children, who would not be adequately served through traditional ambulatory services because of either the severity and complexity of their medical problems or the inability of their families to use such services. An interdisciplinary PHC team provides comprehensive pediatric care and integrates medical and psychosocial services for the child and family. This form of special ambulatory care appears to offer advantages to patients who are at risk in existing ambulatory schemes and is an alternative to inpatient care.