Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing

Abstract

Adapted from the Maternal and Child Health Bureau definition that identifies Children with Special Healthcare Needs, aligned with the ACS-6 disability measure, and consistent with the HHS Multiple Chronic Condition Framework, this definition and screener provide the research community with a common denominator for the identification of ACHCN.

At the intersection of chronic disease, disability and health services research: A scoping literature review

“…Third, the development of a brief screening instrument that is operationalized based on the work described above and that is designed for permanent inclusion in national health surveys could prove to be valuable for the field, providing as it would a common denominator for many different health services research topics. 10 Last, new mechanisms for “segmenting” (or stratifying) this population that go beyond medical diagnoses will be needed, both because we should expect to identify a very large number of individuals under such a definition, and because such individuals will be likely to have numerous co-occurring conditions and circumstances.…”

“…Certain individuals, such as those who experience exceptionally high rates of emergency department visits and/or hospitalizations, have been identified as “super-utilizers”. 1–6 Growing concern over the health and associated health care costs of this population has sparked a number of initiatives at private 4, 5, 7, 8 and federal 9, 10 organizational levels to better characterize the population of working age adults with chronic conditions and disabilities and to better understand their healthcare needs. The ultimate goals of these efforts are to improve population health and to enhance the capacity and performance of the current health care system in order to better meet those needs while controlling costs.…”

“…Beginning in 2012, the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center convened an expert measurement panel to develop a definition and brief survey instrument to bridge this gap. 10 To inform our panel’s development of the instrument, we performed a scoping literature review to characterize the state-of-the-art in measurement of chronic conditions, disability, and their intersection among working age adults. We focused our search on the working age adult population (aged at least 18 but less than 65) for several reasons: 1) A greater number of working age adults have disabilities because the working age population is so large, 16 representing an important subgroup of the high healthcare need population.…”