Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing.
Stephen P Gulley, Elizabeth K Rasch, Barbara M Altman and 6 others
PMID 28823389WHAT IT FOUND
A proposed screener identifies working-age adults with chronic healthcare needs by combining ongoing conditions or functional difficulties with elevated service use or unmet need.
Cognitive testing supported item wording, but it has not yet been field tested.
Key findings
01The proposed ACHCN definition requires ongoing physical, cognitive, or mental health conditions or functional difficulties, plus elevated service use or unmet need.
02In Medical Expenditure Panel Survey analyses, elevated use in any of five service areas identified 54 million working-age adults, about 29% of that population, and they had over five times the percentage of ADL/IADL limitations compared with people with no elevated use.
03Cognitive testing showed that adults answered combined need-and-use questions by reporting typical use while ignoring need, so the panel asked about need and use separately.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The screener has not been field tested, so its sensitivity and specificity are unknown. The supporting evidence comes from secondary survey analyses and cognitive interviews, not from testing the screener in patients or clinicians. The definition is broad and non-diagnostic, so it may include many adults with chronic conditions who do not have elevated service needs. The analyses did not include people in institutional settings and relied on self-report, which may undercount service use or stigmatizing conditions. Clinical applications are described as possible future uses, not as demonstrated workflows.
Declared interests
The article is tagged as supported by NIH intramural research, and the panel was convened by the NIH Clinical Center Rehabilitation Medicine Department. No separate conflict of interest declaration appears in the supplied text.
The easy way to misread this
Do not use this screener as a validated clinical test. It has not been field tested, and its sensitivity and specificity are not yet known.