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Acad Pediatr. 2015 Mar-Apr;15(2):191-6. doi: 10.1016/j.acap.2014.10.007. Epub 2014 Nov 22.

Stratification of children by medical complexity.

Author information

1
Center for Child Health, Behavior, and Development, Seattle Children's Hospital, Seattle, Wash. Electronic address: john.neff@seattlechildrens.org.
2
Department of Knowledge Management, Seattle Children's Hospital, Seattle, Wash.
3
Department of Clinical Effectiveness, Seattle Children's Hospital, Seattle, Wash.
4
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Wash.

Abstract

OBJECTIVE:

To stratify children using available software, Clinical Risk Groups (CRGs), in a tertiary children's hospital, Seattle Children's Hospital (SCH), and a state's Medicaid claims data, Washington State (WSM), into 3 condition groups: complex chronic disease (C-CD); noncomplex chronic disease (NC-CD), and nonchronic disease (NC).

METHODS:

A panel of pediatricians developed consensus definitions for children with C-CD, NC-CD, and NC. Using electronic medical record review and expert consensus, a gold standard population of 700 children was identified and placed into 1 the 3 groups: 350 C-CD, 100 NC-CD, and 250 NC. CRGs v1.9 stratified the 700 children into the condition groups using 3 years of WSM and SCH encounter data (2008-2010). WSM data included encounters/claims for all sites of care. SCH data included only inpatient, emergency department, and day surgery claims.

RESULTS:

A total of 678 of 700 children identified in SCH data were matched in WSM data. CRGs demonstrated good to excellent specificity in correctly classifying all 3 groups in SCH and WSM data; C-CD in SCH (94.3%) and in WSM (91.1%); NC-CD in SCH (88.2%) and in WSM (83.7%); and NC in SCH (84.9%) and in WSM (94.6%). There was good to excellent sensitivity for C-CD in SCH (75.4%) and in WSM (82.1%) and for NC in SCH (98.4%) and in WSM (81.1%). CRGs demonstrated poor sensitivity for NC-CD in SCH (31.0%) and WSM (58.0%). Reasons for poor sensitivity in NC-CD are explored.

CONCLUSIONS:

CRGs can be used to stratify children receiving care at a tertiary care hospital according to complexity in both hospital and Medicaid administrative data. This method will enhance reporting of health-related outcome data.

KEYWORDS:

administrative billing data; children; chronic diseases; clinical risk group; stratification

PMID:
25468428
DOI:
10.1016/j.acap.2014.10.007
[Indexed for MEDLINE]

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