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
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Article Info
Publication History
Published online: November 21, 2014
Accepted:
October 25,
2014
Received:
March 12,
2014
Footnotes
The lead author, JMN, has had a contract from the Children's Hospital Association to contribute to the development of software from 3M Health Information Systems. One of these, CRGs, is used in this study. He also has a no cost research license from 3M Health Information Systems to use CRGs. He has no financial interests in the Children's Hospital Association or 3M Health Information Systems, and receives no royalty revenue from these organizations. Neither the Children's Hospital Association nor 3M Health Information Systems have had any input to this study and have not reviewed the results or the manuscript prior to submission. The other authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
