Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation

BMC Pediatrics

Dingwei Dai⁴  Matt Hall³  Wenjun Zhong⁴  James A Feinstein¹  Chris Feudtner² 

[1] Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA;The Department of Medical Ethics and Health Policy and the Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA;Children’s Hospital Association, Overland Park, KS, USA;Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, CHOP North-Room 1523, 34th and Civic Center Blvd, Philadelphia, PA 10194, USA

关键词: Health services research;    Mortality;    Comorbidity;    International classification of disease codes;    Classification;    Chronic disease;    Complex chronic conditions;    Pediatrics;   

Others  :  1138440
DOI  :  10.1186/1471-2431-14-199

 received in 2014-01-17, accepted in 2014-07-30,  发布年份 2014

【 摘 要 】

Background

The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems.

Results

The CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset.

Conclusions

The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.

【 授权许可】

   
2014 Feudtner et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Feudtner C, Christakis DA, Connell FA: Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997. Pediatrics 2000, 106:205-209.
• [2]Feudtner C, Hays RM, Haynes G, Geyer JR, Neff JM, Koepsell TD: Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics 2001, 107:E99.
• [3]Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM: Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 2011, 52:1108-1115.
• [4]Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM: Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics 2011, 127:e1533-1541.
• [5]Berry JG, Hall DE, Kuo DZ, Cohen E, Agrawal R, Feudtner C, Hall M, Kueser J, Kaplan W, Neff J: Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals. JAMA 2011, 305:682-690.
• [6]Bruijning-Verhagen P, Mangen MJ, Felderhof M, Hartwig NG, van Houten M, Winkel L, de Waal WJ, Bonten MJ: Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal vaccination. BMC Med 2013, 11:112.
• [7]Coffin SE, Leckerman K, Keren R, Hall M, Localio R, Zaoutis TE: Oseltamivir shortens hospital stays of critically ill children hospitalized with seasonal influenza: a retrospective cohort study. Pediatr Infect Dis J 2011, 30:962-966.
• [8]Cohen E, Lacombe-Duncan A, Spalding K, MacInnis J, Nicholas D, Narayanan UG, Gordon M, Margolis I, Friedman JN: Integrated complex care coordination for children with medical complexity: a mixed-methods evaluation of tertiary care-community collaboration. BMC Health Serv Res 2012, 12:366.
• [9]Cohen E, Yantzi N, Guan J, Lam K, Guttmann A: Residential movement patterns of families of young children with chronic conditions in Ontario, Canada: a population-based cohort study. Int J Equity Health 2013, 12:62.
• [10]Edwards JD, Houtrow AJ, Vasilevskis EE, Rehm RS, Markovitz BP, Graham RJ, Dudley RA: Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay*. Crit Care Med 2012, 40:2196-2203.
• [11]Fox D, Morrato E, Campagna EJ, Rees DI, Dickinson LM, Partrick DA, Kempe A: Outcomes of laparoscopic versus open fundoplication in children's hospitals: 2005-2008. Pediatrics 2011, 127:872-880.
• [12]Gerber JS, Coffin SE, Smathers SA, Zaoutis TE: Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clin Infect Dis 2009, 49:65-71.
• [13]Kremeike K, Eulitz N, Junger S, Sander A, Geraedts M, Reinhardt D: Paediatric palliative home care in areas of Germany with low population density and long distances: a questionnaire survey with general paediatricians. BMC Res Notes 2012, 5:498.
• [14]Kronman MP, Hersh AL, Feng R, Huang YS, Lee GE, Shah SS: Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994-2007. Pediatrics 2011, 127:411-418.
• [15]Martin ET, Kuypers J, Wald A, Englund JA: Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Influenza Other Respi Viruses 2012, 6:71-77.
• [16]Matlow AG, Baker GR, Flintoft V, Cochrane D, Coffey M, Cohen E, Cronin CM, Damignani R, Dube R, Galbraith R, Hartfield D, Newhook LA, Nijssen-Jordan C: Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study. CMAJ 2012, 184:E709-718.
• [17]Nageswaran S, Ip EH, Golden SL, O'Shea TM, Easterling D: Inter-agency collaboration in the care of children with complex chronic conditions. Acad Pediatr 2012, 12:189-197.
• [18]Setty BA, O'Brien SH, Kerlin BA: Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer 2012, 59:258-264.
• [19]Shah SS, Hall M, Newland JG, Brogan TV, Farris RW, Williams DJ, Larsen G, Fine BR, Levin JE, Wagener JS, Conway PH, Myers AL: Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood. J Hosp Med 2011, 6:256-263.
• [20]Shah SS, Hall M, Srivastava R, Subramony A, Levin JE: Intravenous immunoglobulin in children with streptococcal toxic shock syndrome. Clin Infect Dis 2009, 49:1369-1376.
• [21]Shah SS, Ten Have TR, Metlay JP: Costs of treating children with complicated pneumonia: a comparison of primary video-assisted thoracoscopic surgery and chest tube placement. Pediatr Pulmonol 2010, 45:71-77.
• [22]Simon TD, Berry J, Feudtner C, Stone BL, Sheng X, Bratton SL, Dean JM, Srivastava R: Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics 2010, 126:647-655.
• [23]Simon TD, Hall M, Dean JM, Kestle JR, Riva-Cambrin J: Reinfection following initial cerebrospinal fluid shunt infection. J Neurosurg Pediatr 2010, 6:277-285.
• [24]Simon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, Lafleur B, Dean JM, Kestle JR: Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. J Neurosurg Pediatr 2009, 4:156-165.
• [25]Srivastava R, Berry JG, Hall M, Downey EC, O'Gorman M, Dean JM, Barnhart DC: Reflux related hospital admissions after fundoplication in children with neurological impairment: retrospective cohort study. BMJ 2009, 339:b4411.
• [26]Weiss AK, Hall M, Lee GE, Kronman MP, Sheffler-Collins S, Shah SS: Adjunct corticosteroids in children hospitalized with community-acquired pneumonia. Pediatrics 2011, 127:e255-263.
• [27]Witmer CM, Huang YS, Lynch K, Raffini LJ, Shah SS: Off-label recombinant factor VIIa use and thrombosis in children: a multi-center cohort study. J Pediatr 2011, 158:820-825 e821.
• [28]Feudtner C, Villareale NL, Morray B, Sharp V, Hays RM, Neff JM: Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study. BMC pediatrics 2005, 5:8.
• [29]Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, Srivastava R: Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011, 127:529-538.
• [30]Anderson RN, Minino AM, Hoyert DL, Rosenberg HM: Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 2001, 49:1-32.
• [31]Goodman RA, Posner SF, Huang ES, Parekh AK, Koh HK: Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Preventing Chronic Disease 2013, 10:E66.
• [32]van der Lee JH, Mokkink LB, Grootenhuis MA, Heymans HS, Offringa M: Definitions and measurement of chronic health conditions in childhood: a systematic review. JAMA: the journal of the American Medical Association 2007, 297:2741-2751.
• [33]Feudtner C, Pati S, Goodman DM, Kahn MG, Sharma V, Hutto JH, Levin JE, Slonim AD, Hall M, Shah SS: State-level child health system performance and the likelihood of readmission to children's hospitals. The Journal of pediatrics 2010, 157:98-102 e101.
• [34]Feudtner C, Levin JE, Srivastava R, Goodman DM, Slonim AD, Sharma V, Shah SS, Pati S, Fargason C Jr, Hall M: How well can hospital readmission be predicted in a cohort of hospitalized children? A retrospective, multicenter study. Pediatrics 2009, 123:286-293.
• [35]Burns KH, Casey PH, Lyle RE, Bird TM, Fussell JJ, Robbins JM: Increasing prevalence of medically complex children in US hospitals. Pediatrics 2010, 126:638-646.
• [36]Minino AM: Death in the United States. NCHS data brief 2011, 2013:1-8.
• [37]Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, Haase N, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O'Donnell CJ, Roger V, Rumsfeld J, Sorlie P, Steinberger J, Thom T, Wasserthiel-Smoller S, Hong Y: American Heart Association Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007, 115:e69-171.
• [38]Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, Gillespie C, Merritt R, Hu FB: Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA: the journal of the American Medical Association 2012, 307:1273-1283.