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Identifying and classifying children with chronic conditions using administrative data with the clinical risk group
John M Neff1, Virginia L Sharp, John Muldoon
1Center for Children with Special Needs, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE-MS: CM-09, Seattle, WA 98105-5371, USA. jneff@chmc.org
Summary
The Clinical Risk Groups (CRGs) system effectively identifies and categorizes children with chronic health conditions. This administrative data tool aids in patient tracking and resource management for pediatric populations.
Area of Science:
- Pediatric Health Services Research
- Health Informatics
- Chronic Disease Management
Background:
- Accurate identification of children with chronic health conditions is crucial for effective healthcare management.
- Administrative data offers a scalable approach to population health analysis.
- The Clinical Risk Groups (CRGs) system is a validated method for health status classification.
Purpose of the Study:
- To evaluate the utility of the Clinical Risk Groups (CRGs) system for identifying and categorizing pediatric populations with chronic health conditions.
- To stratify children by health status and condition severity using administrative claims and enrollment data.
- To analyze healthcare utilization patterns across different CRG categories and severity levels.
Main Methods:
- The study applied the CRG system to classify children aged 0-18 years within a mid-sized health plan.
- Enrollees were categorized into 9 mutually exclusive groups: healthy, significant acute, and 7 chronic condition categories, stratified by severity.
- Eligibility and claims data from calendar year 1999 were analyzed for children enrolled for at least 6 months (newborns 3 months).
Main Results:
- The analysis included 34,544 children, with 85.2% classified as healthy.
- Chronic conditions were identified in 4.6% (minor) and 4.9% (moderate to catastrophic) of the pediatric cohort.
- Healthcare utilization, measured by medical care encounters, increased with both chronic condition category and severity level.
Conclusions:
- The CRG system is a valuable tool for identifying, classifying, and stratifying children with chronic health conditions.
- CRG categorization facilitates patient tracking, case management, and healthcare utilization analysis in pediatric populations.
- The system demonstrates effectiveness in identifying children requiring significant healthcare interactions, aligning with national prevalence data.