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Pediatric Complex Chronic Conditions: Does the Classification System Work for Infants?
Lisa C Lindley1, Christine A Fortney2
11 College of Nursing, University of Tennessee, Knoxville, TN, USA.
Insights
The complex chronic conditions (CCCs) classification identifies infants with serious illnesses, but only 40% met the criteria. Racial disparities exist, with African American infants less likely to be classified, highlighting the need for equitable palliative care research.
Area of Science:
- Pediatric Health
- Medical Classification Systems
- Public Health Research
Background:
- The complex chronic conditions (CCCs) classification is a standard for identifying children with life-limiting conditions.
- Its performance, particularly in infants, remains under-researched.
Purpose of the Study:
- To determine the prevalence of CCCs in infants.
- To identify infant characteristics associated with CCC classification.
Main Methods:
- Utilized the 2012 Kids' Inpatient Database (a national sample).
- Employed multivariate regression analysis on infant decedents under one year old.
Main Results:
- 40% of infants were classified with CCCs.
- African American infants and those with other insurance were less likely to be classified.
- Nonurban residence and comorbidities increased the odds of CCC classification.
Conclusions:
- Infant CCC classification is not universal, with significant racial variations observed.
- Attention to CCC classification is crucial for reducing palliative care disparities.
Background:
One widely accepted approach to identify children with life-limiting health problems is the complex chronic conditions (CCCs) classification system. Although considered the "gold standard" for classifying children with serious illness, little is known about its performance, especially among infants.
Objective/Hypothesis:
This research examined the prevalence of CCCs and the infant characteristics related to a CCC classification.
Methods:
Multivariate regression analysis was conducted with 2012 Kids' Inpatient Database, Healthcare Cost and Utilization Project data files, using a national sample of infant decedents less than 1 year.
Results:
Our findings showed that 40% of the infants were classified with a CCC. African Americans were negatively associated with a CCC classification (adjusted odds ratio [aOR] = 0.63; 95% confidence interval [CI] = 0.543-0.731). When infants had other insurance coverage, they were less likely (aOR = 0.63; 95% CI = 0.537-0.748) to have a CCC classification. Infants who resided in nonurban areas (aOR = 1.21; 95% CI =1.034-1.415) and had comorbidities (aOR = 38.19; 95% CI = 33.12-44.04) had greater odds of having a CCC classification.
Conclusions:
The findings suggested that the infants are not commonly classified with a CCC and highlighted the significant variation in race with African American infants exhibiting different CCC classifications than Caucasian infants. Given the importance of reducing disparities in palliative care, critical attention to using CCC classifications in research is warranted.
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