Pediatric care coordination and risk tiering: Moving beyond claims data

Area of Science:

• Pediatric healthcare research
• Health services research
• Patient stratification

Background:

• Identifying children and youth with special health care needs (CYSHCN) is crucial for appropriate resource allocation.
• Existing tools may not fully capture the complexity of pediatric patients.

Purpose of the Study:

• To evaluate the St. Luke's Children's Acuity Tool (SLCAT) for identifying pediatric patients with varying levels of complexity.
• To compare SLCAT's performance against the Pediatric Chronic Conditions Classification System version2 (CCCv2).

Main Methods:

• Retrospective cohort study of pediatric patients (0-21 years) from 2012-2015.
• Utilized SLCAT to assess resource utilization (dollars billed, encounters, problem list).
• Compared SLCAT with CCCv2 for patient classification.

Main Results:

• SLCAT effectively stratified patients based on resource utilization and condition complexity.
• Children with highly complex conditions showed significantly higher utilization.
• SLCAT identified 515 patients missed by CCCv2, many with mental/behavioral health diagnoses.

Conclusions:

• A tiered classification model incorporating comprehensive care aspects improves CYSHCN identification.
• Accurate identification enables better matching of patients with tailored care coordination services.
• This approach supports primary care providers and care teams in optimizing patient support.