Assessing the Performance of CCCv3 in Epic Cosmos: A Foundation for Future Innovation

Area of Science:

• Pediatric Health Informatics
• Complex Chronic Conditions
• Electronic Health Records

Background:

• Children with medical complexity (CMC) have chronic multisystem conditions, high healthcare utilization, and poor outcomes.
• Existing administrative datasets lack detailed clinical information for CMC research.
• Epic Cosmos offers a national deidentified electronic health record dataset with potential for expanded CMC research.

Purpose of the Study:

• To evaluate the performance of the Pediatric Complex Chronic Condition System version 3 (CCCv3) within the Epic Cosmos EHR dataset.
• To assess the utility of CCCv3 in identifying and characterizing CMC populations.
• To determine the association between the number of complex chronic conditions (CCCs) and healthcare utilization and outcomes.

Main Methods:

• Retrospective cohort study of pediatric hospitalizations (≤18 years) in Epic Cosmos (2015-2025).
• CMC identified using CCCv3 based on admission, discharge, billing, and problem list diagnoses.
• Analysis of CCC distribution, hospitalization burden, demographics, length of stay (LOS), and in-hospital mortality.

Main Results:

• 43.3% of admissions involved patients with at least one CCC, accounting for 55.8% of hospitalizations and 69.0% of hospital days.
• Patients with ≥4 CCCs (4.4% of cohort) accounted for 14.3% of admissions and 27.2% of hospital days.
• Each additional CCC correlated with a 21% increase in LOS and increased mortality risk.

Conclusions:

• CCCv3 in Epic Cosmos effectively stratifies pediatric patient complexity, consistent with prior administrative studies.
• The system identifies a higher absolute prevalence of CCCs but maintains relative trends in utilization and outcomes.
• Epic Cosmos, with CCCv3, provides a clinically rich platform for advancing pediatric research and clinical decision support.