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

Averi Wilson1,2, Musa Ali Rizvi2, Andrew P Bain2,3

  • 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.

Hospital Pediatrics
|March 4, 2026
PubMed

Insights

The Pediatric Complex Chronic Condition System version 3 (CCCv3) effectively identifies children with medical complexity (CMC) in the Epic Cosmos electronic health record dataset. This system helps stratify patient complexity, aiding pediatric research and clinical decision support.

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.
Abstract

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