Stratification of children by medical complexity

Acad Pediatr. Mar-Apr 2015;15(2):191-6. doi: 10.1016/j.acap.2014.10.007. Epub 2014 Nov 22.


Objective: To stratify children using available software, Clinical Risk Groups (CRGs), in a tertiary children's hospital, Seattle Children's Hospital (SCH), and a state's Medicaid claims data, Washington State (WSM), into 3 condition groups: complex chronic disease (C-CD); noncomplex chronic disease (NC-CD), and nonchronic disease (NC).

Methods: A panel of pediatricians developed consensus definitions for children with C-CD, NC-CD, and NC. Using electronic medical record review and expert consensus, a gold standard population of 700 children was identified and placed into 1 the 3 groups: 350 C-CD, 100 NC-CD, and 250 NC. CRGs v1.9 stratified the 700 children into the condition groups using 3 years of WSM and SCH encounter data (2008-2010). WSM data included encounters/claims for all sites of care. SCH data included only inpatient, emergency department, and day surgery claims.

Results: A total of 678 of 700 children identified in SCH data were matched in WSM data. CRGs demonstrated good to excellent specificity in correctly classifying all 3 groups in SCH and WSM data; C-CD in SCH (94.3%) and in WSM (91.1%); NC-CD in SCH (88.2%) and in WSM (83.7%); and NC in SCH (84.9%) and in WSM (94.6%). There was good to excellent sensitivity for C-CD in SCH (75.4%) and in WSM (82.1%) and for NC in SCH (98.4%) and in WSM (81.1%). CRGs demonstrated poor sensitivity for NC-CD in SCH (31.0%) and WSM (58.0%). Reasons for poor sensitivity in NC-CD are explored.

Conclusions: CRGs can be used to stratify children receiving care at a tertiary care hospital according to complexity in both hospital and Medicaid administrative data. This method will enhance reporting of health-related outcome data.

Keywords: administrative billing data; children; chronic diseases; clinical risk group; stratification.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease / classification*
  • Adolescent
  • Child
  • Child, Preschool
  • Chronic Disease / classification*
  • Electronic Health Records
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Information Storage and Retrieval
  • Male
  • Medicaid
  • Outcome Assessment, Health Care
  • Severity of Illness Index
  • Software
  • Tertiary Care Centers
  • United States
  • Washington