Elsevier

Ambulatory Pediatrics

Volume 2, Issue 1, January–February 2002, Pages 71-79
Ambulatory Pediatrics

Identifying and Classifying Children With Chronic Conditions Using Administrative Data With the Clinical Risk Group Classification System

https://doi.org/10.1367/1539-4409(2002)002<0071:IACCWC>2.0.CO;2Get rights and content

Objective.—To identify and categorize children with chronic health conditions using administrative data.

Methods.—The Clinical Risk Groups (CRGs) system is used to classify children, aged 0–18 years, in a mid-sized health plan into mutually exclusive categories and severity groups. Enrollees are categorized into 9 health status groups—healthy, significant acute, and 7 chronic conditions—and are then stratified by severity. Utilization is examined by category and severity level based on eligibility and claims files for calendar year 1999. Only children enrolled for at least 6 months (newborns at least 3 months) are included.

Results.—This analysis of 34 544 children classifies 85.2% as healthy, including 19.6% with no claims; 5.2% with a significant acute illness; 4.6% with a minor chronic condition; and 4.9% with a moderate to catastrophic chronic condition. The average number of unique medical care encounters per child increases by chronic condition category and by severity level. Compared to national prevalence norms for selected conditions, CRGs do well in identifying patients who have conditions that require interaction with the health care system.

Conclusions.—CRGs are a useful tool for identifying, classifying, and stratifying children with chronic health conditions. Enrollees can be grouped into categories for patient tracking, case management, and utilization.

Section snippets

METHODS

CRGs are a categorical clinical classification system that uses proprietary computer software to group individuals into mutually exclusive hierarchical categories and to assign each person to a severity level if he/she has a chronic health condition. CRGs are an integration of 2 systems, the Episode Grouper developed by 3M Health Information Systems (3M HIS) and NACHRI's Classification of Congenital and Chronic Health Conditions (CCCHC).

NACHRI's CCCHC was developed as an ICD-9-CM code–based

RESULTS

CRG classification results for the NWMB calendar year 1999 data are summarized in Table 1, Table 2, Table 3, Table 4. Table 1 summarizes the CRG classification of the 34 544 eligible, unique children covered by NWMB at the CRG's highest level of aggregation: CRG core health status group by severity level (ACRG3). The 29 446 children (85.2%) classified as healthy include 6773 children (19.6%) who had no claims recorded by the health plan during calendar year 1999. Children with no claims are

DISCUSSION

Claims data collected and maintained by health plans are a source of clinical and procedural information that can be used to identify and classify children having a wide range of chronic health conditions. Using 3M's CRG software and these data, we have shown how each child can be classified into mutually exclusive clinically based categories, defined by health status and relative severity. CRGs also can be used for estimating the prevalence of specific chronic health conditions in a population

ACKNOWLEDGMENTS

This work has been supported by a grant from the Maternal and Child Health Bureau (GH93MC00061) and by a research license from 3M Corporation to test CRGs on pediatric populations. Special thanks to Tracy Fitzgibbon and Kristin Myers from the Northwest Washington Medical Bureau, Nanci Larter and Patty Centioli of the Center for Children with Special Needs, and Jan Hicks-Thomson from the Department of Health, Washington State.

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