Identifying and classifying children with chronic conditions using administrative data with the clinical risk group classification system.
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 34544 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.
Neff
John M
JM
Center for Children with Special Needs, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE-MS: CM-09, Seattle, WA 98105-5371, USA. jneff@chmc.org
Sharp
Virginia L
VL
Muldoon
John
J
Graham
Jeff
J
Popalisky
Jean
J
Gay
James C
JC
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002908:Chronic Disease / Q000145:classification / Q000453:epidemiology*; D003625:Data Collection / Q000379:methods*; D003953:Diagnosis-Related Groups; D019988:Children with Disabilities / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data*; D020380:Needs Assessment; D015995:Prevalence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology