Mar 13, 2002

Identifying and classifying children with chronic conditions using administrative data with the clinical risk group classification system

Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association
John M NeffJames C Gay

Abstract

To identify and categorize children with chronic health conditions using administrative data. 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. 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. CRGs are a useful tool for identifying, classifying, and stratifying children with chronic health condit...Continue Reading

Mentioned in this Paper

Catastrophic Illness
Chronic Disease
Severity of Illness Index
Case Mix
Teens
Repeated Rounds of Survey
Educational Needs Assessment
Health Insurance, Voluntary
Health Services, Infant
Absence Epilepsy

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