Abstract
BackgroundThe pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems.ResultsThe CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset.ConclusionsThe updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.
Highlights
The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10)
We evaluated the CCC version 2 (CCC v2) system in three ways: 1) the comparability between the ICD-9 and ICD-10 systems; 2) the year-toyear stability of classification across CCC v2 attributable to cause of death in 1991–2010; and 3) the proportions of patients classified as having a CCC between CCC v2 and CCC v1 systems
With the provisional set of all CCC v2 codes, we used the v2 system to classify all cases in the CDC Multiple Cause of Death data for 1996, 2009 Kids’ Inpatient Database (KID), and 2010 Nationwide Emergency Department Sample (NEDS) datasets, and reviewed all cases classified as not having a CCC to determine whether any codes in the CCC v2 system had been either incorrectly specified or omitted, and we corrected these errors
Summary
The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). In 2000, Feudtner and colleagues developed a definition for CCCs: “Any medical condition that can be reasonably expected to last at least 12 months (unless death intervenes) and to involve either several different organ systems or 1 organ system severely enough to require specialty pediatric care and probably some period of hospitalization in a tertiary care center”[1] Based on this definition, a comprehensive set of codes available at that time from the International Classification of Disease version 9 Clinical Modification (ICD-9-CM) system were identified as indicative of a CCC, and further categorized into 9 categories (cardiovascular, respiratory, neuromuscular, renal, gastrointestinal, hematologic or immunologic, metabolic, other congenital or genetic, and malignancy). The CCC system was initially applied to studying patterns of pediatric mortality and end-of-life care [1,2], and has subsequently been applied to a variety of research problems, including risk adjustment, prediction of adverse health outcomes, and identification of populations with high health care utilization [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]
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