Prevalence of Children With Medical Complexity and Associations With Health Care Utilization and In-Hospital Mortality

作者：JoAnna K. Leyenaar, Andrew Schaefer, Seneca D. Freyleue, Andrea M. Austin, Tamara D. Simon, Jeanne Van Cleave, Erika L. Moen, A. James O’Malley, David C. Goodman · 发表于：Archives of Pediatrics and Adolescent Medicine · 年份：2022 · DOI：10.1001/jamapediatrics.2022.0687 · 被引用次数：119 · 研究领域：Healthcare Policy and Management、Chronic Disease Management Strategies、Healthcare cost, quality, practices

Importance: Children with medical complexity (CMC) have substantial health care needs and frequently experience poor health care quality. Understanding the population prevalence and associated health care needs can inform clinical and public health initiatives. Objective: To estimate the prevalence of CMC using open-source pediatric algorithms, evaluate performance of these algorithms in predicting health care utilization and in-hospital mortality, and identify associations between medical complexity as defined by these algorithms and clinical outcomes. Design, Setting, and Participants: This retrospective cohort study used all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 through 2017. Children and adolescents younger than 18 years residing in these states were included if they had 12 months or longer of enrollment in a participating health care plan. Analyses were conducted from March 12, 2021, to January 7, 2022. Exposures: The pediatric Complex Chronic Condition Classification System, Pediatric Medical Complexity Algorithm, and Children With Disabilities Algorithm were applied to 3 years of data to identify children with complex and disabling conditions, first in their original form and then using more conservative criteria that required multiple health care claims or involvement of 3 or more body systems. Main Outcomes and Measures: Primary outcomes, examined over 2 years, included in-hospital mortality and a composite measure of health care...