Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 3.0

被引:158
作者
Simon, Tamara D. [1 ,2 ]
Haaland, Wren [2 ]
Hawley, Katherine [2 ]
Lambka, Karen [2 ]
Mangione-Smith, Rita [1 ,2 ]
机构
[1] Univ Washington, Dept Pediat, Seattle Childrens Hosp, Seattle, WA 98195 USA
[2] Seattle Childrens Res Inst, M-S JMB 9,1900 Ninth Ave, Seattle, WA 98101 USA
基金
美国医疗保健研究与质量局;
关键词
administrative data; claims data; medical complexity; sensitivity; specificity; stratification; validation; SUPPORTIVE CARE SERVICES; QUALITY MEASURES; WASHINGTON-STATE; CHILDREN; INITIATIVES; POPULATION; PATTERNS;
D O I
10.1016/j.acap.2018.02.010
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
OBJECTIVE: To modify the Pediatric Medical Complexity Algorithm (PMCA) to include both International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) codes for classifying children with chronic disease (CD) by level of medical complexity and to assess the sensitivity and specificity of the new PMCA version 3.0 for correctly identifying level of medical complexity. METHODS: To create version 3.0, PMCA version 2.0 was modified to include ICD-10-CM codes. We applied PMCA version 3.0 to Seattle Children's Hospital data for children with >= 1 emergency department (ED), day surgery, and/or inpatient encounter from January 1, 2016, to June 30, 2017. Starting with the encounter date, up to 3 years of retrospective discharge data were used to classify children as having complex chronic disease (C-CD), noncomplex chronic disease (NC-CD), and no CD. We then selected a random sample of 300 children (100 per CD group). Blinded medical record review was conducted to ascertain the levels of medical complexity for these 300 children. The sensitivity and specificity of PMCA version 3.0 was assessed. RESULTS: PMCA version 3.0 identified children with C-CD with 86% sensitivity and 86% specificity, children with NC-CD with 65% sensitivity and 84% specificity, and children without CD with 77% sensitivity and 93% specificity. CONCLUSIONS: PMCA version 3.0 is an updated publicly available algorithm that identifies children with C-CD, who have accessed tertiary hospital emergency department, day surgery, or inpatient care, with very good sensitivity and specificity when applied to hospital discharge data and with performance to earlier versions of PMCA.
引用
收藏
页码:577 / 580
页数:4
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