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. 2024 Jul 1;7(7):e2420579.
doi: 10.1001/jamanetworkopen.2024.20579.

Pediatric Complex Chronic Condition System Version 3

James A Feinstein  1   2   3 , Matt Hall  4 , Amber Davidson  4 , Chris Feudtner  5
Affiliations

Pediatric Complex Chronic Condition System Version 3

James A Feinstein et al. JAMA Netw Open. .

Abstract

Importance: Since implementation of the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in the US, thousands of new or related codes have been added to represent clinical conditions. The widely used pediatric complex chronic condition (CCC) system required a major update from version 2 (V2) to version 3 (V3) to capture the range of clinical conditions represented in the ICD-10-CM.

Objective: To update the CCC V3 system, creating V3, with new, missing, or retired codes; to reconceptualize the system's use of technology codes; and to compare CCC V3 with V2.

Design, setting, and participants: This repeated cross-sectional study examined US hospitalization data from the Pediatric Health Information System (PHIS) and the Medicaid Merative MarketScan Research Databases from January 1, 2009, to December 31, 2019, for all patients aged 0 to 18 years. Data were analyzed from March 1, 2023, to April 1, 2024.

Exposures: The CCCs were identified in both data sources using the CCC V2 and V3 systems.

Main outcomes and measures: The (1) percentage of pediatric hospitalizations associated with a CCC, (2) numbers of CCC body-system categories per patient, and (3) explanatory power for hospital length of stay and in-hospital mortality were compared over time for V3 vs V2.

Results: Among 7 186 019 hospitalizations within PHIS, 54.3% patients were male, the median age was 4 years (IQR, 1-11 years), and 51.2% were aged 0 to 4 years). The CCC V2 identified 2 878 476 (40.1%) patients as having any CCC compared with 2 753 412 (38.3%) identified by V3. In addition, V2 identified 100 065 (1.4%) patients with transplant status compared with 146 683 (2.0%) by V3, and V2 identified 914 835 (12.7%) as having technology codes compared with 805 585 (11.2%) by V3. The 2 systems were similar in accounting for the number of CCC body-system categories per patient and in explaining variation in hospital length of stay and in-hospital mortality. For both V2 and V3, 10.0% of the variance in hospital length of stay and 12.0% of the variance in in-hospital mortality was explained by the presence of a CCC. Similar patterns were observed when analyzing the 2 999 420 Medicaid Merative MarketScan Research Databases' hospitalizations (52.3% of patients were male, the median age was 1 year [IQR, 0-12 years], and 62.0% were 0 to 4 years old), except that the percentages of identified CCCs were all lower: V2 identified 758 110 hospitalizations (25.3%) with any CCC compared with 718 100 (23.9%) identified by V3.

Conclusions and relevance: These results suggest that, moving forward, V3 should be used to identify CCCs, and ongoing, frequent updates to V3, using a transparent, structured process, will enable V3 to accurately reflect the evolving spectrum of clinical conditions represented in the ICD-10-CM.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Process to Assign Complex Chronic Condition (CCC) Status and CCC Categories Using the CCC System Version 3
The CCC status (ie, yes or no) and CCC categories using CCC diagnosis, procedure, technology, and transplant codes. Cat indicates category; Dx, diagnosis; Flag, status; n-CCC, number of CCC categories; Pr, procedure; Tech, technology; Txp, transplant. aAssigned at the patient level or encounter level (ie, a hospitalization).
Figure 2.
Figure 2.. Percentage of Patients With Complex Chronic Conditions (CCCs) in the Pediatric Health Information System Database, by Year
The McNemar test was used to compare differences in percentages between any CCC in version 2 (V2) and version 3 (V3) by year, which were all significant at P < .001.
Figure 3.
Figure 3.. Comparison of the Complex Chronic Condition (CCC) Systems Version 2 (V2) and Version 3 (V3) in the Pediatric Health Information System Database by the Variance in Hospital Length of Stay and Mortality, by Year
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization . ICD–11 fact sheet. Accessed June 7, 2024. https://icd.who.int/en/docs/icd11factsheet_en.pdf
    1. Feinstein JA, Gill PJ, Anderson BR. Preparing for the International Classification of Diseases, 11th Revision (ICD-11) in the US health care system. JAMA Health Forum. 2023;4(7):e232253. doi:10.1001/jamahealthforum.2023.2253 - DOI - PMC - PubMed
    1. Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014;14:199. doi:10.1186/1471-2431-14-199 - DOI - PMC - PubMed
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