Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora.
Children's Hospital Colorado, Aurora.
JAMA Netw Open. 2024 Jul 1;7(7):e2420579. doi: 10.1001/jamanetworkopen.2024.20579.
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.
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.
The CCCs were identified in both data sources using the CCC V2 and V3 systems.
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.
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.
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.
自美国实施国际疾病分类第十次修订临床修订版（ICD-10-CM）以来，已经增加了数千个新的或相关的代码，以代表临床情况。广泛使用的儿科复杂慢性疾病（CCC）系统需要从版本 2（V2）到版本 3（V3）进行重大更新，以捕捉 ICD-10-CM 中代表的各种临床情况。
更新 CCC V3 系统，创建 V3，包括新的、缺失的或已弃用的代码；重新概念化系统对技术代码的使用；并比较 CCC V3 与 V2。
设计、设置和参与者：这项重复的横断面研究使用儿科健康信息系统（PHIS）和 Medicaid Merative MarketScan Research Databases 的 US 住院数据，从 2009 年 1 月 1 日至 2019 年 12 月 31 日，对所有 0 至 18 岁的患者进行了研究。数据于 2023 年 3 月 1 日至 2024 年 4 月 1 日进行分析。
在这两个数据源中，CCC 使用 CCC V2 和 V3 系统来识别。
比较 V3 与 V2 随时间推移在（1）与 CCC 相关的儿科住院比例、（2）每位患者的 CCC 身体系统类别数量、以及（3）对住院时间和院内死亡率的解释力。
在 PHIS 中的 7186019 例住院中，54.3%的患者为男性，中位年龄为 4 岁（IQR，1-11 岁），51.2%的患者为 0 至 4 岁）。CCC V2 确定了 2878476 名（40.1%）患者患有任何 CCC，而 V3 确定了 2753412 名（38.3%）患者患有 CCC。此外，V2 确定了 100065 名（1.4%）有移植状态的患者，而 V3 确定了 146683 名（2.0%），V2 确定了 914835 名（12.7%）有技术代码的患者，而 V3 确定了 805585 名（11.2%）。这两个系统在解释每位患者的 CCC 身体系统类别数量和解释住院时间和院内死亡率的变化方面相似。对于 V2 和 V3，CCC 的存在解释了住院时间方差的 10.0%和院内死亡率方差的 12.0%。当分析 Medicaid Merative MarketScan Research Databases 的 2999420 例住院数据（52.3%的患者为男性，中位年龄为 1 岁[IQR，0-12 岁]，62.0%为 0 至 4 岁）时，观察到类似的模式，只是确定的 CCC 百分比都较低：V2 确定了 758110 例（25.3%）与任何 CCC 相关的住院，而 V3 确定了 718100 例（23.9%）。
这些结果表明，未来应使用 V3 来识别 CCC，并且使用透明、结构化的流程进行持续、频繁的 V3 更新，将使 V3 能够准确反映 ICD-10-CM 中代表的临床情况的不断变化的范围。
