Keywords

administrative data, care coordination, care management, children, chronic conditions, Clinical Risk Groups (CRGs), condition stability, medical home, special healthcare needs

 

Authors

  1. Neff, John M. MD
  2. Sharp, Virginia L. MA
  3. Popalisky, Jean MN
  4. Fitzgibbon, Tracy BSN

Abstract

This study evaluates stability of chronic condition identification in children older than 4 years in a health plan billing data using Clinical Risk Groups. A total of 31,055 children were continuously enrolled for 4 years; 7.5% (2334) identified with a chronic condition status in year 1, 2002, and another 15.4% (4784) during subsequent years; 63.6% (19,759) were identified as "healthy" throughout. The most stable were those identified with a catastrophic health condition. The least stable were those with minor and moderate/dominant major chronic conditions. Overall, 73.1% (1706) of the children with chronic conditions in year 1 improved in status, and 5.7% (133) progressed to more complex conditions.