Pediatric Complex Chronic Conditions: Does the Classification System Work for Infants?

Lindley, Lisa C.; Fortney, Christine A.

doi:10.1177/1049909119838985

Cited by 10 publications

(9 citation statements)

References 20 publications

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“…However, several studies have shown that both the 9th and the 10th revisions of ICD perform similarly in classifying children with complex chronic conditions enrolled in hospice. 32 The second limitation was that all MHBH diagnoses were coded using the ICD classification system instead of the more commonly used Diagnostic and Statistical Manual of Mental Disorders (DSM). This was the limitation of the original database, which did not include DSM codes.…”

Section: Discussionmentioning

confidence: 99%

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life

Svynarenko¹,

Beebe²,

Lindley³

2021

J Hosp Palliat Nurs

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Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.

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Section: Discussionmentioning

confidence: 99%

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life

Svynarenko¹,

Beebe²,

Lindley³

2021

J Hosp Palliat Nurs

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“…The study data were collected between 2011 and 2013, and all cardiac diagnoses were classified using the previous ICD-9-CM . Studies have shown, however, that both the 9th and 10th versions of the International Classification of Diseases perform similarly in classifying children with complex chronic conditions enrolled in hospice 33 . The sample was limited to children enrolled in Medicaid and did not include children with private insurance or Tricare military healthcare coverage.…”

Section: Discussionmentioning

confidence: 99%

A National Study of Healthcare Service Patterns at the End of Life Among Children With Cardiac Disease

et al. 2021

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Background: Heart diseases are one of the leading causes of health-related deaths among children. Concurrent hospice care offers hospice and nonhospice healthcare services simultaneously, but the use of these services by children with cardiac disease has been rarely investigated. Objective: The aims of this study were to identify patterns of nonhospice healthcare services used in concurrent hospice care and describe the profile of children with cardiac disease in these clusters. Methods: This study was a retrospective cohort analysis of Medicaid claims data collected between 2011 and 2013 from 1635 pediatric cardiac patients. The analysis included descriptive statistics and latent class analysis. Results: Children in the sample used more than 314 000 nonhospice healthcare services. The most common services were inpatient hospital procedures, durable medical equipment, and home health. Latent class analysis clustered children into "moderate intensity" (60.0%) and "high intensity" classes (40.0%). Children in "moderate intensity" had dysrhythmias (31.7%), comorbidities (85.0%), mental/behavioral health conditions (55%), and technology dependence (71%). They commonly resided in urban areas (60.1%) in the Northeast (44.4%). The health profile of children in the "high intensity" class included dysrhythmias (39.4%), comorbidities (97.6%), mental/behavioral health conditions (71.5%), and technology dependence (85.8%). These children resided in rural communities (50.7%) in the South (53.1%). Conclusions: Two patterns of use of nonhospice healthcare services were identified in this study. This information may be used by nurses and other healthcare professionals working in concurrent hospice care to assess the healthcare service needs of children with cardiac conditions at the end of life.

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“…Given that the modified CCC classification system focused on infant-specific revisions, the sampling frame was limited to infants less than 1 year of age (Lindley & Fortney, 2019). The sample was restricted to those infants who had a discharge disposition of death in the hospital occurring from January 1 to December 21, 2012.…”

Section: Methodsmentioning

confidence: 99%

Pediatric Complex Chronic Conditions: Evaluating Two Versions of the Classification System

2019

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The original pediatric complex chronic conditions (CCC) classification system developed in 2000/2001 is the gold standard in classifying children with life-limiting illnesses. It was significantly modified in 2014; yet the two systems have not been evaluated. The objective of this study was to evaluate the agreement and validity of the original versus the modified CCC classification systems. Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) data from 2012 was used with a sample of infant decedents less than 1 years. The agreement (i.e., Cohen’s Kappa Statistic) and validity (i.e., sensitivity, specificity, and positive predictive value [PPV]) statistics were calculated. Among the 10,175 infants that were classified, the modified system performed well in identifying infants who had a CCC, and it captured infants that the original classification did not. The modified system represents an improvement over the original, but additional testing is warranted.

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Pediatric Complex Chronic Conditions: Does the Classification System Work for Infants?

Cited by 10 publications

References 20 publications

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life

A National Study of Healthcare Service Patterns at the End of Life Among Children With Cardiac Disease

Pediatric Complex Chronic Conditions: Evaluating Two Versions of the Classification System

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