Demographic and Clinical Differences Between Applied Definitions of Medical Complexity

Title

Demographic and Clinical Differences Between Applied Definitions of Medical Complexity

Creator

Heneghan J A; Goodman DM; Ramgopal S

Publisher

Hospital Pediatrics

Date

2022

Subject

Child; Chronic Disease; Cross-Sectional Studies; Demography; Hospitalization; Hospitals; Pediatric; Humans; Infant; Retrospective; Studies

Description

OBJECTIVES: To identify the degree of concordance and characterize demographic and clinical differences between commonly used definitions of multisystem medical complexity in children hospitalized in children's hospitals. METHODS: We conducted a retrospective, cross-sectional cohort study of children <21 years of age hospitalized at 47 US Pediatric Health Information System-participating children's hospitals between January 2017 to December 2019. We classified patients as having multisystem complexity when using 3 definitions of medical complexity (pediatric complex chronic conditions, pediatric medical complexity algorithm, and pediatric chronic critical illness) and assessed their overlap. We compared demographic, clinical, outcome, cost characteristics, and longitudinal healthcare utilization for each grouping. RESULTS: Nearly one-fourth (23.5%) of children hospitalized at Pediatric Health Information System-participating institutions were identified as meeting at least 1 definition of multisystem complexity. Children with multisystem complexity ranged from 1.0% to 22.1% of hospitalized children, depending on the definition, with 31.2% to 95.9% requiring an ICU stay during their index admission. Differences were seen in demographic, clinical, and resource utilization patterns across the definitions. Definitions of multisystem complexity demonstrated poor agreement (Fleiss' κ 0.21), with 3.5% of identified children meeting all 3. CONCLUSIONS: Three definitions of multisystem complexity identified varied populations of children with complex medical needs, with poor overall agreement. Careful consideration is required when applying definitions of medical complexity in health services research, and their lack of concordance should result in caution in the interpretation of research using differing definitions of medical complexity.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

October 2022 List

Collection

Citation

Heneghan J A; Goodman DM; Ramgopal S, “Demographic and Clinical Differences Between Applied Definitions of Medical Complexity,” Pediatric Palliative Care Library, accessed February 5, 2023, https://pedpalascnetlibrary.omeka.net/items/show/18396.

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