Measures of ED utilization in a national cohort of children.

Objectives: Emergency department (ED) utilization is often used as an indicator of poor chronic disease control and/or poor quality of care. We sought to determine if 2 ED utilization measures identify clinically or demographically different populations of children.

Study Design: Retrospective cohort study utilizing IBM Health/Truven MarketScan Medicaid data.

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases.

Background And Objectives: Expenditures for children with noncomplex chronic diseases (NC-CDs) are related to disease chronicity and resource use. The degree to which specific conditions contribute to high health care expenditures among children with NC-CDs is unknown. We sought to describe patient characteristics, expenditures, and use patterns of children with NC-CDs with the lowest (≤80th percentile), moderate (81-95th percentile), high (96-99th percentile), and the highest (≥99th percentile) expenditures.

Health Care Expenditures and Utilization for Children With Noncomplex Chronic Disease.

Background: Pediatric health care expenditures and use vary by level of complexity and chronic illness. We sought to determine expenditures and use for children with noncomplex chronic diseases (NC-CDs).

Methods: We performed a retrospective, cross-sectional analysis of Medicaid enrollees (ages 0-18 years) from January 1, 2012, through December 31, 2013, using administrative claims (the Truven MarketScan Medicaid Database).

Trends in Health Care Spending for Children in Medicaid With High Resource Use.

Objectives: To assess characteristics associated with health care spending trends among child high resource users in Medicaid.

Methods: This retrospective analysis included 48 743 children ages 1 to 18 years continuously enrolled from 2009-2013 in 10 state Medicaid programs (Truven MarketScan Medicaid Database) also in the top 5% of all health care spending in 2010. Using multivariable regression, associations were assessed between baseline demographic, clinical, and health services characteristics (using 2009-2010 data) with subsequent health care spending (ie, transiently, intermittently, persistently high) from 2011-2013.

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance.

Background And Objectives: Opportunities to improve health care quality and contain spending may differ between high and low resource users. This study's objectives were to assess health care and spending among children with Medicaid insurance by their resource use.

Methods: Retrospective cross-sectional analysis of 2012 Medicaid health administrative data from 10 states of children ages 11 months to 18 years.

Stratification of children by medical complexity.

Objective: To stratify children using available software, Clinical Risk Groups (CRGs), in a tertiary children's hospital, Seattle Children's Hospital (SCH), and a state's Medicaid claims data, Washington State (WSM), into 3 condition groups: complex chronic disease (C-CD); noncomplex chronic disease (NC-CD), and nonchronic disease (NC).

Methods: A panel of pediatricians developed consensus definitions for children with C-CD, NC-CD, and NC. Using electronic medical record review and expert consensus, a gold standard population of 700 children was identified and placed into 1 the 3 groups: 350 C-CD, 100 NC-CD, and 250 NC.

Comparison of Administrative Data Versus Infection Control Data in Identifying Central Line-Associated Bloodstream Infections in Children's Hospitals.

Objective: As of July 2012, the Centers for Medicare and Medicaid Services prohibited state Medicaid programs from paying for medical care related to certain provider-preventable conditions. The most prevalent provider-preventable condition in pediatrics is central line-associated bloodstream infections (CLABSIs), which cause significant morbidity and mortality. The objective of this study was to compare the uses of administrative data and infection control data in measuring CLABSIs.

Obesity in pediatric specialty clinics: an underestimated comorbidity.

Objectives: (a) To examine the prevalence of obesity across 31 subspecialties in a tertiary care children's hospital and (b) to examine the percentage of obesity-specified diagnosis codes used for obese patient visits.

Methods: We analyzed 48 479 youth aged 2 to 18 years in 31 outpatient subspecialty clinics at Seattle Children's Hospital between 2005 and 2007. Body mass index (BMI) percentiles were determined by age- and gender-adjusted BMI calculated from height/weight obtained at clinic visits.

Family-centered care: current applications and future directions in pediatric health care.

Family-centered care (FCC) is a partnership approach to health care decision-making between the family and health care provider. FCC is considered the standard of pediatric health care by many clinical practices, hospitals, and health care groups. Despite widespread endorsement, FCC continues to be insufficiently implemented into clinical practice.

Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data.

Background: Children with lifelong chronic conditions (LLCC) are costly, of low prevalence, and a high proportion of patients at children's hospitals. Few methods identify these patients.

Objectives: We sought to identify children with LLCC in hospital discharge data for care coordination by using clinical risk groups (CRGs), to evaluate the accuracy of this methodology compared with a chart review and to investigate accuracy according to condition groups.

Care management for children with special needs: Part II: the role of primary care.

This study documents care management services in 2 pediatric clinics for children with or at risk for a chronic condition during 8 months in 2005. Patients were identified by the clinic staff from a list provided by the health plan of patients at risk for or with a chronic condition. Care management services were documented for 161 of 189 selected patients.

Care management for children with special needs: part I: the role of health plans.

This study documents screening methods and services provided by health plan case managers for high need children in a Washington State health plan. Enrollees were screened to identify 315 children who had or were at risk of developing a chronic condition and were high users of health services. From this group, 46 children/families could be contacted and needed case management.

Using medical billing data to evaluate chronically ill children over time.

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% (2,334) identified with a chronic condition status in year 1, 2002, and another 15.

Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.

Background: Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.

Methods: Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000.

The US smallpox vaccination program: a review of a large modern era smallpox vaccination implementation program.

We describe the US experience with a large-scale smallpox vaccination program in the modern era and quantify the anticipated and unanticipated local and systemic side-effects of smallpox vaccination. In addition, we review unexpected issues, such as the development of myopericarditis discovered during the implementation of this program. These results constitute the largest dataset of a vaccinia vaccination program utilizing calf-lymph derived New York City Board of Health strain vaccine (Dryvax, Wyeth) since the 1970s.

Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.

Objective: To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999.

Smallpox vaccine: problems and prospects.

Smallpox justifiably is feared because of its morbidity and mortality. Wide-spread population-level susceptibility to smallpox exists, and the only effective tool against the virus is a live, attenuated vaccine that is highly reactogenic and controversial. A significant minority of the population has contraindications that prevent preexposure use of this vaccine.

Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management.

Objective: To develop Clinical Risk Groups (CRGs), a claims-based classification system for risk adjustment that assigns each individual to a single mutually exclusive risk group based on historical clinical and demographic characteristics to predict future use of healthcare resources. STUDY DESIGN/DATA SOURCES: We developed CRGs through a highly iterative process of extensive clinical hypothesis generation followed by evaluation and verification with computerized claims-based databases containing inpatient and ambulatory information from 3 sources: a 5% sample of Medicare enrollees for years 1991-1994, a privately insured population enrolled during the same time period, and a Medicaid population with 2 years of data.

Results: We created a system of 269 hierarchically ranked, mutually exclusive base-risk groups (Base CRGs) based on the presence of chronic diseases and combinations of chronic diseases.

Hospital care for children and young adults in the last year of life: a population-based study.

Background: To help design population-based pediatric palliative care services, we sought to describe the hospital care received in the last year of life by children and young adults who died. We also determined the proportion with complex chronic conditions (CCCs) and tested whether the use of hospital services increased as the date of death drew nearer.

Methods: For all deaths occurring under 25 years of age from 1990 to 1996 in Washington State, USA, we linked death certificate information to hospital utilization records and analyzed the timing and duration of hospitalizations and the nature of hospital procedures during the year prior to death.

Smallpox vaccination: a review, part II. Adverse events.

Smallpox vaccination of health care workers, military personnel, and some first responders has begun in the United States in 2002-2003 as one aspect of biopreparedness. Full understanding of the spectrum of adverse events and of their cause, frequency, identification, prevention, and treatment is imperative. This article describes known and suspected adverse events occurring after smallpox vaccination.