Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
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DOI：
10.1542/hpeds.2016-0173
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发表时间：
2017-07-01
影响因子：
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通讯作者：
Mangione-Smith, Rita
中科院分区：
文献类型：
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作者：
Simon, Tamara D;Cawthon, Mary Lawrence;Mangione-Smith, Rita
背景和目的：儿科医疗复杂性算法（PMCA）是为了按医疗复杂性水平对儿童进行分层而开发的。我们试图完善PMCA和评估其性能的基础上的持续时间的资格和完整性的Medicaid data.METHODS：PMCA版本1.0被应用到一个队列的299名儿童投保的华盛顿州医疗补助与≥1西雅图儿童医院门诊，急诊科，和/或住院遇到在2012年。通过使用病历对验证队列的PMCA类别进行盲态评估。对不一致病例进行了深入审查，并为PMCA版本2.0的开发提供了信息。PMCA 2.0版的敏感性和特异性进行了评估。结果：使用医疗补助数据，PMCA 2.0版的敏感性为74%的复杂的慢性疾病（C-CD），60%的非复杂的慢性疾病（NC-CD），和87%的那些没有慢性疾病（CD）。所有3组的医疗补助数据的特异性为84%至91%。医疗补助数据是最完整的儿童，主要是收费服务索赔和不完整的那些与一些管理式护理遇到的数据。PMCA 2.0版在儿童有较长的覆盖时间时表现最佳（25至36个月），诊断C-CD儿童的灵敏度为85%，特异性为75%，诊断NC-CD儿童的灵敏度为55%，特异性为88%，诊断非CD儿童的灵敏度为100%，特异性为97%。PMCA 2.0版识别C-CD儿童具有良好的敏感性和非常好的特异性时，应用于医疗补助数据。数据质量是使用PMCA时的关键考虑因素。
BACKGROUND AND OBJECTIVES: The Pediatric Medical Complexity Algorithm (PMCA) was developed to stratify children by level of medical complexity. We sought to refine PMCA and evaluate its performance based on the duration of eligibility and completeness of Medicaid data.METHODS: PMCA version 1.0 was applied to a cohort of 299 children insured by Washington State Medicaid with ≥1 Seattle Children's Hospital outpatient, emergency department, and/or inpatient encounter in 2012. Blinded assessment of the validation cohort's PMCA category was performed by using medical records. In-depth review of discrepant cases was performed and informed the development of PMCA version 2.0. The sensitivity and specificity of PMCA version 2.0 were assessed.RESULTS: Using Medicaid data, the sensitivity of PMCA version 2.0 was 74% for complex chronic disease (C-CD), 60% for noncomplex chronic disease (NC-CD), and 87% for those without chronic disease (CD). Specificity was 84% to 91% in Medicaid data for all 3 groups. Medicaid data were most complete for children that had primarily fee-for-service claims and were less complete for those with some managed care encounter data. PMCA version 2.0 performed optimally when children had a longer duration of coverage (25 to 36 months) with fee-for-service reimbursement, identifying children with C-CD with 85% sensitivity and 75% specificity, children with NC-CD with 55% sensitivity and 88% specificity, and children without CD with 100% sensitivity and 97% specificity.CONCLUSIONS: PMCA version 2.0 identifies children with C-CD with good sensitivity and very good specificity when applied to Medicaid data. Data quality is a critical consideration when using PMCA.