Pennsylvania — Targeted Issue

Creating a Diagnosis Grouping System for Child Emergency Department Visits

March 1, 2004 - Feb. 28, 2007

Grant Number

H34MC02547

Project Overview

Creating a taxonomy and general severity of illness and injury system for EMSC is a research priority, yet no such system exists. Standard systems must be available to assess quality of emergency care across settings, patient populations and practitioners.
The goals of this project are to (1) create taxonomy of disease for EMSC, titled the Diagnosis Grouping System (DGS), which will group ICD-9 diagnoses into clinically sensible categories for research and reporting; (2) create a Severity of Illness Classification System (SCS) by stratifying ICD-9 diagnoses in each DGS Group into severity categories and examine the relationship between severity and resource use; and (3) evaluate the DGS and SCS by applying it to external data sets to ensure the system is applicable to data sets routinely used by EMSC researchers, clinicians, policy makers, and administrators.

Institution

Children's Hospital of Philadelphia

Main Contact

Evaline Alessandrini, MD

Award Amount

$437,422

Contacts

Name	Role(s)	Phone	Email
Evaline Alessandrini, MD	Principal Investigator

Disseminations

Title	Type	Publication/Event	Published/Presented	Identifier	Details
Developing a diagnosis-based severity classification system for use in emergency medical services for children	Research Paper/Publication	Academic Emergency Medicine	2012	PMID: 22251193	Developing a diagnosis-based severity classification system for use in emergency medical services for children Author(s)/Presenter(s) Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Holubkov R, Gorelick MH; Pediatric Emergency Care Applied Research Network Abstract/Description OBJECTIVES: Lack of adequate risk adjustment methodologies has hindered the progress of emergency medicine health services research. The authors hypothesized that a consensus-derived, diagnosis-based severity classification system (SCS) would be significantly associated with actual measures of emergency department (ED) resource use and could ultimately be used to examine severity-adjusted outcomes across patient populations. METHODS: A panel of subject matter experts used consensus methods to assign severity scores (1 = lowest severity to 5 = highest severity) to 3,041 ED International Classifications of Diseases (ICD), 9th revision, diagnosis codes. SCS scores were assigned to ED visits using the visit diagnosis code with the highest severity. We tested the association between the SCS scores and measures of ED resource use in three data sets: the Pediatric Emergency Care Applied Research Network Core Data Project (PCDP), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Connecticut state ED data set. RESULTS: There was a significant association between the five-level SCS and all six measures of resource use: triage category, disposition, ED resource use, Current Procedural Terminology Evaluation and Management (CPT E&M) codes, ED length of stay, and ED charges within the three ED data sets. CONCLUSIONS: The SCS demonstrates validity in its strong association with actual ED resource use. The use of readily available ICD-9 diagnosis codes makes the SCS useful as a risk adjustment tool for health services research. View On Pub Med
A new diagnosis grouping system for child emergency department visits	Research Paper/Publication	Academic Emergency Medicine	2010	PMID: 20370751	A new diagnosis grouping system for child emergency department visits Author(s)/Presenter(s) Alessandrini, E. A., E. R. Alpern, J. M. Chamberlain, J. A. Shea and M. H. Gorelick Abstract/Description Objectives: A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type. Methods: A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP). Results: A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity. Conclusions: The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning. View On Pub Med