COE4CCN Consensus Definitions of 3 Levels of Medical Complexity

Condition Description Potential Example a
Children with C-CD a
Significant chronic conditions in ≥2 body systems:Type 1 diabetes and static encephalopathy; type 1 diabetes and depression; developmental delay and chronic pulmonary conditions
Significant chronic condition is defined as a physical, mental or developmental condition that can be expected to last at least a year, will use health care resources above the level for a healthy child, require treatment of control of the condition, and the condition can be expected to be episodically or continuously debilitating.
Body systems include: cardiac, craniofacial, dermatologic, endocrinologic, gastrointestinal, genetic, genitourinary, hematologic, immunologic, mental health, metabolic, musculoskeletal, neurologic, ophthalmologic, otologic, pulmonary/respiratory, and renal.
ORA progressive condition that is associated with deteriorating health with a decreased life expectancy in adulthood.Muscular dystrophy, cystic fibrosis, paraplegia, quadriplegia, malignancy
ORContinuous dependence on technology for at least 6 months.Tracheostomy ± ventilator assistance, renal dialysis, gastrostomy tube, cerebrospinal fluid shunt
ORMalignancies: progressive or metastatic malignancies that affect life function. Exclude those in remission for >5 years.Lymphoma, leukemia, brain tumor
Children with NC-CD
Chronic conditions that last at least 1 year: These conditions are commonly lifelong but can be episodic with periods of good health between episodes. They include physical, developmental, or mental health conditions that may persist into adulthood but may also resolve either secondary to the natural history of the disease or as a result of surgical intervention. These conditions involve a single body system, are not progressive, can vary widely in severity, and result in highly variable health care utilization.Type 1 diabetes, atrial septal defect, asthma, depression, attention-deficit/hyperactivity disorder
Children without CD
Acute nonchronic conditions: A physical, developmental or mental health condition that is not expected to last >1 year. These children may temporarily (for <1 year) use health care resources above the normal level for a healthy child.Ear infection, pneumonia, diarrhea and dehydration, bronchiolitis
Healthy: No acute or chronic health conditions. These children do not use health care resources above the normal level for a healthy child.NA
  • NA, not applicable.

  • a The examples used in this document to illustrate definitions of medical complexity and chronicity are intended to demonstrate characteristics specified in the definition/descriptions. It is not our intention to imply that specific diseases and conditions are by default linked to the categories that they were used to illustrate.