Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics
Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics
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DOI：
10.1093/ije/29.2.336
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发表时间：
2000-04-01
影响因子：
7.7
通讯作者：
Chou, MC
中科院分区：
文献类型：
--
作者：
Lu, TH;Lee, MC;Chou, MC
摘要本研究的目的是评估死因编码的准确性，确定编码员遵守《国际疾病分类》第九版（ICD-9）编码选择规则的程度，以及错误编码对台湾死亡率统计的影响。方法系统抽取5621份死亡证明进行复核。将审稿人为每个死亡证明选择的潜在死因（UCD）与原始编码器选择的死因进行比较。根据ACME（医疗实体自动分类）决策表选择UCD。结果审稿人与编码员对ICD-9三位数和两位数分类的总体符合率分别为80.9%和83.9%。恶性肿瘤（kappa = 0.94）、损伤和中毒（kappa = 0.97）的一致性较好，但肾病（kappa = 0.74）、高血压相关疾病（kappa = 0.74）和脑梗死（kappa = 0.77）的一致性较差。产生分歧的原因包括命名法不一致（42.8%）、对因果关系判断不当（41.5%）、对选择规则3和修改规则的解释不正确（15.7%）。结论本研究显示审稿人与原编码器在选择UCD时对不同疾病有不同程度的一致。由于“误差补偿效应”，全国死亡率统计数据没有受到显著影响。国家行政部门应进行例行的内部研究，以控制UCD编码实践的质量。
Background The objectives of this study were to assess the accuracy of cause-of-death coding, determine the extent to which coders follow the selection rules of coding set out in the International Classification of Diseases, 9th Revision (ICD-9), and the effects of miscoding on mortality statistics in Taiwan.Method A systematic sample of 5621 death certificates was reviewed. The underlying cause of death (UCD) selected by the reviewer for each death certificate was compared with that selected by the original coder. The UCD was selected according to ACME (Automated Classification of Medical Entities) Decision Tables.Results The overall agreement rates between the reviewer and coders according to the three-digit and two-digit categories of ICD-9 were 80.9% and 83.9%, respectively. Good agreement was found for malignant neoplasms (kappa = 0.94) and injuries and poisoning (kappa = 0.97), but there was poor agreement for nephrotic dis eases (kappa = 0.74), hypertension-related diseases (kappa = 0.74), and cerebral infarction (kappa = 0.77). Reasons for disagreements included disagreement in nomenclature (42.8%), inappropriate judgement of causal relationships (41.5%), and incorrect interpretation of Selection Rule 3 and Modification Rules (15.7%).Conclusion This study showed various levels of agreement for different diseases between the reviewer and the original coders in selection of the UCD. Owing to the 'compensatory effect of errors', the national mortality statistics were not affected significantly. The national administration should undertake routine internal studies to control the quality of UCD coding practices.