Reliability diagnoses coding with ICD-10
Reliability diagnoses coding with ICD-10
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DOI：
10.1016/j.ijmedinf.2006.11.005
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发表时间：
2008-01-01
影响因子：
4.9
通讯作者：
Stein, Markus
中科院分区：
文献类型：
--
作者：
Stausberg, Juergen;Lehmann, Nils;Stein, Markus
目标：诊断编码的可靠性对于国家医疗保健系统中常规数据的使用至关重要。本次调查比较了三组编码受试者之间用ICD-10进行诊断编码的可靠性。方法：118名学生编码了15份诊断清单，27名医院的医疗管理人员编码了34份出院信，13名专家编码了12份出院信。使用 Cohen 的 Kappa 以及与先前开发的测量 p(om) 的全套诊断的配对数量的重合分数来评估主要诊断的一致性。结果：对于终端代码，Kappa 值是公平的（经理）或中等（编码器）为 0.27 和 0.42（一致性为 29.2% 与 46.8%），对于章节级别来说相当重要，为 0.71 和 0.72 （协议 78.3% 与 80.8%）。全套诊断的 p(om) 低于主要诊断，例如，终端代码为 0.21 的管理器与 0.29 的管理器相比。学生编写诊断列表取得了最佳结果。总之，结果明显低于早期出版物。结论：ICD-10 的细化伴随着无数编码规则建立了一个复杂的环境，即使对于专家来说也会导致很大的不确定性。将编码数据用于质量管理、医疗保健融资和医疗保健政策需要对 ICD-10 进行显着简化，以获得医疗保健现实的有效图像。 (c) 2006 Elsevier Ireland Ltd. 保留所有权利。
Objective: Reliability of diagnoses coding is essential for the use of routine data in a national health care system. The present investigation compares reliability of diagnoses coding with ICD-10 between three groups of coding subjects.Method: One hundred and eighteen students coded 15 diagnoses lists, 27 medical managers from hospitals 34 discharge letters, and 13 coding specialists 12 discharge letters. Agreement in principal diagnosis was assessed using Cohen's Kappa and the fraction of coincidences over the number of pairs agreement for the full set of diagnoses with a previously developed measure p(om).Results: Kappa values were fair (managers) or moderate (coders) for terminal codes with 0.27 and 0.42 (agreement 29.2% versus 46.8%), substantial for the chapter level with 0.71 and 0.72 (agreement 78.3% versus 80.8%). p(om) was lower for the full set of diagnoses than for principal diagnoses, for example in case of managers with 0.21 versus 0.29 for terminal codes. Best results were achieved by students coding diagnoses lists. In summary, the results are remarkably lower than in earlier publications.Conclusion: The refinement of the ICD-10 accompanied by innumerous coding rules has established a complex environment that leads to significant uncertainties even for experts. Use of coded data for quality management, health care financing, and health care policy requires a remarkable simplification of ICD-10 to receive a valid image of health care reality. (c) 2006 Elsevier Ireland Ltd. All rights reserved.