Research

Training and support to improve ICD coding quality: A controlled before-and-after impact evaluation

Robin Dyers, Grant Ward, Shane du Plooy, Stephanus Fourie, Juliet Evans, Hassan Mahomed

Abstract


Background. The proposed National Health Insurance policy for South Africa (SA) requires hospitals to maintain high-quality International Statistical Classification of Diseases (ICD) codes for patient records. While considerable strides had been made to improve ICD coding coverage by digitising the discharge process in the Western Cape Province, further intervention was required to improve data quality. The aim of this controlled before-and-after study was to evaluate the impact of a clinician training and support initiative to improve ICD coding quality.

Objective. To compare ICD coding quality between two central hospitals in the Western Cape before and after the implementation of a training and support initiative for clinicians at one of the sites.

Methods. The difference in differences in data quality between the intervention site and the control site was calculated. Multiple logistic regression was also used to determine the odds of data quality improvement after the intervention and to adjust for potential differences between the groups.

Results. The intervention had a positive impact of 38.0% on ICD coding completeness over and above changes that occurred at the control site. Relative to the baseline, patient records at the intervention site had a 6.6 (95% confidence interval 3.5 - 16.2) adjusted odds ratio of having a complete set of ICD codes for an admission episode after the introduction of the training and support package. The findings on impact on ICD coding accuracy were not significant.

Conclusion. There is sufficient pragmatic evidence that a training and support package will have a considerable positive impact on ICD coding completeness in the SA setting.


Authors' affiliations

Robin Dyers, Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Western Cape Government: Health, Cape Town, South Africa

Grant Ward, Western Cape Government: Health, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Shane du Plooy, Western Cape Government: Health, Cape Town, South Africa

Stephanus Fourie, Western Cape Government: Health, Cape Town, South Africa

Juliet Evans, Western Cape Government: Health, Cape Town, South Africa

Hassan Mahomed, Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Western Cape Government: Health, Cape Town, South Africa

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Keywords

ICD coding; NHI; National Health Insurance; Discharge summary; Discharge process; Inpatient; Electronic discharge record; Hospital; Impact evaluation; Difference in differences; Western Cape; South Africa

Cite this article

South African Medical Journal 2017;107(6):501-506. DOI:10.7196/SAMJ.2017.v107i6.12075

Article History

Date submitted: 2017-05-24
Date published: 2017-05-24

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