Reliability of Secondary Central Coding of Medical Problems in Primary Care by Non-medical Coders, using the International Classification of Primary Care (ICPC)

LUNA, DANIEL R.; GONZÁLEZ, B. DE QUIRÓS F.; GARFI, LEONARDO; SORIANO, ENRIQUE; FLAHERTY, MARTIN

Studies In Health Technology And Informatics

Hospital Italiano de Buenos Aires

Año: 2001

0926-9630

Introduction: There are several ways to codify medical problems in primary care. ICPC was developed as an epidemiological tool for use by primary care provider during the consultation as a primary decentralized coding system. In practice however this is difficult to se up, so we apply ICPC in a secondary centralized coding system by a limited number of non medical coders. Objectives: To assess the reliability of secondary central coding of medical problems by trained medical students and nurses using ICPC. Material and Methods: All medical problems in our adult population recorded by primary care physicians in a electronic medical record system as narrative text are centralized coded by trained medical students and nurses. Use of the electronic medical record by physicians is not compulsive but is strongly encouraged. A random sample of 300 medical problems were selected for intra-coder reliability by asking coders to blindly re-code the free text and comparing it with the previous coding, and for inter-coder reliability by comparison with a group of expert physicians. Percentage of agreement and Kappa statistic was calculated at chapter and rubric levels. The coding centre was treated as a single observer, as the objective was to assess the system reliability and not observers themselves. Results: In the last two years 164,745 medical problems were codified in 45,365 adult patients (mean 3.63 problems DS: 2.69). Intra-coder agreement at chapter level was: 97,7 % (Kappa: 0,97; p