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

IOS Press

Año: 2018

0926-9630

Introduction: There are several ways to codify medicalproblems in primary care. ICPC was developed as anepidemiological tool for use by primary care providerduring the consultation as a primary decentralized codingsystem. In practice however this is difficult to se up, so weapply ICPC in a secondary centralized coding system by alimited number of non medical coders.Objectives: To assess the reliability of secondary centralcoding of medical problems by trained medical studentsand nurses using ICPC.Material and Methods: All medical problems in our adultpopulation recorded by primary care physicians in aelectronic medical record system as narrative text arecentralized coded by trained medical students and nurses.Use of the electronic medical record by physicians is notcompulsive but is strongly encouraged. A random sampleof 300 medical problems were selected for intra-coderreliability by asking coders to blindly re-code the free textand comparing it with the previous coding, and for intercoderreliability by comparison with a group of expertphysicians. Percentage of agreement and Kappa statisticwas calculated at chapter and rubric levels. The codingcentre was treated as a single observer, as the objectivewas to assess the system reliability and not observersthemselves.Results: In the last two years 164,745 medical problemswere codified in 45,365 adult patients (mean 3.63 problemsDS: 2.69). Intra-coder agreement at chapter level was:97,7 % (Kappa: 0,97; p