ICD-11 Chapter 23 Field Trial pilot phase, Dr. Nenad Kostanjsek.
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Transcript ICD-11 Chapter 23 Field Trial pilot phase, Dr. Nenad Kostanjsek.
Meeting on ICD-11 Chapter 23 Field Trial pilot phase
25-26 March 2013, Seoul, Korea
ICD-11Chapter 23
Field Trial pilot phase
Nenad Kostanjsek
Classifications, Terminologies, Standards (CTS)
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Draft program
Day 1. (Korean ICTM Working Group meeting)
Review & discussion of overall FT pilot phase incl.
analysis plan
Review & discussion of frequency analysis and draft
case summaries
Review & discussion of procedure and instruments for
Study 1.Reliability and Feasibility
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Form I
Form J
Form E
PI Form
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Draft program
Day 2, FT site Kyung Hee University Hospital
FT site coordinator(s) to familiarise group of selected
clinicians/coders (i.e. TM residents)
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Familiarization with ICD Chapter 23
Briefing on Study 1 instruments
Familiarization with interviewing techniques
Coders perform Live case evaluations (which are video
recorded if possible)
Coders perform CS evaluations
Discussion and evaluation
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
ICD-11 Field Trials
Basic aims
– To test the “fitness of ICD-11 for multiple purposes”
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Mortality coding
Morbidity coding
Other use cases
– To ensure the comparability between ICD-10 and ICD-11
– To increase consistency, identify improvement paths, and reduce errors
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Key Assessments:
• Applicability – feasibility
easy to use
• Reliability - consistency
gives same results in the hands of all
• Utility - added value
renders useful information
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
ICD-11 Field Trials
Applicability (Feasibility) –
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Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ?
Utility –
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What is the value of the classification to enhancing data capture and its uses?
Does it improve recognition?
Does it serve for better documentation?
Does it enable re-use?
Does it guide better diagnosis?
Does it allow better resource allocation?
Reliability –
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Is the classification used in the same manner by different users?
Do two different users code the same case with the same code?
What are the sources of discrepancy?
What are the factors to improve comparability and consistency?
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trial Studies
1. Core Studies (mandatory)
– Study One:
• Reliability & Feasibility
– Study Two:
• Bridge Coding
– Study Three:
• Basic Questions
2. Additional Studies
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e.g. testing index
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trials
KEY USES:
– Mortality: cause of death coding, verbal autopsy
– Morbidity: various morbidity codings – hospital discharge, DRG etc.
– Other uses
DIFFERENT SETTINGS:
– Primary Care
• High-resource settings
• Low-resource settings
– General Health Care
• Specialty settings
– Research settings
• Use in population studies - epidemiology
• Use in clinical research
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trials Chapter 23
Pilot Phase & Main Phase
Pilot Phase is about testing the FT procedure and the
instruments and understand what works & what does
not work
Things that don’t work in the pilot phase can be put
aside.
Things that work in the pilot phase can be used in the
main phase
Pilot Phase is conducted in selected countries, Main
Phase is implemented in multiple countires
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Management of FT pilot phase (1)
FT Structure
– WHO
– Field Trial Centres
– Field Trial Sites
Roles & Responsibilities
– Coder/rater
– FT site coordinator & assistant
– FT center coordinator & assistant
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Management of FT pilot phase (2)
Data management
– Infrastructure
• (web-base software (multilingual) & Paper and pencil
– Workflow
• Entry, check/validation/submission
Ethics review (e.g. WHO ERC, national ERC)
– Check requirements
– If review & clearance is needed stress that:
“in the FT we are capturing how clinician/raters represent their diagnosis
in ICD- 11 Chapter 23 codes. FT do not interfere with the diagnostic
procedure”
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Study 1: Inter-rater reliability
The Case information
• Case Summaries (CS)
• Live Cases (LC)
• Other (e.g. Video Cases)
Coded using ICD-11 Chapter
by at least two different
people
Agreement rates measured
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Case Assessments can include
(simulate or real)…
Patient history
Tongue examination
Pulse examinations
Physical examinations
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Analysis
Case 1, 2, 3…
High
Agreement
Level of agreement among
multiple raters
– Who agrees on what?
– Reason for disagreement
Predictors of reliability
Testing of hypothesis
Data patterns
Low
Agreement
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea