Factors affecting the quality of diagnosis coding data with a triangulation view: A qualitative study.

Abstract

The most important challenge in utilizing medical record codes is the quality of coding data. The present study aims to investigate factors affecting the quality of diagnosis coding from different aspects covering different stakeholders in a multi-dimensional approach. First, we used Conventional Content Analysis to maximally gather all effective factors. As such, semi-structured interviews were conducted with medical record coders (N=32) at the referral hospitals in Mashhad, Iran. Second, 86 hospital staff members from 25 provinces were surveyed using a web-based questionnaire. Finally, a focus group discussion was conducted among coders (N=18) in different hospitals across the country. In general, the barriers to quality of inpatient record coding can be classified into three categories: (I) physician-related, (II) coder-related, and (III) managerial, financial and administrative factors. A triangulation view (related to coders, physicians as well as managerial, financial and administrative dimensions) could be used to identify the barriers affecting the quality of diagnosis coding data. The results of this study may help policymakers in development and implementation of appropriate strategies and effective interventions to improve the quality of clinical coding.