Abstract
BackgroundDiagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration. The primary aim of this study was to determine the views and perspectives of chiropractors about diagnostic coding and explore the use of it in a chiropractic setting. A secondary aim was to compare the diagnostic coding undertaken by chiropractors and an independent coder.MethodA codin exercise based on the International Classification of Primary Care version 2, PLUS extension (ICPC-2 PLUS) provided the 14 chiropractors with some experience in diagnostic coding, followed by an interview on the topic. The interviews were analysed thematically. The participating chiropractors and an independent coder applied ICPC-2 PLUS terms to the diagnoses of 10 patients. Then the level of agreement between the chiropractors and the coder was determined and Cohen’s Kappa was used to determine the agreement beyond that expected by chance.ResultsFrom the interviews the three emerging themes were: 1) Advantages and disadvantages of using a clinical coding system in chiropractic practice, 2) ICPC-2 PLUS terminology issues for chiropractic practice and 3) Implementation of a coding system into chiropractic practice. The participating chiropractors did not uniformly support or condemn the idea of using diagnostic coding. However there was a strong agreement that the terminology in ICPC-2 PLUS would not be applicable or desirable for all practice types. In the coding exercise the chiropractors in total coded 202 diagnoses for 135 patients. The overall percentage agreement between the chiropractors and the coder was 52% (17% expected by chance) with a Kappa score of 0.4 (95% CI 0.3-0.7). Agreement was lower for more detailed coding (percentage agreement 35%; Kappa score of 0.3 (95% CI 0.2-0.5)).ConclusionIt appears that implementation of diagnostic coding would be possible in the majority of the chiropractic practices that participated in this study. However for those chiropractors who do not focus on symptoms in their approach to clinical care, it could be challenging to use the ICPC-2 PLUS coding system, since ICPC-2 PLUS is a symptom-based classification.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-015-0051-1) contains supplementary material, which is available to authorized users.
Highlights
Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration
Agreement was lower for more detailed coding (percentage agreement 35%; Kappa score of 0.3). It appears that implementation of diagnostic coding would be possible in the majority of the chiropractic practices that participated in this study
For those chiropractors who do not focus on symptoms in their approach to clinical care, it could be challenging to use the International Classification of Primary Care (ICPC)-2 PLUS coding system, since ICPC-2 PLUS is a symptom-based classification
Summary
Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration. The primary aim of this study was to determine the views and perspectives of chiropractors about diagnostic coding and explore the use of it in a chiropractic setting. Diagnostic coding in chiropractic practice has several potential benefits These benefits include improving the feasibility of data collection for research and clinical audits, improving the clinical applicability of research, and providing a common clinical language to help improve. The International Classification of Primary Care (ICPC) is an example of a diagnostic coding system that could be relevant for chiropractic practice [2]. A second version of the diagnostic code system, International Classification of Primary Care, Version 2 (ICPC-2), was published in 1998. ICPC has gradually received increasing recognition and use, especially in Europe and Australia [2]
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