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On information quality in primary health care registries
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Data compilation has a long history in the field of medicine, and domains for which data are pooled include, among others, epidemiological studies and quality assessment. Unfortunately, data may be of low quality with poor validity and reliability, and consequently, decisions based on statistics may be unreliable. The range of applications of information use and reuse is expected to extend from aggregation of information to retrieval of specific cases, which further emphasizes the importance of high quality data. The present thesis deals with aspects of information quality in Swedish primary health care registries. Such information is commonly encoded according to standardized coding systems.

In order to improve coding quality, it is necessary to study the content, structure, and semantics of the coding systems, as well as the functionality of the tools used to access them. In particular, the thesis discusses the effect of the coding system structure - as an instrument for code retrieval as well as data aggregation - on the reliability of coding. In summary, the functionality of a tool that supports coding of medical problems must meet numerous requirements. Flexible structures for browsing the coding system and different types of lexical tools are needed, as are rules for guiding the correct choice of code with respect to a particular medical problem. As an instrument for data compilation, the structure of the coding system may support aggregation in ways that reflect dimension with low variability.

The main contribution of this thesis is to increase understanding of the complexity of disease concepts and the coding systems used for representing them. In addition, it also encompasses the measurements of reliability in coded Swedish primary health care data that were carried out in both a smaller prospective and a larger retrospective study. Further, the thesis proposes a metric for retrospective reliability studies. Finally, the presented coding tool - the Classification Browser - is in itself a platform for further discussion and development in the domain of diagnostic coding.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 65 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 805
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24499Local ID: 6623ISBN: 91-7373-612-0 (print)OAI: oai:DiVA.org:liu-24499DiVA: diva2:244820
Public defence
2003-04-11, Patologsalen, Universitetssjukhuset, Linköping, 09:15 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-02-20
List of papers
1. Semantic modeling of a traditional classification: results and implications
Open this publication in new window or tab >>Semantic modeling of a traditional classification: results and implications
Show others...
1998 (English)In: Medinfo ‘98: Proceedings of the Ninth World Congress on Medical Informatics / [ed] Cesnik, B., McCray, A.T., Scherrer, J.-R., Australia: IOS Press , 1998, 613-617 p.Conference paper, Published paper (Refereed)
Abstract [en]

A primary health care version of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), together with a three-dimensional model for classification of diseases according to locations, origin, and type has been semantically represented. The resulting computer-based version is made available via the World Wide Web.

Place, publisher, year, edition, pages
Australia: IOS Press, 1998
Series
Studies in Health Technology and Informatics, 52
Keyword
informations systems, diagnosis classification, primary health care, medical informatics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29900 (URN)15322 (Local ID)978-90-5199-407-0 (ISBN)15322 (Archive number)15322 (OAI)
Conference
MEDINFO '98, 9th World Congress on Medical Informatics, 1998 August 18-22, Seoul, South Korea
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2013-02-20
2. Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic codig
Open this publication in new window or tab >>Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic codig
2002 (English)In: Yearbook of Medical Informatics, 377-383 p.Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24555 (URN)6717 (Local ID)6717 (Archive number)6717 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-02-20
3. The connection between terms used in medical records and coding system: a study on Swedish primary health care data
Open this publication in new window or tab >>The connection between terms used in medical records and coding system: a study on Swedish primary health care data
2001 (English)In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 26, no 2, 87-99 p.Article in journal (Refereed) Published
Abstract [en]

Implementation of problem lists and their relation to standardized coding systems have been approached and analysed in different ways. Most evaluations concern quantitative aspects such as content coverage in a specific domain. In order to reveal the qualitative aspects of diagnostic coding, medical record texts from primary health care encounters were compared with terms from a coding system that was used for describing them statistically. The records were coded by six general practitioners, and in some cases, an applied diagnostic term was found within the text, while other record text-coding system relationships were categorized as synonyms, alternative terms, and interpretations. Thus, the categories roughly corresponded to a measure of semantic distance between the terms in the record text and the rubrics of the coding system, and there was a correlation between semantic distance and inter-rater agreement. The subcategories of this scheme corresponded fairly well to recently published desiderata for clinical terminology servers, including functionality such as word normalization and spelling correction. However, not all problems could have been automatically coded by means of lexical methods, which can be partly explained by the fact that diagnostic coding also relies on clinical knowledge. In addition, proper automation relies on context representation within the records.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29002 (URN)11560294 (PubMedID)14235 (Local ID)14235 (Archive number)14235 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2013-02-20
4. A variance-based measure of inter-rater agreement in medical databases
Open this publication in new window or tab >>A variance-based measure of inter-rater agreement in medical databases
2002 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 35, no 5-6, 331-342 p.Article in journal (Refereed) Published
Abstract [en]

The increasing use of encoded medical data requires flexible tools for data quality assessment. Existing methods are not always adequate, and this paper proposes a new metric for inter-rater agreement of aggregated diagnostic data. The metric, which is applicable in prospective as well as retrospective coding studies, quantifies the variability in the coding scheme, and the variation can be differentiated in categories and in coders. Five alternative definitions were compared in a set of simulated coding situations and in the context of mortality statistics. Two of them were more effective, and the choice between them must be made according to the situation. The metric is more powerful for larger numbers of coded cases, and Type I errors are frequent when coding situations include different numbers of cases. We also show that it is difficult to interpret the meaning of variation when the structures of the compared coding schemes differ.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24560 (URN)10.1016/S1532-0464(03)00036-4 (DOI)6722 (Local ID)6722 (Archive number)6722 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-02-20
5. Improving inter-rater reliability by coding scheme reorganization: managing signs and symptoms
Open this publication in new window or tab >>Improving inter-rater reliability by coding scheme reorganization: managing signs and symptoms
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this paper is to study the potential for improving inter-rater reliability in general practice registries through the use of a semantic terminology model that enables diagnostic labels to be separated into symptoms and diseases, i.e. into different levels of diagnostic precision. Cases coded as symptoms according to the ICD-based coding system currently in use in Swedish general practice were reclassified with the help of the model, and inter-rater variability was measured through divergences of observed coding distributions from expected distributions. 40 percent of the symptom cases were candidates for reclassification; half of these could actually be reclassified. This decreased inter-rater variability, but the difference was not statistically significant. Diagnostic categories with large variation in utilization rates were foWld, which calls for careful selection of topics for medical audit. Although reclassification of symptoms may improve reliability, no straightforward association was found between a chapter's diagnostic precision and its contribution to overall variability. Nor could differences in diagnostic precision explain all variation within a chapter. Further research on other dimensions of the coding system is needed before symptom reclassification can be recommended as a general reliability-improving tool.

Keyword
Statistics, Data collection, Family practice, Observer variation, Signs and symptoms
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-89100 (URN)
Available from: 2013-02-20 Created: 2013-02-20 Last updated: 2013-02-20

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Petersson, Håkan

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