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Improving inter-rater reliability by coding scheme reorganization: managing signs and symptoms
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
(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 [en]
Statistics, Data collection, Family practice, Observer variation, Signs and symptoms
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-89100OAI: oai:DiVA.org:liu-89100DiVA: diva2:606721
Available from: 2013-02-20 Created: 2013-02-20 Last updated: 2013-02-20
In thesis
1. On information quality in primary health care registries
Open this publication in new window or tab >>On information quality in primary health care registries
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:nbn:se:liu:diva-24499 (URN)6623 (Local ID)91-7373-612-0 (ISBN)6623 (Archive number)6623 (OAI)
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

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Petersson, HåkanGill, HansÅhlfeldt, Hans

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