The Paediatric Outpatient Coding Pilot Study
Kerr, Neal Alexander Moealia
In New Zealand, recent literature would suggest that children with chronic health conditions and disabilities, and their families are in need of greater support. The primary aims of this thesis were to; determine whether the information currently available on these children was sufficient for service planning; explore the options for information collection; assess whether paediatric outpatient diagnostic coding could be used to inform planning and funding decisions for this group. These aims were addressed by examination of the national information sources on children with chronic health conditions and disabilities and assessing their ability to inform population Health Needs Assessment for service planning within District Health Boards. The data within the National Non-Admitted Patient Collection was then analysed in detail to determine whether it could yield findings on children with chronic health conditions and disabilities useful for service planning. Finally, a pilot study was undertaken to determine whether clinician based diagnostic coding of paediatric outpatient services comparing the use of ICD-10-AM and SNOMED-CT to yield data on these children is suitable for service planning and funding decisions. Review of the available information on children with chronic health conditions and disabilities in New Zealand confirmed that these children and their families are in need of greater support but that there are no sources currently in use which are suitable to inform service planning and funding decisions at the local District Health Board level (e.g. Timely, Comprehensive, Consistent, Regionally Specific, Diagnostically Defined and with associated Demographic Elements). The National Non-Admitted Patient Collection was shown to have many of the elements required to inform planning and funding decisions but lacked diagnostic information. Preliminary analysis of the Paediatric Outpatient Coding Pilot Study findings from the Southern District Health Board indicated that on average clinician based coding was faster with SNOMED-CT (1.1minutes) per visit than ICD-10-AM (1.6 minutes) or than Trained Clinical Coders using ICD-10-AM (3.1 minutes). Trained Clinical Coders using ICD-10-A M were able to assign diagnostic codes to the most common conditions more consistently than clinicians using ICD-10-AM or SNOMED-CT. Overall, 85 percent of participating clinicians either supported or strongly supported the national routine collection of paediatric outpatient diagnostic codes. A number of conclusions were evident from the research. The information currently available on children with chronic health conditions and disabilities is adequate to demonstrate that they need greater support. However, the information is not sufficient to inform local service planning to address this need. The preliminary findings of the Paediatric Outpatient Coding Pilot Study would suggest that, with further development in IT systems particularly, paediatric outpatient diagnostic coding combined with the National Non-Admitted Patient Collection, would constitute an ideal approach to capturing information on children with chronic health conditions and disabilities suitable to inform planning of local and national level health support services.
Advisor: Craig, Elizabeth; McDonald, Gabrielle
Degree Name: Bachelor of Medical Science with Honours
Degree Discipline: Women's and Children's Health
Publisher: University of Otago
Research Type: Thesis