งานนำเสนอเรื่อง: "ICD-10-TM for PCU Implementation in Thailand"— ใบสำเนางานนำเสนอ:
1ICD-10-TM for PCU Implementation in Thailand POLAWAT Witoolkollachit, MD., M.Sc.(IT-M)Deputy director Tak Public Health office andBureau of Policy and StrategyMinistry of Public healthWANSA PAOIN, MD.,Phd.Faculty of Medicine, Thammasat University
2ICD Implementation in Thailand 1950 ICD-7 for mortality statistics1963 ICD-81980 ICD-91994 ICD-102005 ICD-10-TM (ICD-10 Thai Modification)
3Level of Health Service Providers University Hospitals(Teaching Hospital bed)Center and Provincial HospitalsCommunity HospitalsPrimary Care Units (PCUs)
4Primary Care Unit (PCU) Front liner health providers10,068 PCUs across the countryProvide preventive care and primary medical care3-5 employees/PCUsNurses, health workers and public health professionalsNO DOCTOR !!!619 Public’s Clinics in Bangkok
5First evaluation of ICD-10 coding quality in Primary care Unit Conducted in 2007Bureau of policy and Strategy , Ministry of Public Health collected individual patient data coded in ICD-10 from every PCU in the countryError rates 70-90%Most common type of error = Invalid codeSecond common type = Incorrect code when recheck with diagnosis
6Cause of error analysis round 1 No ICD books available in PCUThey use local Diagnosis Name = ICD ListNo training on ICD-coding for PCU staffThey ‘ve just select something in the list.
8Training of PCU staff Feedback from participants ICD full version is too complicated and too heavy !!We will hardly found cases to use those codes!! We have common patients with diarrhea, pharyngitis, diabetes mellitus, hypertension etc.Give me copies of ICD book set!!Give me more people to do ICD coding !!
9ICD-10-TM for PCU project Make ICD-10-TM easier for use in PCUReduce number of codes by analysis past usage and choose some codes that represent common diseases found in PCUEliminate complexityDagger – Asterisk systemHide and seek feature ( Chapter XIII site codes, etc.)Confusing code descriptionC Lips, unspecifiedShould be C00.9 Malignant neoplasm of lipNon user friendly words and symbolsE14.9 Unspecified Diabetes Mellitus
10Simplified ICD-10-TMDelete Category header together with some specific codeBecomeA00.9 Cholera
11Simplified ICD-10-TMReduce index termsInclude Self Directed Training book (How to code ICD-10- TM for PCU) in the book set
12ICD-10-TM Original PCU version ~35,000 codes 401 pages of index Dagger –asterisk systemAdditional codes (option)Complex words and symbols~ 1,900 codes123 pages of indexNo complicated featuresNo additional codingSimple words
17Implementation of ICD-10-TM for PCU Testing of beta version July 2009Finished first version August1st phase ImplementationSeptember - November 20092nd phase Implementation 20103rd phase Implementation 2012
23Coding Quality Audit Jan 2013 DistrictNameCoding ErrorAเมือง58.44%Bแม่สอด57.20%Cแม่ระมาด46.11%Dบ้านตาก39.90%Eวังเจ้า52.64%Fท่าสองยาง52.05%GสามเงาHพบพระ46.92%Iอุ้มผาง50.46%
24Type of Coding Errors A Incorrect Code (Compare to diagnosis word) B No diagnosis word to support the codeC Ambiguous Code (Silly Codes)(e.g. L02.9 Skin Abscess unknown location)D Incomplete Code (Loss of Final Digit)E Use External Cause as Principal DiagnosisF Code with Too much Digit (e.g. M130005)G Use ICD code instead of diagnosis word