Forskelle i praktiserende laegers anvendelse af International Classification for Primary Care-diagnoser. Inter- og intraobservationen
Engelsk titel: Differences in general practitioners' use of International Classification for Primary Care diagnoses. The inter and intraobserver variation
Läs online
Författare:
Schroll H
;
Stövring H
;
Kragstrup J
Email: hschroll@health.sdu.dk
Språk: Dan
Antal referenser: 9
Dokumenttyp:
Fallbeskrivning
UI-nummer: 03111625
Sammanfattning
Introduction: Some general practitioners code their patient contacts according to diagnosis. It is, however, not known to what extent different doctors use the same diagnosis in the same clinical situation, or whether the doctors use the same diagnosis next time they encounter the same clinical situation. Material and methods: Forty general practitioners trained in coding with the International Classification for Primary Care (ICPC) used diagnosis codes on ten written case stories. Four months later the doctors were asked to code the same case stories. The inter-observer variation was determined using percentage agreement in the diagnosis coding. Diagnoses for selected disorders were grouped in advance in bigger clinical units. The intra-observer variation was determined using percentage agreement as above and by means of Kappa analysis. Results: The inter-observer variation on single diagnosis was level 71%, by grouping the diagnoses the agreement increased to 84%, and on ICPC chapter level the agreement reached 94%. The intra-observer variation for the total group of doctors was small from first to second coding, but 25% of the doctors changed diagnosis from first to second coding. Discussion: The study showed that ICPC coding may be used in general practice but that the variation may be considerable on single diagnosis level. Grouping of the diagnoses or use of chapter diagnoses increase the reliability considerably. The study indicates that clear criteria (inclusion and exclusion criteria) for the diagnosis coding are needed.