ICD-11 Chapter 23 Field Trial pilot phase, Dr. Nenad Kostanjsek.

Report
Meeting on ICD-11 Chapter 23 Field Trial pilot phase
25-26 March 2013, Seoul, Korea
ICD-11Chapter 23
Field Trial pilot phase
Nenad Kostanjsek
Classifications, Terminologies, Standards (CTS)
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Draft program
Day 1. (Korean ICTM Working Group meeting)
 Review & discussion of overall FT pilot phase incl.
analysis plan
 Review & discussion of frequency analysis and draft
case summaries
 Review & discussion of procedure and instruments for
Study 1.Reliability and Feasibility
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Form I
Form J
Form E
PI Form
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Draft program
Day 2, FT site Kyung Hee University Hospital
 FT site coordinator(s) to familiarise group of selected
clinicians/coders (i.e. TM residents)
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Familiarization with ICD Chapter 23
Briefing on Study 1 instruments
Familiarization with interviewing techniques
 Coders perform Live case evaluations (which are video
recorded if possible)
 Coders perform CS evaluations
 Discussion and evaluation
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
ICD-11 Field Trials
 Basic aims
– To test the “fitness of ICD-11 for multiple purposes”
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Mortality coding
Morbidity coding
Other use cases
– To ensure the comparability between ICD-10 and ICD-11
– To increase consistency, identify improvement paths, and reduce errors
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Key Assessments:
• Applicability – feasibility
 easy to use
• Reliability - consistency
 gives same results in the hands of all
• Utility - added value
 renders useful information
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
ICD-11 Field Trials
 Applicability (Feasibility) –
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Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ?
 Utility –
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What is the value of the classification to enhancing data capture and its uses?
Does it improve recognition?
Does it serve for better documentation?
Does it enable re-use?
Does it guide better diagnosis?
Does it allow better resource allocation?
 Reliability –
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Is the classification used in the same manner by different users?
Do two different users code the same case with the same code?
What are the sources of discrepancy?
What are the factors to improve comparability and consistency?
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trial Studies
1. Core Studies (mandatory)
– Study One:
• Reliability & Feasibility
– Study Two:
• Bridge Coding
– Study Three:
• Basic Questions
2. Additional Studies
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e.g. testing index
| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trials
 KEY USES:
– Mortality: cause of death coding, verbal autopsy
– Morbidity: various morbidity codings – hospital discharge, DRG etc.
– Other uses
 DIFFERENT SETTINGS:
– Primary Care
• High-resource settings
• Low-resource settings
– General Health Care
• Specialty settings
– Research settings
• Use in population studies - epidemiology
• Use in clinical research
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Field Trials Chapter 23
Pilot Phase & Main Phase
 Pilot Phase is about testing the FT procedure and the
instruments and understand what works & what does
not work
 Things that don’t work in the pilot phase can be put
aside.
 Things that work in the pilot phase can be used in the
main phase
 Pilot Phase is conducted in selected countries, Main
Phase is implemented in multiple countires
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Management of FT pilot phase (1)
 FT Structure
– WHO
– Field Trial Centres
– Field Trial Sites
 Roles & Responsibilities
– Coder/rater
– FT site coordinator & assistant
– FT center coordinator & assistant
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Management of FT pilot phase (2)
 Data management
– Infrastructure
• (web-base software (multilingual) & Paper and pencil
– Workflow
• Entry, check/validation/submission
 Ethics review (e.g. WHO ERC, national ERC)
– Check requirements
– If review & clearance is needed stress that:
“in the FT we are capturing how clinician/raters represent their diagnosis
in ICD- 11 Chapter 23 codes. FT do not interfere with the diagnostic
procedure”
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Study 1: Inter-rater reliability
 The Case information
• Case Summaries (CS)
• Live Cases (LC)
• Other (e.g. Video Cases)
 Coded using ICD-11 Chapter
by at least two different
people
 Agreement rates measured
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Case Assessments can include
(simulate or real)…
 Patient history
 Tongue examination
 Pulse examinations
 Physical examinations
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea
Analysis
Case 1, 2, 3…
High
Agreement
 Level of agreement among
multiple raters
– Who agrees on what?
– Reason for disagreement
 Predictors of reliability
 Testing of hypothesis
 Data patterns
Low
Agreement
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| ICD-11 Ch. 23 FT pilot phase Meeting, 25-26 March 2013, Seoul, Korea

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