Identification of root causes of clinical coding problems in Iranian hospitals

2021 ◽  
pp. 183335832110604
Author(s):  
Mohamad Jebraeily ◽  
Jebraeil Farzi ◽  
Shahla Fozoonkhah ◽  
Abbas Sheikhtaheri
Keyword(s):  
Medical Records ◽  
Working Environment ◽  
Clinical Documentation ◽  
Clinical Coding ◽  
Staff Support ◽  
Hospital Managers ◽  
Coding Quality ◽  
Support Tools ◽  
Cause And Effect Diagram

Background Improving the quality of coded data requires the identification and evaluation of the root causes of clinical coding problems to inform appropriate solutions. Objective The objective of this study was to identify the root causes of clinical coding problems. Method Twenty-one clinical coders from three cities in Iran were interviewed. The five formal categories in Ishikawa's cause-and-effect diagram were applied as pre-determined themes for the data analysis. Results The study indicated 16 root causes of clinical coding problems in the five main themes: (i) policies, protocols, and processes (lack of clinical documentation guidelines; lack of audit of clinical coding and feedback to clinical coders; the long interval between documentation and clinical coding; and not using coded data for reimbursement; (ii) individual factors (shortage of clinical coders; low-skilled clinical coders; clinical coders' insufficient communication with physicians; and the lack of continuing education; (iii) equipment and materials (incomplete medical records; lack of access to electronic medical records and electronic coding support tools; (iv) working environment (lack of an appropriate, dynamic, and motivational workspace; and (v) management factors (mangers' inattention to the importance of coding and clinical documentation; and to providing the required staff support. Conclusion The study identified 16 root causes of clinical coding problems that stand in the way of clinical coding quality improvement. Implications The quality of clinical coding could be improved by hospital managers and health policymakers taking these problems into account to develop strategies and implement solutions that target the root causes of clinical coding problems.

Hospital Information Systems Replacement and Healthcare Quality

2012 ◽  
Vol 1 (3) ◽  
pp. 1-12 ◽  
Author(s):  
Anargyros Chryssanthou ◽  
Iraklis Varlamis ◽  
John Constantine Sarivougioukas ◽  
Ioannis Apostolakis
Keyword(s):  
Information System ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Working Environment ◽  
Economic Factors ◽  
System Operation ◽  
Technological Factors ◽  
Hospital Managers ◽  
New Information

The aim of this paper is to develop a methodology for deciding when a Hospital Information System (HIS) must be replaced and in addition to discuss how the decision for system replacement affects the quality of healthcare services. In the hypothesis, the Hospital IS has been in operation for a period of time and the Hospital managers have to choose between the replacement with a new Information System (IS) and the continuation of its use. Leaving aside the economic factors concerning the return of a possible investment, the decision is still difficult and will be based on scientific and technological factors. The proposed methodology employs confidential information from the Hospital, which relates to the system operation and usability, the satisfaction of doctors and patients, etc. It also examines the entire working environment and common factors that affect the choice of Hospital managers (e.g., financial constraints).

scholarly journals Effects of Training on Quality of Clinical Coding at Mbagathi County Referral Hospital, Nairobi City County, Kenya

2018 ◽  
Vol 6 (1) ◽  
pp. 231-237
Author(s):  
Josephat Gachoka Kiongo ◽  
Otieno G. O. ◽  
Yitambe A. O
Keyword(s):  
Health Sector ◽  
Poor Quality ◽  
Referral Hospital ◽  
Clinical Coding ◽  
Code Assignment ◽  
Coding Quality ◽  
Process And Outcome ◽  
Code Completion ◽  
Code Quality

Introduction: Professionals from various cadres in the health sector raise concerns regarding the poor quality of clinical coding leading to lack of evidence-based practice. Assessing the quality of the clinical coding in one of Nairobi City County’s major hospital would be a step towards establishing the exact gaps in quality of the coding process and outcome. Training the professionals would also foster better clinical coding practice in one of the major facilities nationally. Method: The study aimed at establishing the quality of clinical coding within Mbagathi County Referral Hospital, and thereafter determined the effect of training on the established clinical coding quality. An interventional trial study design was used, with a quality of clinical coding checklist used classify codes assignment or lack of which. The sample included 320 patient files selected randomly from a month-long list of patients. Results: The study found out that the overall baseline code quality was slightly above average given that majority (55%) of the code assignment were good as established by a composite score of the various coding quality attributes assessed. Given the need for training based on the low quality, a training intervention was then conducted based on the needs identified. An indexing database was also installed for the coders to use in encoding the codes assigned. Code quality improved to 77% after the training. Code completion was excellent at the facility, as established from the 97% of the files that were completely coded at baseline and later improved to 99%. Notably, also, is that the hospital improved its coding of procedures and death certification by 32 and 53% respectively. The hospital also started using the indexing tool that was introduced as an intervention. Conclusions: The health facility could act as a good benchmark for code completion. However, code completion without accuracy in the code assignment invalidates the overall quality of coding. Code accuracy improved with the training almost immediately after the interventions. More practice would for sure lead to better clinical coding accuracy.  

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

1996 ◽  
Vol 35 (01) ◽  
pp. 41-51 ◽  
Author(s):  
F. Molino ◽  
D. Furia ◽  
F. Bar ◽  
S. Battista ◽  
N. Cappello ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Information ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Clinical Documentation ◽  
Data Set ◽  
Knowledge Based ◽  
Number Of Patients ◽  
Support Tools ◽  
Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Antecedents And Outcomes Of Qwl Among Employees In Banks

2019 ◽  
Vol 118 (7) ◽  
pp. 1-19
Author(s):  
Geethanjali N ◽  
Parveen Roja M ◽  
Lavanya D
Keyword(s):  
Organizational Climate ◽  
Job Stress ◽  
Work Life ◽  
Working Environment ◽  
Quality Of Work Life ◽  
Quality Of Work ◽  
Significant Difference ◽  
Service Productivity ◽  
The Impact

Quality of work life is the major factor to be considered in working environment of any organization. The performance of employees and the organization lies on the ability of the employees based on working environment. The QWL leads to better working environment which improves the performance of organization. The present study has made an attempt to find the level of factors causing QWL and the impact of outcome of QWL in banks. Since the profile of the banks may be associated with the level of outcomes of QWL, the present study has made an attempt to examine it with the help of one way analysis of variance and t-test. The included outcomes of QWL are job satisfaction, job stress, organizational climate, organizational commitment, employees retention behaviour, service quality employees and service productivity of employees. The highly associated determinants of QWL and the significant difference among the PUSBs and PRSBs have been noticed. The significantly associating important profiles of the banks regarding the existence of outcome of QWL are identified.

METHODOLOGY OF OBJECTIVE EVALUATION OF THE QUALITY BEARINGS BY VIBRO-ACOUSTICS AND ITS COMPARISON WITH A SUBJECTIVE METHOD

Akustika ◽  
2020 ◽  
pp. 58-66
Author(s):  
Stanislav Žiaran ◽  
Ondrej Chlebo ◽  
Ĺubomír Šooš
Keyword(s):  
Dynamic Load ◽  
Subjective Evaluation ◽  
Objective Evaluation ◽  
Living Environment ◽  
Working Environment ◽  
Subjective Method ◽  
Auditory Organ ◽  
Objective Methodology ◽  
Fft Analysis

The quality of bearing production has an impact not only on their reliability and lifetime, but also on the dynamic load of the working and living environment by excessive vibration and thus also noise. The intensity of the noise emitted by a bearing which is perceived by man characterizes the quality of its production. Reducing the dynamic load of mechanical systems and their components is reflected in the working environment by reducing noise emissions and immissions. The article proposes an objective method of bearing quality assessment based on measuring vibro-acoustic parameters of dynamic load of a new bearing using FFT analysis and the magnitude of the amplitude of bearing vibration acceleration and compares it with a subjective method that also uses the human auditory organ to assess bearing quality. The results of vibro-acoustic measurements were analysed in terms of vibration intensity and the noise of the produced bearings. The proposed objective methodology was compared with the subjective evaluation of the quality of bearings and the results of this methodology matched. The proposed methodology is applicable to all types of bearings, and it is possible to automate this methodology in the production process.

Comparative analysis of intelligent planning methods

2012 ◽  
Vol 9 (2) ◽  
pp. 53-57 ◽  
Author(s):  
O.V. Darintsev ◽  
A.B. Migranov
Keyword(s):  
Neural Networks ◽  
Genetic Algorithms ◽  
Fuzzy Logic ◽  
Comparative Analysis ◽  
Mobile Robots ◽  
Sensory Information ◽  
Working Environment ◽  
Planning Methods ◽  
Intelligent Planning

The main stages of solving the problem of planning movements by mobile robots in a non-stationary working environment based on neural networks, genetic algorithms and fuzzy logic are considered. The features common to the considered intellectual algorithms are singled out and their comparative analysis is carried out. Recommendations are given on the use of this or that method depending on the type of problem being solved and the requirements for the speed of the algorithm, the quality of the trajectory, the availability (volume) of sensory information, etc.

Quality of Work Life and Job Satisfaction: A Case of Veterinary Doctors in Punjab

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Deepak Kochar
Keyword(s):  
Job Satisfaction ◽  
Social Relations ◽  
Linear Regression Analysis ◽  
Strong Association ◽  
Work Life ◽  
Working Environment ◽  
Quality Of Work Life ◽  
Quality Of Work ◽  
Future Growth

The present study attempts to establish the association between Quality of Work Life (QWL) and job satisfaction among the veterinary doctors of Punjab. Multiple linear regression analysis has been employed to examine how far the factors of QWL identified with the help of factor analysis affect the job satisfaction. Job satisfaction is a dependent variable and factors, Monetary Consideration, Social Relations at Work, Constitutionalism at Work, Pride in Job, Facilitation for Current Performance and Future Growth, Nature of Job, Security and Safety, Innovative and Challenging Job, Fair and Unbiased Attitude of Top Officials, Less Educated and Ignorant Clients, Space and Infrastructure, Insufficient Diagnostic Facilities and Staff, and Reporting are independent variables. The results of the present study reveal strong association of Monetary Consideration, Facilitation for Current Performance and Future Growth, Security and Safety, Nature of Job, and Space and Infrastructure with job satisfaction. The eight variables which were not found significant include, Social Relations at Work, Constitutionalism at Work , Pride in Job, Innovative and Challenging Job, Fair and Unbiased Attitude of Top Officials, Less Educated and Ignorant Clients, Insufficient Diagnostic Facilities and Staff, and Reporting. The present study conducted on veterinarians working under department of animal husbandry, Punjab can make a niche in this area. Commitment on the part of government and department itself to work on the activities and initiatives which promote QWL and job satisfaction of the respondents can create a sound and harmonious working environment to get the desired results.

scholarly journals Doctors and Nurses: A Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout

2021 ◽  
Vol 18 (6) ◽  
pp. 3280
Author(s):  
Jose Miguel Giménez Lozano ◽  
Juan Pedro Martínez Ramón ◽  
Francisco Manuel Morales Rodríguez
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Workplace Violence ◽  
Physical Violence ◽  
Health Sector ◽  
Risk And Protective Factors ◽  
Working Environment ◽  
Academic Degree ◽  
Authoritarian Leadership

The present study aims analyze the risk factors that lead to high levels of burnout among nurses and physicians and the protective factors that prevent them. Thus, it is also intended to explore the possible correlation between physical and verbal violence produced at work and the symptoms derived from burnout. Methods: The search was carried out on the Scopus, PubMed and Web of Science databases between 2000 and 2019 (on which date the bibliographic search ends). Descriptive studies estimating the prevalence of workplace violence and risk and protective factors and burnout were included. An adapted version of the Downs and Black quality checklist was used for article selection. 89.6 percent of the studies analysed were in the health sector. There is a significant correlation between burnout symptoms and physical violence at work. On the one hand, the risk factors that moderate this correlation were of structural/organisational type (social support, quality of the working environment, authoritarian leadership, little autonomy or long working days, etc.) and personal type (age, gender, nationality or academic degree, etc.). On the other hand, protective factors were the quality of the working environment, mutual support networks or coping strategies. The results were analysed in-depth and intervention strategies were proposed.

scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

scholarly journals Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric D. Moyer ◽  
Erik B. Lehman ◽  
Matthew D. Bolton ◽  
Jennifer Goldstein ◽  
Ariana R. Pichardo-Lowden
Keyword(s):  
Blood Glucose ◽  
Continuity Of Care ◽  
Clinical Documentation ◽  
Stress Hyperglycemia ◽  
Optimal Care ◽  
Continuity Clinic ◽  
Altered Glucose ◽  
Discharge Summaries

AbstractStress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.

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