Ankathil, Ravindran
(2012)
Data quality related to ungroupable cases :
A pilot study for pre-implementation of
casemix system in Hospital Universiti Sains Malaysia.
Other.
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia.
Abstract
Universiti Sains Malaysia (USM) as a premier university in Malaysia awarded an
APEX (Accelerated Programme for Excellence) status has given an autonomy and flexibility in
administration and access to additional funding from the government that the university heavily
committed with a long term objective to transform the university into a centre of excellence at par
with top universities of the world. Decision of using UNU-CBG Grouper as the grouping tool in
Hospital USM (HUSM), the second oldest teaching hospital in Malaysia is the brilliant step to
implement the casemix system as one of the initiative to improve quality and efficiency of its
services. Project collaboration between HUSM and United Nations University-International
Institute for Global Health and International Centre for Casemix and Clinical Coding of
National University of Malaysia has developed a three year programme to gradually
implement casemix system in the hospital. A pilot study was carried out to assess the quality
of coding system currently practice at the Patient Record Unit, HUSM.
Methods: All in-patient medical records for patients discharged in 2009 and 2010 were reviewed and
selected for the pilot study. Six trained coders coded the diagnosis using ICD1 0 and procedures
using ICD9-CM classifications. Those coded data set were exported into UNU-CBG Grouper for
patient grouping process. In UNU-CBGs the first level of classification is Casemix Main Group
(CMG) and the second level with higher degree of granularity is Case-Based Group (CBG).
Results: A total of 43, 273 medical records contained adequate information to be grouped
using the UNUCBG Groupers. This represents 60.6% of the total discharges for the two years
period. 60% were female. Most the patients were of younger age group with 29.7% below the
age of 20 years, 21.2% between the age of 21-30 years and only 14.5% are above 60years. A
total of 1,806 (4.2%) discharges were ungroupable. Common reasons for ungroupable
are coding errors of principle diagnosis (49.7%), no birth weight for babies (33.5%), coding errors for
deliveries (7.9%) and wrong gender (5.5%). High percentage of invalid principle code was due to the
technical error (50.2%) in assigning the ICD-10 codes where coders were mistakenly encode an
extra digit or incomplete code or wrong character listed within the ICD-1 0 Classification System.
Conclusions: Although the rate of ungroupable is quite low, more efforts should be made to train
the coders on the coding rules as required by the casemix groupers. The outcome of this pilot
study showed that the medical records system in the hospital could be further enhanced by
ensuring that the minimum data set for casemix system is captured routinely. Therefore, would
achieve the inspiration of cqsemix principle as an initiative to improve quality and efficiency of
!'lealthcare services in HUSI'y1 and thus, support the University for the APEX agenda.
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