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ICD-11Chapter 23 Field Trial pilot phase

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) . Draft program Day 1. (Korean ICTM Working Group meeting).

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ICD-11Chapter 23 Field Trial pilot phase

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  1. 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)

  2. Draft programDay 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 • Form I • Form J • Form E • PI Form

  3. 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) • 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

  4. ICD-11 Field Trials • Basic aims • To test the “fitness of ICD-11 for multiple purposes” • 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 . Key Assessments: • Applicability – feasibility  easy to use • Reliability - consistency  gives same results in the hands of all • Utility - added value  renders useful information

  5. ICD-11 Field Trials • Applicability (Feasibility) – • Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ? • Utility– • 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– • 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?

  6. Field Trial Studies • Core Studies (mandatory) • Study One: • Reliability & Feasibility • Study Two: • Bridge Coding • Study Three: • Basic Questions • Additional Studies • e.g. testing index

  7. 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-resourcesettings • Low-resourcesettings • General Health Care • Specialty settings • Research settings • Use in population studies - epidemiology • Use in clinical research

  8. Field Trials Chapter 23Pilot 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

  9. 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

  10. 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”

  11. 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

  12. Case Assessments can include (simulate or real)… • Patient history • Tongue examination • Pulse examinations • Physical examinations

  13. Analysis Case 1, 2, 3… • Level of agreement among multiple raters • Who agrees on what? • Reason for disagreement • Predictors of reliability • Testing of hypothesis • Data patterns High Agreement Low Agreement

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