A proposal for an evaluation for mortality coders

Education Committee meetingMay 2006Cassia Maria Buchalla

Background

Education Committee Meeting 2005 –examBrazilian Center volunteer WHO-FIC Meeting 2005 – MRG volunteer to test the set December 2005 – Brazilian Center sent the set to MRG April 2006 – answers from 8 people/groups

Background

100 death certificates and– abbreviation list for selection rules – scale for classification of the DC (level) – proposal form for the applicants– answer form sheet

Mortality Reference Group – answers and suggestions

Abbreviation list

Notes NeoMalignant Neoplasms

Notes OpOperations

Notes for interpretation of entries of causes of death

RFRule F

RERule E

RDRule D

RCRule C

RBRule B

RARule A

R3Rule 3

R2Rule 2

R1Rule 1

GPGeneral principle

abbreviationsDescriptions

Scale for the level of difficulty

1 -for very easy 2 -for easy 3 -for medium difficult4 -difficult5 -very difficult

Answer Sheet

Nº Medical part I Part II U C Rules used to select the

UC

* *

I a) I b) I c) I d)

1

2

3

Method

Analysis related to the UCAnalysis for rules applied Suggestions for the forms (answer and applicant) Comments on the exam, the set, etc

Results

All answers agree in 43% - in 3 the agreement was only at category level Rules used to select the UC were:– GP alone in almost 50% – Rule 1 and Rule C – Rule 2 , malign neoplasm , rule 3 and notes on

operation

Results

There was a scale for the level of difficulty from this 43 Death certificates: N= 43 %

1 (very easy) and 2 (easy) 25 58.1 > 2 to 3 (medium difficult) 15 34.9 > 3 to 4 (difficult) 3 7.0 > 4 to 5 (very difficult) 0

Results

From the 57 that were not completely agreed

N= 57 %1 (very easy) and 2 (easy) 13 22.8 > 2 to 3 (medium difficult) 34 59.6 > 3 to 4 (difficult) 10 17.5 > 4 to 5 (very difficult) 0

Results

From the 57 cases we did not agree completely – suggestion to exclude 5 cases

(# 13, 34, 8, 87, 100)– 12 hours and 25 minutes to complete all set

Results

Comments on the wording - a new fileComments on the answer sheet - it was only for the evaluation of the set. We have got many interesting suggestions for this form.Comments on the form for the candidates - new file (3apresentaçao formulario.doc)

Answer Sheet What ICD version do you use to fill this? ...............

1- Female, 90 years old CODE CODE CODE time Part I a) Osteoporosis 40 years b)Anaemia 2 years c) Gastritis 5 years d) Coronary

arteriosclerosis 10 years

Part II Urinary infection 10 days Dehydration 10 days UC code:…….. Rules applied:……………………………………………………………………….. ………………………………………………………………………………………..

Suggestions

The exam must refers to both UC and multiple cause coding;We will have to enlarge it to include examples of Rules B and E, more Neoplasm, include time information;Should it include abbreviations?More than one version of exam availablePeople will have some time to answer and send to the group (how long?)

Next steps

The rules used will be analyzed The set will be present regarding their level of difficulty and rules applied To include more DC in which rules not covered in this set are appliedTo repeat this trial to got a number of sets of DC

Final Comments

Translation problems – the exam should be offered in many languagesHow to deal with the differences among the diseases panorama that differs from country to country?It is a challenger to make an international examHow the exam will be done (by internet, on line, by mail, etc)How many set of questions (versions of the exam) should we have?