title: Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).
abstract: The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data.
authors.affiliation: Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Southern
authors.affiliation: Department of Psychiatry, Columbia University and the New York StatePsychiatric Institute, New York, NY, USA Irving Institute for Clinical and Translational Research at Columbia University and New York-Presbyterian Hospital, New York, NY, USA RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pincus
authors.affiliation: Division of General Medicine, University of California-Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.affiliation: Institute of Social and PreventiveMedicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: Flinders University, Adelaide, SA, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Harrison
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
authors.affiliation: Canadian Institute of Health Information, Ontario, Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Moskal
authors.affiliation: Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.affiliation: Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, 47805, Krefeld, Germany.
authors.forename: Saskia E
authors.initials: SE
authors.lastname: Droesler
authors.affiliation: Department of Medicine, St. Vincent's Hospital, University ofMelbourne, Australia Department of Medicine, Southern Clinical School, Monash University, Australia.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
authors.affiliation: Department of Medical Information, Health Evaluation and ClinicalResearch, University Lyon I, Hospices Civils de Lyon, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.affiliation: Canadian Institute of Health Information, Ontario, Canada.
authors.forename: Yana
authors.initials: Y
authors.lastname: Gurevich
authors.affiliation: HealthQuality Ontario, Toronto, Ontario.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Brien
authors.affiliation: World Health Organization, Classifications, Terminology and Standards, Geneva, Switzerland.
authors.forename: Nenad
authors.initials: N
authors.lastname: Kostanjsek
authors.affiliation: World Health Organization, Classifications, Terminology and Standards, Geneva, Switzerland.
authors.forename: Bedirhan
authors.initials: B
authors.lastname: Üstün
authors.affiliation: Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D006801:Humans; D038801:International Classification of Diseases; D061214:Patient Safety / Q000592:standards*; D019984:Quality Indicators, Health Care; D014944:World Health Organization
keywords: International Classification of Diseases; World Health Organization; patient safety; quality indicators