title: Coding paediatric outpatient data to provide health planners with information on children with chronic conditions and disabilities.
abstract: OBJECTIVE
  In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.
  
  
  METHODS
  Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.
  
  
  RESULTS
  In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.
  
  
  CONCLUSIONS
  Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information.
authors.affiliation: NZ Child and Youth Epidemiology Service, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Craig
authors.affiliation: NZ Child and Youth Epidemiology Service, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Neal
authors.initials: N
authors.lastname: Kerr
authors.affiliation: NZ Child and Youth Epidemiology Service, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: McDonald
mesh_terms: D001315:Australia; D002662:Child Health Services; D002675:Child, Preschool; D002908:Chronic Disease; D059019:Clinical Coding; D006233:Persons with Disabilities; D005240:Feasibility Studies; D006285:Health Planning; D006801:Humans; D009520:New Zealand; D010045:Outpatients; D010372:Pediatrics; D011795:Surveys and Questionnaires; D039061:Systematized Nomenclature of Medicine
keywords: New Zealand; child health services; clinical coding; disabled children; outpatients