Publication:

Improving the Quality of Clinical Coding through the Training of Health Records and Information Officers in Selected Hospitals, Nairobi City County, Kenya

Clinical coding quality is increasingly becoming an important arm in health and statistics. The objective of this research was to establish whether training could improve the quality of clinical coding in Nairobi City County Hospitals. A before-and-after interventional design was used for the study. The study was conducted at Mbagathi County Referral Hospital and Mama Lucy Kibaki Hospital, with the latter acting as the control group. The study took the form of a baseline and two follow-up studies. The intervention was training on ICD-10. A sample of 612 subjects with 306 cases from each hospital was audited. Pretesting was conducted at Mama Lucy Kibaki Hospital. Data analysis was done using Statistical Package for Social Science (SPSS) Version 25. Fisher’s Exact and Paired T- test were conducted to establish the significance of differences between the two groups. The study revealed a low proportional (52%) of files were coded in MCRH than in MLKH (62%) therefore, biasing the intervention to MCRH. The mean for MLKH was 3.63 ± 0.916 compared to 3.56 ± 726 for MCRH. The mean difference of on how to use of ICU-10 was 0.25. The mean speed of coding was better in MCRH (4.00 ± 1.000) than in MLKH (3.13 ± 1.458). Coding of cause of death was wanting in MCRH (4.00 ± 1.453) than in MLKH (4.13 ± 0.35). Completeness also varied across. The difference in coding of external injury files between MLKH and MCRH prior to and after intervention was explicit. Coding of external injury files in the intervention arm improved to 100% from 97.3%. While that of control arm enhanced from 50% to 83.3%. The fisher exact p value was <0.001 before intervention but reduced 0.018 post intervention. Coding for medical procedure files was much less complete before training at 33.3% in MLKH and 93.3% in MCRH. However, coding changed to 83.3% and 100% correspondingly after the training. The Fisher Exact p-value for coding of medical procedures was <0.001 prior to training and 0.001 after training. Accuracy in assigning the appropriate code for diseases and injuries significantly varied after training (p=<0.001) contrary to indifferent (p=0.665) before training. However, the difference before (p<0.001) and after the intervention (p<0.001) in assigning the appropriate code for medical procedure was evident. Accuracy in assigning the appropriate code for death certification also varied significantly before (p=0.009) and after the intervention (p<0.001). The study revealed mean difference after the training. T-Test was statistically significant in death certification (t=-12.283; d.f=38; p=0.000), assigning the appropriate code for medical procedure (t=-6.969; d.f=42; p=0.000) and assigning the appropriate code for external causes of injuries (t=-4.953; d.f=73; p=0.000). Appropriate code for comorbidities was (t=-7.473; d.f=78), p=0.000), correct code for diseases and injuries (t=-5.015; d.f=226;p=0.000). The study findings support the hypothesis that training of health records and information officers significantly improved the quality of clinical coding. Based on the results, coding was influenced by both coder awareness level, keenness in documentation and interpretation. The study revealed the importance of adequate training, planning and awareness as key ingredients to effective implementation of ICD-10. Enhanced training improves documentation, which in turn enables providers to analyze patient details, thereby leading to better care coordination and health outcomes. The study recommends greater investment in staff through ICD-10 training and recruitment as well as IT systems across all hospitals within the county.