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There are too many, but never enough: qualitative case study investigating routine coding of clinical information in depression.

Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

Authors

Kathrin Cresswell

Aziz Sheikh

Dipak Kalra



Abstract

Background: We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods: Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results: Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions: There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

Citation

CRESSWELL, K., MORRISON, Z., SHEIKH, A. and KALRA, D. 2012. There are too many, but never enough: qualitative case study investigating routine coding of clinical information in depression. PLoS ONE [online], 7(8), article ID e43831. Available from: https://doi.org/10.1371/journal.pone.0043831

Journal Article Type Article
Acceptance Date Jul 30, 2012
Online Publication Date Aug 24, 2012
Publication Date Aug 24, 2012
Deposit Date Aug 11, 2020
Publicly Available Date Mar 29, 2024
Journal PLoS ONE
Print ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 7
Issue 8
Article Number e43831
DOI https://doi.org/10.1371/journal.pone.0043831
Keywords Depression; Primary care; Mental health and psychiatry; Data management; Diagnostic medicine; Nurses; Allied health care professionals; Professions
Public URL https://rgu-repository.worktribe.com/output/960148
Related Public URLs https://rgu-repository.worktribe.com/output/960160

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