Full Project – IMPACT OF CODING AND INDEXING IN HEALTH-CARE MANAGEMENT IN FTH KATSINA

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ABSTRACT

This study investigated the Impact of Coding and Indexing In Health-Care Management in Katsina. The objectives of the study are:- to explore the extraction of clinical data for clinical coding and indexing to assess the importance of coding and indexing in the hospital, to reveal how healthcare personnel access coded data for decision making in the teaching hospital management eighty questionnaires were distributed, eighty questionnaires were retrieved return rate. Data were analyzed using table. Finding revealed that coding and indexing is very important in the hospital and are utilized in the hospital for the following purpose research work, statistical compilation, planning and facilitate easy retrieval of patient record. Base on the finding the following recommendations are made: hospital management should pay attention to the unit also, data supplied by the coding and indexing section should be utilized in order to ensure that effective and efficiency health care delivery is been given to the populace.

TABLE OF CONTENT

Cover Page i

Title Page ii

Certification iii

Dedication iv

Abstract v

Acknowledgement vi

Table of Contents vii

List of Tables viii

1.0 CHAPTER ONE_ INTRODUCTION

1.1 Background of the study

1.2 Statement of the Research problem

1.3 Purpose /Objective of the study

1.4 Significance of the study

1.5 Research questions

1.6 Scope of the study

1.7 Limitation of the study

1.8 Operation definition terms

CHAPTER TWO LITERATURE REVIEW

2.0 Introduction

2.1 Concepts of clinical coding and indexing

2.2 significance of clinical coding

2.3 Application of clinical coding and indexing in decision making

2.4 Utilization of clinical coding and indexing The Empirical Studies.

2.5 uses of clinical coding and indexing

2.6 clinical decision making

2.7 accuracy of data in computer􀀀based patient records

2.8 clinical coders and decision making

2.9 The clinical coding process

2.10 proficiency in clinical coding

3.0 CHAPTER THREE_ METHODOLOGY

3.1 Introduction

3.2 Research Design

3.3 Research population

3.4 sample and sampling techniques

3.5 Instrumentation

3.6 Reliability and validity

3.7 Data collection procedure

3.8 Method of data analysis

3.9 Ethical consideration

4.0 CHAPTER FOUR 􀀀DATA PRESENTATION, ANALYSIS AND DISCUSSION OF FINDINGS

4.1 Introductions

4.2 Data presentation

4.3 Data analysis

4.4 Discussion of findings

5.0 chapter five_summary, conclusion, and recommendations

5.1 introduction

5.2 Summary

5.3 Conclusion

5.4 Recommendations

5.5 Suggestions for further studies

5.6 Reference

Appendix

! Questionnaire

!! Letter of introduction

LISTS OF TABLES

Table1: Gender distribution of the respondents

Table2: Age distribution of the respondents

Table3: Educational qualification of the respondents

Table4: Occupation distribution of the respondents

Table5: Significant different between the uses coded data and indexed

Table6: Easy accessibility of coded data for utilization

Table7: Adequacy of clinically coded and indexed data for decision making

Table8: Relevance of clinically coded and indexed data to a hospital and medical practitioners

CHAPTER ONE

Alin Liviu PREDA, Nona Delia CHIRIAC, Simona MUSAT. (2012), Clinical coding is the process by which some clinical information about the patient are transformed into codes, to enable grouping of medical activities in a limited number of categories, that are easy to process, store and analyzed. The essential element in making a correct clinical coding is the allocation of each diagnosis or procedure in the group category to which it belongs, underpinning the general concept for the quality in clinical coding.

Modernization of health care involves the continuous guidance towards quality standards of both medical act itself and adjacent activities. Clinical coding is one of the key components of the coordination process for all stakeholders and has a major impact on health service monitoring, but also on morbidity assessment and estimates regarding the need for health services.

Good clinical coding is one of the essential elements for quality care therefore providing resources for this and implementing a clinical coding system will have a positive impact on the process.

Transnational comparative research development; application of management monitoring tools or for funding of health services. Ignorance of basic coding principles sometimes causes major errors, which result in dissatisfaction, frustration or attempts to “cheat” coding rules. Considering that in Romania there is not a real school clinical coding, this article aims to summarize the most important aspects of this concept. Seen by many practitioners as an unnecessary task, ignored by the health system managers, clinical coding is often a subject of controversy, ambiguous or a true “source of legends” when is linked to medical services reimbursement.

Patricia T. Aalseth, Jones and Bartlett Learning (2006), clinical coding is the process of transferring a part of clinical information into codes. This operation allows to group medical activity to a much easier to process limited number of categories.

We must accept from the start that diagnoses and procedures which often are the subject of codification are complex concepts established by the physician cannot be resumed entirely by a code. In other words, we can say that the clinical coding process is a concession on quality of medical information in favors of quantity to be used in statistics. Medical information stored in the form of codes can more easily be analyzed and used in decision making. (Alin Liviu Preda 2006),and etel

1.1 BACKGROUND OF THE STUDY

According to Patricia T Aalseth ,Jones and Bartlett Learning (2006), in the Middle Ages, when the great plague of 1327 reduced the population of Europe by one third, for the first time people recognized the importance of measures to prevent disease transmission by isolating those infected and avoiding contact with them or with their environment. After the great plague, several small outbreaks have existed throughout the continent, keeping alive people’s fear of the disease. To meet the need of tracking any disease outbreaks in London where for the first time put in place centralized registers for causes of death. These occurred in 1629 and were released once a week to inform people about the number of people and areas affected. Records of mortality in London consisted of 60 categories of death.

During the eighteenth century several additional classifications were made by Linnaeus, Bossier de Lacroix and Cullen.

William Farr in his findings on diseases classification with collaboration with the public service of his days and sir George Kiubbs, the element Australian statistician, couple with john Grant on the London Bill of Mortality and the effect of congress held in various countries that universally agree on classification of diseases as a system of categorizing morbid entities according to some established criteria (Olaosebikan 2010).

Omidoyin (2001) writes that coding and indexing is generally recognized in all health information management sectors because it brings efficiency into the work of health records in terms of research and even helps in projecting into the future.

Coding and classification processes transform natural language descriptions in clinical text into coded data that can be subsequently used for clinical care, research, and other purposes . The code is measured in detail in order to accurately describe diagnoses (i.e. what is wrong with the patient) and the procedures performed to test or correct these diagnoses. Because medicine is not an exact science, codes were developed to identify all reasons for seeking healthcare. Although, coding was perceived to have potentially jeopardized doctor-patient relationship and was said to be a difficult and often tedious activity, it has been established that it has no equal in health data management and as such, healthcare systems at large. Codes also allow insurance providers to map equivalences across different healthcare providers who may use different terminologies or abbreviations in claim forms. A universal veritable tool that facilitates good clinical coding is the discharge summary (or clinical résumé) which is a concise recapitulation of the patients course in the hospital. Though it was reported not to be written always or vital part omitted when written, it provides the information to support clinical documentation review process and clinical coding. While it is true that clinical coders variability in coding maybe related to the inadequacy of their training and experience, physicians documentation can impede accurate interpretation of medical charts by the coders .Good clinical documentation enhances clinical coding as it ensures the availability of reliable information for the production of quality and accurate data for quality patient care. Conversely, poor documentation undermines analyses-based chart review ,affects clinical coding processes and can reduce the quality of care. Clinical documentations in computer-based records are found to be more complete and appropriate for clinical decisions than those in paper-based records. Likewise, automated coding and classification encompasses a variety of computer based approaches, that are faster, reduce error rates, and are more efficient and accurate. S.D. Lusignan(2003).

1.2 STATEMENTOF THE PROBLEM

Over the years, coding and indexing has been used in various ways such as research, disease notification etc. Despite these advantages of coded and indexed data for decision making in the hospital, there are still problems which arise such as inadequate utilization of coded data and indexed data for decision making, shortage of most essential coding tools, unconducive environment and improper storage of index cards on which there is a kind of little improvement.

1.3 OBJECTIVES OF THE STUDY

BROAD OBJECTIVE

To assess the impact of clinical coding and indexing for decision making in a hospital using FTH Katsina Teaching Hospital, Katsina, Katsina State as a case study.

SPECIFIC OBJECTIVES

To explore the generation of clinical data for clinical coding and indexing.

To assess the importance of coding and indexing in the hospital.

To explore and reveal how healthcare personnel access coded and indexed data for decision making in the teaching hospital.

To determine the importance of clinical coding and indexing in disease notification.

1.4 SIGNIFICANCE OF THE STUDY.

Over the years , coding and indexing have been recognized as an essential tool use in the hospital to perform a good number of functions such as clinical research , health services management and planning for better healthcare services. This study will assist the clinical coder to improve on the standard of coding in FTH Katsina Teaching Hospital, Katsina Katsina State.

It will also reveal strategy for improvement of coding and indexing and utilization of coded data and indexed data in hospital for better decision making.

1.5 RESEARCH QUESTIONS

Is there any significant effect of the use of clinical coded data by the management on her decision making?
Is the any significant difference between the uses of coded and indexed data and better decision making
Do the coded data capture all clinical information about patients which will be necessary for decision making?
Is accessibility granted to utilization of coded and indexed data?

1.6 Research hypothesis

Ho: There is no significant effect of utilization of clinical coded data and indexed data on decision making.

Hi: There is significant effect of utilization of clinical coded data and indexed data for decision making.

1.7 SCOPE OF THE STUDY

The focus of the study is the assessment of impact of clinical coding and indexing in a hospital. The study particularly targeted clinical coding and uses of coded data and indexed data at FTH Katsina Teaching Hospital, Katsina. The choice of limiting the study to AKTH is based on the fact that it is one of the Nigeria tertiary facilities practicing coding and indexing.

1.8 LIMITATIONS OF THE STUDY

The global pandemic, COVID-19 advisories and safety protocols and time constraint available for carrying out the research. Also, inadequate financial support occasioned by recession.

1.9 OPERATIONAL DEFINITION OF TERMS

Impact: the action of anything making an effect or influence on specified something

Utilization: the action of making practical and effective use of clinical coding and indexing for decision making.

Clinical Coding: The process of assigning a code number to diseases or operations with the use of ICD and CSO.

Indexing: The process of listing on a card for specific diseases or operations according to a recognized classification

Patient: A person who is receiving medical /surgical treatment in the hospital.

Disease Notification: Formal reporting of diseases to the appropriate health authority.

Decision Making: Process of identifying and choosing better health alternatives based on the values, preferences and beliefs of the decision makers/hospital management by using clinical coded data and indexed data.

ICD: International Classification of Diseases.

CSO: Classification of Surgical Operations.

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Full Project – IMPACT OF CODING AND INDEXING IN HEALTH-CARE MANAGEMENT IN FTH KATSINA

Full Project – IMPACT OF CODING AND INDEXING IN HEALTH-CARE MANAGEMENT IN FTH KATSINA

Full Project – IMPACT OF CODING AND INDEXING IN HEALTH-CARE MANAGEMENT IN FTH KATSINA

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