why can’t we fix this already? the workgroup for external cause coding improvement (wecci)
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Why Can’t We Fix This Already? The Workgroup for External Cause Coding Improvement (WECCI). Mel Kohn, MD MPH State Epidemiologist Public Health Division, Oregon Department of Human Services CSTE 2007 Annual Meeting Atlantic City, NJ, June 26, 2007. Background. - PowerPoint PPT PresentationTRANSCRIPT
Why Can’t We Fix This Already? The Workgroup for External Cause Coding Improvement
(WECCI)
Mel Kohn, MD MPHState Epidemiologist
Public Health Division, Oregon Department of Human Services
CSTE 2007 Annual MeetingAtlantic City, NJ, June 26, 2007
Background Injury data used to design, implement and evaluate Injury data used to design, implement and evaluate
injury prevention activitiesinjury prevention activities Need data on both fatal and non-fatal injuriesNeed data on both fatal and non-fatal injuries Statewide hospital discharge data and emergency Statewide hospital discharge data and emergency
room data important for injury surveillanceroom data important for injury surveillance Variability in data collection processesVariability in data collection processes
External cause of injury codes (E-codes) identify External cause of injury codes (E-codes) identify causes of injuriescauses of injuries
1997 Report on E-coding
APHA’s Injury Control and Emergency APHA’s Injury Control and Emergency Health Services Section surveys states Health Services Section surveys states about E-coding in statewide hospital about E-coding in statewide hospital discharge and emergency department data discharge and emergency department data systemssystems
Documented serious gaps and variability in Documented serious gaps and variability in E-codingE-coding
Repeat of Study in 2004
To assess the current status of E-coding in To assess the current status of E-coding in statewide morbidity data systemsstatewide morbidity data systems
Compare with 1997 resultsCompare with 1997 results Are we making progress in improving the Are we making progress in improving the
data infrastructure for state-level injury data infrastructure for state-level injury surveillance?surveillance?
Hospital Discharge Data Systems
19971997 20042004
Have statewide HD data systemHave statewide HD data system 4242 4545Routinely collect E-codesRoutinely collect E-codes 3636 4242
E-coding mandatedE-coding mandated 2323 2626
Record 2 or more E-codesRecord 2 or more E-codes 2525 3232
Record place of occurrence E-codeRecord place of occurrence E-code 1616 2323
Able to identify initial hospital visitAble to identify initial hospital visit 2424 3030
Have evaluated extent of E-codingHave evaluated extent of E-coding 2323 3232
Number of states
Completeness of E-coding in Hospital Discharge Data Systems, 2004
Percentage of Injury Percentage of Injury Records E-codedRecords E-coded Number of StatesNumber of States
<< 90% 90% 88
91 – 100%91 – 100% 1414
UnknownUnknown 1010
SubtotalSubtotal 3232
No EvaluationNo Evaluation 1010
TotalTotal 4242
Little Progress Has Been Made
In 2004 Only 22 states knew the In 2004 Only 22 states knew the completeness of E-codingcompleteness of E-coding Only 14 had >90% E-codedOnly 14 had >90% E-coded
Issues of non-specific codesIssues of non-specific codes E.g., Fall NOSE.g., Fall NOS
No systematic evaluation of validity of E-No systematic evaluation of validity of E-codescodes
WECCI is born…
Current organizations represented: CSTE, Current organizations represented: CSTE, APHA, STIPDA, PHDSC, ASTHOAPHA, STIPDA, PHDSC, ASTHO
Goal: Spur improvements in external cause Goal: Spur improvements in external cause codingcoding
Monthly conference callsMonthly conference calls
Getting E-coding on the Radar Revise policy statementsRevise policy statements
Collected existing statementsCollected existing statements Submitted updated CSTE and APHA Submitted updated CSTE and APHA
statementsstatements PublicationsPublications
MMWR on CSTE studyMMWR on CSTE study Journal editorial(s)Journal editorial(s)
Possible summit?Possible summit?
Tools
Training and feedback for reportersTraining and feedback for reporters Assessment of e-coding by statesAssessment of e-coding by states Policy options to be exploredPolicy options to be explored
Tie to reimbursementTie to reimbursement MandatesMandates
Monitor and respond to legislative threatsMonitor and respond to legislative threats Politics of ICD10-CM implementationPolitics of ICD10-CM implementation