[Interobserver agreement on diagnoses classified according the International Classification of Primary Care]

OBJECTIVE

To measure interobserver agreement on diagnoses classified and coded by family physicians using manual or computerized input modes.

METHOD

Used increasingly in a variety of information management systems, the International Classification of Primary Care is the system best adapted to primary care. Ten physicians independently viewed 44 taped medical visits. Five physicians were randomly assigned to manual coding and five to computer coding. The study of reproducibility explored three aspects: written diagnoses, manually coded diagnoses, and diagnoses coded using a software program. The K statistic was calculated in order to compare interobserver agreement.

RESULTS

Descriptive analysis of interobserver agreement in the written diagnoses revealed an agreement rate of 70.5% (+/- 6.3). Among physicians using manual coding, the agreement rate was 70.2% (+/- 7.2). In the group using the software program, the agreement rate was 75.0% (+/- 8.7). The K coefficients were low, but three were significant with critical ratios (z) above 1.96.

CONCLUSION

Results suggest that input method has no bearing on interobserver agreement and that agreement is more a function of clinical presentation of health problems than of coding process.

[Utilization of computerized classification system of primary care: three years of experience]

OBJECTIVE

To develop and implement a computerized version of the International Classification of Primary Care. To create a data bank and to conduct a descriptive study of our clinic's clientele.

DESIGN

Testing a software program and creating a data bank.

SETTING

Family Medicine Unit at Enfant-Jésus Hospital, Quebec City.

PARTICIPANTS

All Family Medicine Unit doctors and patients seen between July 1, 1990, and June 30, 1993.

MAIN OUTCOME MEASURE

Description of our clientele's health problems using the ICPC.

RESULTS

During the study, 48,415 diagnostic codes for 33,033 visits were entered into the bank. For close to 50% of these visits, two or more health problems were coded. There was good correlation between the description of our clientele and descriptions in other studies in the literature.

CONCLUSION

This article describes the development of a data bank in a family medicine unit using a software program based on the ICPC. Our 3-year experiment demonstrated that the method works well in family physicians' daily practice. A descriptive study of our clientele is presented, as well as a few examples of the many applications of such a data bank.