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Family Practice Vol. 6, No. 2, 92-97
© Oxford University Press 1989

research-article

Morbidity Coding in General Practice

DENNIS GRAY, AUSON WARD, PETER UNDERWOOD, BARRY FATOVICH and ROBIN WINKLER*

Cinical Unit, Department of Psychology, University of Western Australia
*Department of General Practice, University of Western Australia

Correspondence to Dr A Ward, Clarcmont Community Health Centre, 328 Stirling High Way, Claremont, Western Australia 6010

If research is to be of any use the phenomena being studied must be clearly defined. Almost 30 years ago the difficulty of classifying primary care problems using the International Classification of Diseases (ICD-8) was demonstrated. This led to the development of the International Classification of Health Problems in Primary Care-2-Defined which is based on ICD-9. Despite the work that has gone into the development ofICHPPC-2-Defined, relatively little work has been undertaken to assess the validity and reliability of its use. This paper describes the results of such a study conducted as a preliminary to the use of ICHPPC-2-Defined in a study of consulting patterns in general practice.

The participating general practitioners were trained in the use of ICHPPC-2-Defined and then coded problems which they identified in a set of clinical vignettes. Following the coding exercise, a review session was held in which difficulties and errors in the use of ICHPPC-2-Defined were discussed. Subsequently, the general practitioners were required to code two more sets of vignettes, which included some problems repeated from the preceding sets. Comparisons were then made of changes in the validity and reliability of coding from one round to the next.

The results of the study suggest that the reliability and validity of morbidity data collected using ICHPPC-2-Defined can be increased by training sessions for the coders which focus on the main sources of error in the use of ICHPPC-2-Defined. These include: over-reliance on memory; specificity of diagnosis; multiplicity of problems; and over-riding categories. The study also examined methods of aggregating the 362 ICHPPC-2-Defined codes for meaningful data analyses.


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