[Determinants of time required by medical information technicians for quality control of hospital activity coding, in French medico-administrative system]

Rev Epidemiol Sante Publique. 2019 Jul;67(4):213-221. doi: 10.1016/j.respe.2019.05.006. Epub 2019 Jun 10.
[Article in French]

Abstract

Background: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls.

Methods: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half.

Results: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding.

Conclusion: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.

Keywords: Activity-based funding; Codage; Coding; Contrôle qualité; Diagnosis-related groups; Optimisation; PMSI; Quality control; Tarification à l’activité.

Publication types

  • Validation Study

MeSH terms

  • Case-Control Studies
  • Clinical Coding* / organization & administration
  • Clinical Coding* / standards
  • Diagnosis-Related Groups / organization & administration
  • Diagnosis-Related Groups / standards
  • Electronic Health Records / organization & administration
  • Electronic Health Records / standards
  • Fees, Medical
  • Female
  • France
  • General Practice* / organization & administration
  • General Practice* / standards
  • General Surgery* / organization & administration
  • General Surgery* / standards
  • Humans
  • Length of Stay* / economics
  • Length of Stay* / statistics & numerical data
  • Male
  • Medical Informatics* / methods
  • Medical Informatics* / organization & administration
  • Medical Informatics* / standards
  • Obstetrics* / organization & administration
  • Obstetrics* / standards
  • Quality Control*
  • Quality Indicators, Health Care / standards
  • Quality of Health Care
  • Regional Medical Programs / organization & administration
  • Regional Medical Programs / standards
  • Time Factors
  • Workload