Utilization of Disease Classification Systems among Health Information Professionals in ‘Selected Public Hospitals’ in Kiambu County, Kenya
Maina, Duncan Mutongu
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Despite the globally acclaimed efficacy of the disease classification systems as a tool for health planning, reporting and reimbursement, not enough emphasis is laid on the quality of disease coding by the forerunners in the field. The starting point to sustaining the quality of disease coding is establishing its utilization. The purpose of the study is to establish the utilization of disease classification systems in Kiambu County, Kenya. Specifically, the study aims to determine health professionals' factors, health system factors and technological factors affecting utilization of disease classification systems (DCS) in Public Hospitals. This study was conducted in Kiambu County, Kenya, with a focus on public hospitals. Cross-sectional descriptive study design was used by employing total population sampling of the target population. The population of interest was the health records and information management professionals within the study area; as well as the key opinion leaders. Complete enumeration and purposive sampling designs were used to select the study participants, which included all 119 HRIOs in Kiambu County. Data was collected using self-administered questionnaires and key informant guides with the help of two research assistants. Data entry and analysis was done using SPSS v22. Data analysis included both descriptive (frequencies, means, percentages) and inferential statistics (Pearson chi-square with degrees of freedom), with the alpha level of significance set at 5%. Out of the 112 respondents, 75 (67%) indicated that the systems were utilized either frequently or always on average for the functions studied. Clinical coding was done at various locations within the hospitals and broadly depended on the layout of each facility. The study also found that greater age (X2= 7.719; p=0.003), increase in length of coding experience (X2= 3.7; p=0.027), and better DCS perception (X2= 9.74; p=0.00) were significantly associated with frequent use of DCS utilization. Additionally, from the qualitative findings, resource allocation for health, and consequently for DCS was inadequate; International coding guidelines and policies were present as availed through the World Health Organization (WHO), although local or national guidelines were missing. The study found sufficient evidence to reject the null hypothesis that health professionals age, duration of disease classification experience, and perception of DCS were not statistically significantly associated with DCS utilization. The study concludes that, based on these findings, coding experience, positive perception, health facility budget and availability of disease classification technology were central to the success of utilization of DCS. The study recommends 1) County Health Management Team (CHMT) and Sub-CHMT to increase exploitation of the various uses of DCSs at facility level so as to improve the perception of the staff; 2) The HRIOs to emphasize on importance of DCS technology in the health facilities to increase utilization of the DCSs; and 3) The MOH should increase resource allocation for health, and consequently for DCS at all levels: national and county.