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