Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participant Recruitment
2.2. Data Collection and Measures
2.2.1. Questionnaire Development
2.2.2. Questionnaire Structure
2.2.3. Data Collection Procedures
2.3. Data Analysis
2.4. Ethical Procedures
3. Results
3.1. Basic Characteristics of Respondents
3.2. Normality Test
3.3. Awareness of Coding-Related Work
3.4. Analysis of Influencing Factors of MR and Coding Quality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
DRG | Diagnosis-Related Group |
MR | Medical Record |
MRS | Medical Records Section |
HIM | Health Information Management |
NHIB | National Health Insurance Bureau |
CMI | Case Mix Index |
CDGMRC | Classification of Diseases Group of the Medical Records Committee |
CHA | China Hospital Association |
NHC | National Health Commission |
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Items | Number of People | Proportion (%) | |
---|---|---|---|
Sex | Male | 163 | 33.7 |
Female | 321 | 66.3 | |
Age group | ≤25 | 111 | 22.9 |
26~35 | 172 | 35.5 | |
36~45 | 121 | 25.0 | |
46~55 | 69 | 14.3 | |
≥56 | 11 | 2.3 | |
Education level | Post-secondary and below | 10 | 2.1 |
Junior college education | 41 | 8.5 | |
Bachelor Degree | 316 | 65.3 | |
postgraduate | 105 | 21.7 | |
PhD student | 12 | 2.5 | |
Title | Senior | 22 | 4.5 |
Deputy Senior | 53 | 11.0 | |
Intermediate | 168 | 34.7 | |
Junior | 174 | 36.0 | |
None | 67 | 13.8 | |
Years of coding * | ≤4 | 172 | 46.9 |
(n = 367) | 5–9 | 89 | 24.3 |
10–14 | 53 | 14.4 | |
15–19 | 31 | 8.4 | |
≥20 | 22 | 6.0 | |
Hospital level | Tertiary hospital | 375 | 77.5 |
Secondary Hospital | 68 | 14.0 | |
First level hospital | 14 | 2.9 | |
Unrated hospital | 27 | 5.6 |
Items | Years of Coding Rank Mean | Kruskal-Wallis Test Statistic h-Value | p-Value | ||||
---|---|---|---|---|---|---|---|
≤4 (n = 172) | 5–9 (n = 90) | 10–14 (n = 53) | 15–19 (n = 31) | ≥20 (n = 22) | |||
Code according to the doctor’s diagnosis | 210.92 a | 176.89 | 148.97 b | 154.47 c | 137.00 | 25.362 | 0.000 ** |
Code after communicating with the doctor in agreement | 155.72 a | 211.21 b | 222.65 c | 203.94 | 180.91 | 34.804 | 0.000 ** |
Code after reading the chart and find the basis for the diagnosis | 163.63 a | 207.63 b | 197.70 | 192.27 | 210.32 | 16.661 | 0.002 ** |
Code according to the coding rules, regardless of group entry | 197.63 | 178.41 | 178.95 | 155.68 | 160.75 | 6.797 | 0.147 |
Code according to coding rules, tends to reorganize to higher weights | 186.37 | 182.43 | 178.54 | 187.81 | 188.02 | 0.330 | 0.988 |
Disregard of coding rules, tend to reorganize to higher weights | 221.01 a | 154.71 b | 150.42 b | 154.55 b | 145.23 b | 40.542 | 0.000 ** |
Items | Age Rank Mean | Kruskal-Wallis Test Statistic h-Value | p-Value | ||||
---|---|---|---|---|---|---|---|
≤25 (n = 111) | 26–35 (n = 172) | 36–45 (n = 121) | 46–55 (n = 69) | ≥56 (n = 11) | |||
Code according to the doctor’s diagnosis | 306.18 a | 257.15 d | 206.14 b | 177.12 c | 181.00 | 53.181 | 0.000 ** |
Code after communicating with the doctor in agreement | 176.27 a | 242.24 b | 287.41 b | 259.02 b | 317.27 b | 55.658 | 0.000 ** |
Code after reading the chart and find the basis for the diagnosis | 190.93 a | 244.73 b | 272.12 b | 262.83 b | 274.59 | 28.390 | 0.000 ** |
Code according to the coding rules, regardless of group entry | 272.12 | 243.58 | 227.36 | 221.62 | 224.32 | 8.576 | 0.073 |
Code according to coding rules, tends to reorganize to higher weights | 255.63 | 240.46 | 238.16 | 230.72 | 263.50 | 1.997 | 0.736 |
Disregard of coding rules, tend to reorganize to higher weights | 314.75 a | 248.66 b | 209.24 c | 174.43 e | 210.05 | 57.037 | 0.000 ** |
Influencing Factors | Title Rank Mean | Kruskal-Wallis Test Statistic h-Value | p-Value | ||||
---|---|---|---|---|---|---|---|
Senior (n = 22) | Deputy Senior (n = 53) | Intermediate (n = 168) | Junior (n = 174) | None (n = 67) | |||
Individual physician | 223.07 | 293.24 a | 259.45 a | 237.75 a | 178.57 b | 29.551 | 0.000 ** |
Information system and equipment | 247.95 | 262.56 | 252.12 | 240.57 | 205.74 | 7.554 | 0.109 |
Hospital management | 232.11 | 313.10 a | 261.50 c | 220.29 b | 200.10 d | 31.516 | 0.000 ** |
Organizational processes | 234.14 | 307.01 a | 255.12 c | 229.38 b | 196.65 d | 24.838 | 0.000 ** |
Policy/External factors | 243.82 | 282.15 | 261.41 | 224.51 | 209.99 | 15.833 | 0.003 ** |
Influencing Factors | Title Rank Mean | Kruskal-Wallis Test Statistic h-Value | p-Value | ||||
---|---|---|---|---|---|---|---|
Senior (n = 22) | Deputy Senior (n = 53) | Intermediate (n = 168) | Junior (n = 174) | None (n = 67) | |||
Individual coder | 279.91 | 312.31 a | 258.94 d | 222.14 c | 186.81 b | 37.341 | 0.000 ** |
Information systems and equipment | 261.61 | 278.58 a | 249.07 | 237.55 | 204.07 b | 10.982 | 0.027 * |
Hospital management | 237.66 | 290.59 a | 252.14 | 231.58 | 210.25 b | 13.587 | 0.009 ** |
Organizational process | 243.45 | 287.10 a | 258.23 | 228.65 | 203.43 b | 17.005 | 0.002 ** |
Policy/External Factors | 275.27 | 272.29 | 255.87 | 229.95 | 207.25 | 12.504 | 0.014 * |
Influencing Factors | Title Rank Mean | Kruskal-Wallis Test Statistic h-Value | p-Value | ||||
---|---|---|---|---|---|---|---|
Senior (n = 22) | Deputy Senior (n = 53) | Intermediate (n = 168) | Junior (n = 174) | None (n = 67) | |||
Poor quality within the MR | 252.20 | 296.66 a | 264.12 d | 234.30 b | 163.57 c | 43.163 | 0.000 ** |
Not proficient in coding rules | 280.64 | 307.81 a | 254.13 | 223.68 b | 198.03 b | 28.771 | 0.000 ** |
Inadequate comprehension of chart | 270.89 | 308.40 a | 256.56 | 219.83 b | 204.68 b | 28.204 | 0.000 ** |
Lacking experience with difficult codes | 267.20 | 301.04 a | 255.57 | 225.47 b | 199.52 b | 24.171 | 0.000 ** |
Lacking knowledge of clinical medical | 269.68 | 297.42 a | 260.73 | 218.29 b | 207.29 b | 25.353 | 0.000 ** |
Lacking communication with doctors | 280.09 | 317.47 a | 253.83 b | 218.36 b | 205.15 b | 32.174 | 0.000 ** |
Not make a scientific judgment | 270.55 | 309.59 a | 246.32 | 226.12 b | 213.19 b | 21.095 | 0.000 ** |
Lack of incentives and penalties | 302.68 | 269.60 | 238.79 | 227.21 | 250.32 | 9.124 | 0.058 |
Overthinking DRG enrollment | 247.27 | 256.44 | 243.96 | 241.27 | 229.42 | 1.291 | 0.863 |
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Fu, Y.; Gao, G.; Xing, H.; Dai, S.; Cai, X.; Tian, J. Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research. Healthcare 2025, 13, 849. https://doi.org/10.3390/healthcare13080849
Fu Y, Gao G, Xing H, Dai S, Cai X, Tian J. Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research. Healthcare. 2025; 13(8):849. https://doi.org/10.3390/healthcare13080849
Chicago/Turabian StyleFu, Yinghong, Guangying Gao, Huiying Xing, Shanshan Dai, Xinyu Cai, and Jiashuai Tian. 2025. "Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research" Healthcare 13, no. 8: 849. https://doi.org/10.3390/healthcare13080849
APA StyleFu, Y., Gao, G., Xing, H., Dai, S., Cai, X., & Tian, J. (2025). Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research. Healthcare, 13(8), 849. https://doi.org/10.3390/healthcare13080849