Challenges to reliable ICD-10 coding of child maltreatment: A qualitative interview study of healthcare professionals in German and Swedish hospitals.

BACKGROUND

Child maltreatment (CM) is a major public health issue. Data collection, analysis, and reporting are widely recognized as key components in developing policies and programs aimed at preventing child maltreatment. Unfortunately, CM is significantly under-coded by healthcare professionals (HCPs) in hospitals. Due to a lack of studies, causes of this under-coding are not fully understood.

OBJECTIVE

The aim was to identify and understand challenging factors leading to under-coding of CM in hospitals in Germany and Sweden.

PARTICIPANTS AND

SETTING

The sample includes 28 HCPs from different professional groups involved in coding-process: pediatricians (n = 14), child psychiatrists (n = 6), pediatric surgeons (n = 4), medical coding professionals (n = 3), and child protection coordinators (n = 1). Nineteen identified as female and 9 as male; age ranged from 24 to 65.

METHODS

The transcripts of the semi-structured interviews have been coded and analyzed using the thematic analysis approach of Braun & Clarke.

RESULTS

In this study, four major themes were identified influencing child maltreatment coding practices on multiple levels. (1) The Impact of Systemic Frameworks, describing systemic factors, such as legal requirements and lack of mandatory education; (2) The Role of Organizational Culture and Structures, describing attitude of the clinic, transparency, and shortcomings in quality control; (3) Interpersonal Dynamics of Multidisciplinary Cooperation and Communication; and (4) Intrapersonal Barriers: Knowledge, Uncertainty, and Emotional Burdens.

CONCLUSION

Identified themes significantly influence HCPs coding practices. Addressing these multifaceted challenges requires comprehensive educational programs, improved organizational support, and systemic changes to counteract the under-coding of CM in hospitals.