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Int J Qual Health Care. 2016 Feb;28(1):129-35. doi: 10.1093/intqhc/mzv096. Epub 2015 Dec 8.

Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data.

Author information

Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Division of General Medicine, University of California-Davis School of Medicine, Sacramento, CA, USA.
Department of Medicine, St Vincent's Hospital, University of Melbourne, Parkville, Australia Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia.
Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, 48705, Krefeld, Germany.
Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA Irving Institute for Clinical and Translational Research at Columbia University and New York-Presbyterian Hospital, New York, NY, USA RAND Corporation, Pittsburgh, PA, USA.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.



In 2018, the World Health Organization (WHO) plans to release the 11th revision of the International Classification of Diseases (ICD). The overall goal of the WHO is to produce a new disease classification that has an enhanced ability to capture health concepts in a manner that is compatible with contemporary information systems. Accordingly, our objective was to identify opportunities and challenges in improving the utility of ICD-11 for quality and safety applications.


A survey study of international stakeholders with expertise in either the production or use of coded health data.


International producers or users of ICD-coded health care data.


We used a snowball sampling approach to identify individuals with relevant expertise in 12 countries, mostly from North America, Europe, and Australasia. An 8-item online survey included questions on demographic characteristics, familiarity with ICD, experience using ICD-coded data on healthcare quality and safety, opinions regarding the use of ICD classification systems for quality and safety measurement, and current limitations and potential future improvements that would permit better coding of quality and safety concepts in ICD-11.


Two-hundred fifty-eight unique individuals accessed the online survey; 246 provided complete responses. The respondents identified specific desires for the ICD revision: more code content for adverse events/complications; a desire for code clustering mechanisms; the need for diagnosis timing information; and the addition of better code definitions to reference materials.


These findings reinforce the vision and existing work plan of the WHO's ICD revision process, because each of these desires is being addressed.


International Classification of Diseases; World Health Organization; patient safety; quality indicators

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