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Int J Qual Health Care. 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099. Epub 2015 Dec 10.

Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).

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Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Department of Psychiatry, Columbia University and the New York StatePsychiatric 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.
Division of General Medicine, University of California-Davis School of Medicine, Sacramento, CA, USA.
Institute of Social and PreventiveMedicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
Flinders University, Adelaide, SA, Australia.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Canadian Institute of Health Information, Ontario, Canada.
Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, 47805, Krefeld, Germany.
Department of Medicine, St. Vincent's Hospital, University ofMelbourne, Australia Department of Medicine, Southern Clinical School, Monash University, Australia.
Department of Medical Information, Health Evaluation and ClinicalResearch, University Lyon I, Hospices Civils de Lyon, France.
HealthQuality Ontario, Toronto, Ontario.
World Health Organization, Classifications, Terminology and Standards, Geneva, Switzerland.


The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data.


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

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