对可靠的ICD-10儿童虐待编码的挑战：对德国和瑞典医院医疗保健专业人员的定性访谈研究

IF 3.4 2区心理学 Q1 FAMILY STUDIES

Child Abuse & Neglect Pub Date : 2025-04-16 DOI:10.1016/j.chiabu.2025.107446

Teresa Walter , Laura Korhonen , Gabriel Otterman , Godfried van Agthoven , Andreas Jud

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引用次数: 0

摘要

儿童虐待（CM）是一个重大的公共卫生问题。数据收集、分析和报告被广泛认为是制定旨在防止儿童虐待的政策和计划的关键组成部分。不幸的是，医院的医疗保健专业人员（hcp）对CM的编码严重不足。由于缺乏研究，这种编码不足的原因尚未完全了解。目的识别和了解导致德国和瑞典医院CM编码不足的挑战性因素。样本包括28名参与编码过程的医护人员：儿科医生（n = 14）、儿童精神科医生（n = 6）、儿科外科医生（n = 4）、医疗编码专业人员（n = 3）和儿童保护协调员（n = 1）。其中19名为女性，9名为男性；年龄从24岁到65岁不等。方法采用Braun &的专题分析方法对半结构化访谈文本进行编码和分析；克拉克。结果本研究确定了四个主要主题在多个层面上影响儿童虐待编码行为。(1)系统框架的影响，描述系统因素，如法律要求和缺乏义务教育；(2)组织文化和结构的作用，描述了诊所的态度、透明度和质量控制方面的不足；(3)多学科合作与沟通的人际动力学；(4)人际障碍：知识、不确定性和情绪负担。结论确定的主题对医护人员编码实践有显著影响。应对这些多方面的挑战需要全面的教育计划、改进的组织支持和系统性变革，以抵消医院对CM的编码不足。

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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.

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来源期刊

Child Abuse & Neglect Multiple-

CiteScore

7.40

自引率

10.40%

发文量

397

期刊介绍： Official Publication of the International Society for Prevention of Child Abuse and Neglect. Child Abuse & Neglect The International Journal, provides an international, multidisciplinary forum on all aspects of child abuse and neglect, with special emphasis on prevention and treatment; the scope extends further to all those aspects of life which either favor or hinder child development. While contributions will primarily be from the fields of psychology, psychiatry, social work, medicine, nursing, law enforcement, legislature, education, and anthropology, the Journal encourages the concerned lay individual and child-oriented advocate organizations to contribute.