Intimate partner violence and clinical coding: issues with the use of the International Classification of Disease (ICD-10) in England

Abstract

Objectives To investigate the availability of intimate partner violence-related population health information in England and the possibility of identifying intimate partner violence-exposed population sample frames from administrative health data systems in England employing the International Classification of Disease. Methods Research design was an exploratory mixed method approach that involved trend analysis of numbers of applications of International Classification of Disease intimate partner violence classifications for admissions to NHS hospitals in England over a five-year period and semi-structured focus group interviews with clinical coders at an NHS Hospital. Results Use of International Classification of Disease intimate partner violence classifications was generally low across NHS Trusts in England. There was notable variation in the numbers of applications across NHS providers which demographic differences or rates of violence perpetration would not account for. The interview findings revealed conceptual ambiguity regarding intimate partner violence classifications which presented challenges for clinical coding and raised questions about the reliability and validity of International Classification of Disease's intimate partner violence classifications. Conclusion It would not be possible to extract robust data about populations exposed to intimate partner violence for the purposes of audit, governance or research from health information systems using current International Classification of Disease-10 classifications. Development of these International Classification of Disease codes is essential for violence and abuse to be captured more accurately in health information systems and afforded greater prioritization and funding proportionate to the health burden and service demands that intimate partner violence is responsible for.

Trends in Hospital Admissions for Intimate Partner Violence in Australian Mothers With Children Born From 1990 to 2009

“…Partner Conflict Impacting Health Status (Conflict) included counseling for marital and partner problems and problems in relationship with spouse or partner that influence health status (ICD-9: V61.1; ICD-10-AM: Z63.0—Discord between partners resulting in severe or prolonged loss of control, in generalization of hostile or critical feelings, or in a persisting atmosphere of severe interpersonal violence [hitting or striking]). Z codes are acknowledged as a conceptually discrete category (Olive, 2018; WHO, 2016); therefore, it was important to acknowledge them in their own specific category.…”

“…While assault-related ICD codes do not specifically indicate the relationship to the perpetrator, there are specific Z-codes related to partner relationships These codes represent factors that influence a person's health state, and we used the Z-code relating to partner conflict that impacts health status: Z63.0 and its predecessor V61.1. The Z63.0 code captures victimisation of multiple forms of violence which are important to the understanding of hospitalisations due to IPV (Olive, 2018). We focused on hospitalisations of mothers in two time periods: i) those occurring 12 months prior to birth; and ii) those occurring 12 months prior to birth and up to 36 months after birth.…”

“…For both groups, classifications were grouped into the following: ing for marital and partner problems and problems in relationship with spouse or partner that influence health status (ICD-9: V61.1; ICD-10-AM: Z63.0-Discord between partners resulting in severe or prolonged loss of control, in generalization of hostile or critical feelings, or in a persisting atmosphere of severe interpersonal violence [hitting or striking]). Z codes are acknowledged as a conceptually discrete category (Olive, 2018;WHO, 2016); therefore, it was important to acknowledge them in their own specific category. • All IPV (All) included all codes for Assault and Conflict and additional codes for external cause of injury and poisoning, including undetermined intent (ICD-9: E980 to E989 and ICD-10-AM: Y10 to Y34).…”

Exploration of trends in the incidence and prevalence of childhood maltreatment and domestic abuse recording in UK primary care: a retrospective cohort study using ‘the health improvement network’ database

“…There is no specific international classification of disease code that are specific to domestic abuse: The closest matches are T74.1 (physical abuse, confirmed), Y07.0 (spouse or partner, perpetrator of maltreatment and neglect) and Z63.0 (and problems in a relationship with spouse or partner) which when specified in adults relate to physical abuse, maltreatment. 29 However, there are substantial limitations to utilising these codes to describe the epidemiology of domestic abuse, due to low numbers of such codes being recorded and also ambiguities in coding practice between hospital trusts. 29 The state of epidemiological estimates when exploring childhood maltreatment suffers from similar challenges.…”

“…29 However, there are substantial limitations to utilising these codes to describe the epidemiology of domestic abuse, due to low numbers of such codes being recorded and also ambiguities in coding practice between hospital trusts. 29 The state of epidemiological estimates when exploring childhood maltreatment suffers from similar challenges. A recent observational study used data from 1858 to 2016 that was derived from child mortality records, police recorded-homicides, crimes against children, child protection data, children in care and data taken from the National Society for the Prevention of Cruelty to Children (NSPCC) to study long term trends of child maltreatment.…”