Developing and Measuring the Reliability and Validity of the Factors Influencing the Implementation of ICD-10-AM and Clinical Coding in Saudi Public Hospitals

BACKGROUND: The introduction of a mandatory health insurance system contributing towards the funding of national healthcare in Saudi Arabia necessitates the implementation of clinical coding and a unified health classification system, which has previously not been a feature of Saudi healthcare. As the Ministry of Health (MOH) moves to introduce ICD-10-AM, the Australian modification of the WHO ICD-10, in the Kingdom’s public hospitals, it is important to understand the factors that will influence its successful implementation.

OBJECTIVE: The purpose of this article is to develop and evaluate the internal consistency reliability and validity of a questionnaire establishing the factors influencing the the implementation ICD-10-AM and clinical coding in Saudi public hospitals.

METHOD: The content validity method was initiated by sending the whole draft questionnaire to a panel of experts to indicate values for each item based on a scale of content validity created by the researchers and, subsequently, using the internal consistency reliability and factorial validity methods to estimate the internal reliability of clusters of items, which were assumed to measure the same factors, grouped in this study into three factorial categories, health information (clinical documentation, classification, and coding requirements), organization (the implementation preparation in individual organizations), and national (institutional support through the national hierarchical structure).

RESULTS: The content validity identified all items of the proposed questionnaire to be valid. Based on the content validity test, several items were removed as they did not meet the proposed model and the final questionnaire was created in accord with the pilot study result. The pilot study utilized Cronbach's α and factor analysis to examine the reliability and validity of Part 2 of the questionnaire and the findings indicated high internal consistency reliability and factorial validity.