Improving Clinical Coding Coverage and Accuracy Through Cadre-Specific Training: Evidence from a Federal Tertiary Hospital in Southwest Nigeria

                @article{CRSIJ26000507,
                  author = {Ayoola  Sunday Ekundayo, Best Ordinioha, jacob kehinde opele, Folasade Adediran, Modupe Grace Aromokeye},
                  title = {Improving Clinical Coding Coverage and Accuracy Through Cadre-Specific Training: Evidence from a Federal Tertiary Hospital in Southwest Nigeria},
                  journal = {Cosmo Research and Science International Journal},
                  year = {2026},
                  volume = {2},
                  number = {2},
                  pages = {1093-1098},
                  issn = {3108-1584},
                  url = {https://cosmorsij.com/published/CRSIJ26000507.pdf},
                  abstract = {Accurate clinical coding is essential for reimbursement, epidemiological surveillance and health-care planning, yet coding in Nigerian tertiary hospitals is often incomplete and inaccurate owing to inadequate training, backlogs and poor source documentation. This study assessed the effect of a structured training programme for Health Information Management (HIM) Practitioners on the coverage and accuracy of clinical coding. Methods: An interventional, quasi-experimental, one-group pre-test–post-test design was conducted at the Federal Medical Centre, Owo, Ondo State. A structured programme on clinical coding, including detailed instruction in ICD-10 and ICD-11 and a joint inter-professional session with doctors, was delivered in April 2025. Coding was audited in 351 patient folders drawn by simple random sampling from the discharge register in each of two one-year windows (702 folders in total), one year before and one year after the training, using a clinical-coding audit checklist and the WHO ICD as the reference standard. Coverage items were scored dichotomously and accuracy items on a five-point scale; composite scores were compared using an independent-samples t-test at the 0.05 level. Results: Primary-diagnosis coding coverage rose from 59.0% to 90.9% and secondary diagnostic coding from 31.9% to 72.6%. The composite clinical-coding quality score rose from 2.42 (SD = 1.08) to 4.55 (SD = 0.91) out of 5.0 (t = 28.26, df = 700, p < 0.001). The largest gain was in the correspondence between the documented diagnosis and the assigned code, which rose from 2.20 to 4.50. Conclusion: Cadre-specific training significantly improved both coding coverage and accuracy. The exceptional gain in diagnosis–code correspondence, achievable only by training both cadres together, shows that the deficiency is relational and is best addressed through joint inter-professional training supported by institutionalised coding audit.},
                  keywords = {Clinical coding, ICD; coding accuracy, health information management, training intervention, health data quality, Nigeria},
                  month = {September}
        }