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Incidence Of Clinical Coding Errors And Implications On Casemix Reimbursement In A Teaching Hospital In Malaysia

Malaysian Journal of Public Health Medicine.2017;17(2):19-28.

Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.

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The Malay Version Of Antenatal And Postnatal Breastfeeding Self-Efficacy Scale-Short Form: Reliability And Validity Assessment

Huzaimah Husin1 ; ZalehaMd Isa ; Khalib Abd Latif ; Rosemawati Ariffin ; Suriati Abd Rahman ; Hasanain Faisal Ghazi

Malaysian Journal of Public Health Medicine.2017;17(2):62-69.

Maternal self-efficacy in breastfeeding is one of the potential modifiable factors which is consistently linked with positive breastfeeding outcomes. This study aimed to develop a Malay translation of the original English BSES-SF and to conduct a validity and reliability assessment on both antenatal and postnatal questionnaires among 101 pregnant women in their third trimester and 104 women on their first week postpartum. The Malay translation of the English BSES-SF was conducted by using back-to-back translation processes, followed by validity and reliability evaluation. The validated Malay version of the questionnaire BSES-SF was then administered on the respondents. The questionnaire comprised of socio-demographic, antenatal, and breastfeeding information. Furthermore, data on infant feeding method were collected via telephone call made to the respondents at four weeks postpartum. The Cronbach’s Alpha value for antenatal BSES-SF questionnaire was0.94, while the value for postnatal BSES-SF questionnaire was 0.95. The factor analysis identified a one-dimensional structure which able to explain 59.02% of the variance for antenatal questionnaire and 60.43% of the variance for postnatal questionnaire. In addition, high antenatal and postnatal breastfeeding self-efficacy scores were significantly associated with the practice of exclusive breastfeeding at four weeks postpartum. As a conclusion, Both Malay versions of the antenatal and postnatal BSES-SF questionnaires are valid and reliable tools to assess breastfeeding self-efficacy among Malaysian mothers.
Malay Version ; breastfeeding ; breastfeeding self-efficacy

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Assessment Of Ergonomic Risk Level And Working Performance Of Pre-Cast Construction Workers In Sabah

Muhamed Zainal Muktar ; Shamsul Bahari Shamsudin ; Khamisah Awang Lukman ; Mohammad Saffree Jeffree

Malaysian Journal of Public Health Medicine.2017;17(2):151-158.

A cross-sectional study was conducted on 116 male pre-cast construction workers in Sipitang, Sabah to evaluate the association between Ergonomic Risk Level exposure and their working performances for 6 months (June to November 2014). Initially, a structured interview using a modified-Standardized Nordic Questionnaire was conducted on each study subject to determine the prevalence of Musculoskeletal Disorders (MSDs). The results showed that 93 out of 116 subjects (80.17%) complained of experiencing ache, pain or body discomfort during and after work with high percentage of MSDs prevalence affecting the wrist (78.5%), shoulder (73.1%), and lower leg (71.0%) regions of the body. Pictures and videos of workers performing their routine tasks were analyzed using Rapid Entire Body Assessment (REBA) tool to generate individual Ergonomic Risk Level classification. The results showed that all subjects were exposed to Medium (56.90%), High (29.31%) and Very High (13.79%) level of Ergonomic Risk. Pearson Correlation and One-way ANOVA test was conducted to determine the association between Ergonomic Risk Level and the subjects’ individual working performances. The results indicated that there was a significant negative association between Ergonomic Risk Level and the workers' performances in terms of tendency to work overtime (p<.001, r=-.55) and the frequency of taking unpaid leaves (p=.038, r=.56). In conclusion, continuous exposure to significant Ergonomic Risk Level among the pre-cast construction workers has triggered the development of MSDs which eventually affected their working performances.
Pre-cast construction ; Ergonomic Risk Level ; Rapid Entire Body Assessment ; Musculoskeletal Disorders ; Working Performances.

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Development And Validation Of A Questionnaire On Socio-Cultural Factors Among The Orang Asli And General Population In Selangor

Aniza I ; Norhayati M ; Norfazilah A

Malaysian Journal of Public Health Medicine.2017;17(2):140-150.

Cultural attitudes of the societies have long been identified as one of the important determinants of Quality of Life (QoL). Yet there is a dearth of socio-culturally validated instruments for local population to assess the impact of socio-cultural practice on health. The aim of this validation study is to develop and test the validity and reliabilityof a questionnaire on culture dimensions.Respondents were asked about their engagement in socio-cultural aspects including beliefs and practice oftraditional customs and culture using a set of newly developed questionnaire.A total of 275eligible respondentsparticipatedwith150(54.5%)from the general population and 125 (45.5%)from the Orang Asli population. Kaiser-Meyer Olkin measure of Sampling Adequacy (KMO) was 0.791 and 0.677 for the general and Orang Asli population respectively. Bartlett’s test for both population was significant (p<0.001). By Principal Common Analysis, four factorswere extracted (Eigen values >1.0) that jointly accounted for 54.7% and 52.0% of the total variance among the general population and Orang Asli respectively.The Cronbach alpha value score was 0.785and 0.730 for the general population and Orang Asli population respectively. The Cronbach alpha values foreach of the four domains ranged from 0.477-0.865 and 0.543-0.758 for the general population and Orang Asli population respectively.These results suggest that the newly developed questionnaire appeared to have adequate validity and reliability in measuringsocio-cultural factors in the population.
general population & ; Orang Asli ; cultural believe & ; practice

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Cardiorespiratory Fitness, Physical Activity Level, Body Mass Index And Blood Pressure Among University Students In Negeri Sembilan

Thirumalaya Balaraman ; Vinodhkumar Ramalingam ; Punithakumar Ramasamy Kantharuban ; Jayesh Chandran1 ; Praveen Jayaprabha Surendran

Malaysian Journal of Public Health Medicine.2017;17(2):128-139.

Noncommunicable diseases are the number one killer globally and it could develop due to various risk factors. This cross-sectional study was aimed to identify these risk factors by assessing body mass index, waist circumference, waist to hip ratio and blood pressure and to find out the correlation between these risk factors, and cardiorespiratory fitness and physical activity level. The study samples were 103 students from two universities in Negeri Sembilan state selected by the convenience sampling method. After ethical clearance, International Physical Activity Questionnaire-short form in English was used to assess the physical activity level. The cardiorespiratory fitness was assessed by the Rockport one mile walk test and the other parameters were assessed following the standard protocols. The percentage of overweight (32.04%) and pre-hypertension (25.24%) were higher among students. 35.92% of students reported a low physical activity level and 46.6% having a lower fitness level (fair and poor). The physical activity level correlated with the cardiorespiratory fitness level (P<0.01). The body mass index (P<0.01) and systolic blood pressure (male P 0.05, female P<0.01) negatively correlated with the cardiorespiratory fitness level. Therefore, measures have to be taken to improve the physical activity level and cardiorespiratory fitness to lower the risk of overweight and high blood pressure among university students.
cardiorespiratory fitness ; VO2 max ; Body mass index ; waist circumference ; Waist to hip ratio ; blood pressure

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Provider Costs Of Treating Dementia Among The Elderly In Government Hospitals Of Malaysia

Amrizal Muhammad Nur ; Syed Mohamed Aljunid ; Normazwana Ismail ; Sharifah Azizah Haron ; Asrul Akmal Shafie ; Norashidah Mohamed Nor ; Mohmad Salleh ; Roshanim Koris ; Namaitijiang Maimaiti

Malaysian Journal of Public Health Medicine.2017;17(2):121-127.

he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
dementia ; Provider Cost ; CCM ; Step-down costing

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Assessment Of Indoor Airborne Microorganisms In A Densely Populated Malaysian Public University

Eric Tzyy Jiann Chong ; Khairul Atikah Khairul Faizin ; Lucky Poh Wah Goh ; Ping-Chin Lee

Malaysian Journal of Public Health Medicine.2017;17(2):113-120.

Indoor air quality is an essential aspect for occupational health including in a densely populated university. This study aimed to assess the indoor airborne microorganisms via biochemical and molecular approaches in five enclosed workplaces, and their resistance towards six commonly used antibiotics. Cfu/dm2/h for five enclosed workplaces was determined using settle plate technique with 1/1/1 scheme and Gram staining was performed for all pure strains isolated. Two strains with the highest count and with different morphologies were identified using biochemical test as well as 16S rRNA amplification and direct sequencing. Minimum inhibitory concentration for antibiotics was carried out for these two strains. In this study, 27 microbial strains with different morphologies were obtained from all workplaces and 2 strains with the highest count were strain J in café and strain M in library, which were identified as Bacillus cereus and Staphylococcus cohnii, respectively. Both of them were highly susceptible to ampicillin and tetracycline. With resistance up to 0.78 µg/mL; B. cereus was less sensitive to kanamycin and neomycin whereas S. cohnii was less sensitive to streptomycin. In conclusion, antibiotics resistant B. cereus and S. cohnii were two of the microorganisms showing the most abundance in the café and library of a Malaysian public university, respectively. This study may serve as the baseline for the prescriptions of antibiotics to airborne microbial related infections especially to the community in the university who seek for medical treatments; particularly for respiratory and digestive infections which often associated with indoor microenvironment.
antibiotic resistance ; Bacillus cereus ; indoor air quality ; minimum inhibitory concentration ; Staphylococcus cohnii

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Systematic Review Of Factors Associated With Willingness To Pay For Health Financing Scheme

A Azimatun Noor ; Syed Mohamed Aljunid

Malaysian Journal of Public Health Medicine.2017;17(2):103-112.

Health care has emerged as one of the fastest growing industry worldwide. This induced health care costto rise tramendously. However, it is important to preserve high quality health care services that are equitable and affordable. In many countries, people are expected to contribute to the cost of the health care. Are populations ready to accept the concept and willing to pay for health financing scheme? What possible factors that may associate with their decision? This is the objective of the study, to examine the relevance evidence for this through a systematic review of literatures.We systematically searched Ovid MEDLINE and Google Schoolar databases until April 2016. We assessed the study population willingness to pay for health financing scheme and determine the significant variables that associate with WTP. 19 full-text articles were included in the review. Factors that were found significantly associated with WTP for health financing scheme by many studies were age, education, income and residential locality. Other factors that also found associated with WTP were health care services utilization and expenditure. The review findings showed that WTP for health financing scheme is beyond the households’ financial capacity and has multifactorial influences.
Willingness to pay, health financial scheme, health insurance, social health insurance

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Factors Determining Attempt-To-Quit Smoking Among Adult Current Smokers In Sarikei, Sarawak, Malaysia

Wong Khung Ying ; Md Mizanur Rahman

Malaysian Journal of Public Health Medicine.2017;17(2):96-102.

Achieving smoking cessation is an arduous process, where smokers try different methods or approaches to achieve cessation. Quit smoking attempts play an important role in smoking cessation.Thus, this study was conducted to determine the factors associated with attempt-to-quit smoking among the currentsmokers in Sarawak.This cross-sectional study was conducted among adult smokers in Sarikei, Sarawak by face-to-face interview using an adapted and validated questionnaire. Non-probability sampling method was used to select the study place. An adult smoker was selected systematically from each selected household. A total of 482 smoker households were identified with a response rate of 92.3%. Data was analysed using IBM SPSS Version 22.0. A p-value of <0.05 was considered statistically significant. The mean (SD) age of the smokers was 36.3(13.3) years. However, the mean (SD) age of smoking initiation was 18.5(4.8) years. Majority of the smokers were male (91.5%), with the male to female ratio being 1:0.1. Mean (SD) score on The Fagerström Test for Nicotine Dependence was 4.75(2.4), while motivation to quit smoking score was 3.04(1.0). Majority of the smokers (83.1%) hadever seen pictorial health warnings on cigarette packs. More than half of the smokers (54.8%) had ever tried to quit smoking. Binary logistic regression analysis revealed that marital status, religion, ethnicity, pictorial health warnings on cigarette packs and motivation to quit smoking appeared to be the significant predictors of attempt-to-quit smoking (p<0.05). Understanding the attempts to quit smoking will assist inclinical expectations. Thus, a smoking cessation programme should be designed in line with these factors, to aid quit smoking attempts.
Smoking ; Attempt-to-quit ; Addiction ; Motivation ; Pictorial Health Warning ; Sarawak

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Consumer Perception Of The Health Care Services In Yemen And Its Impact On Self-Medication Practice

Sami Mohammed Albawani ; Yahaya Bin Hassan ; Noorizan Abd-Aziz ; Shubashini Gnanasan

Malaysian Journal of Public Health Medicine.2017;17(2):90-95.

Community pharmacists are expected to have the necessary knowledge to give advice on safe and appropriate drug use during self-medication. However, the profession of pharmacist in Yemen has become less trustworthy and less reliable. In addition, quality of medication has been raising a lot of questions among consumers and fake medications have been entering the country without quality control checks. The aim of this study was to determine the consumer perception of health care services provided and its impact on self-medication practice in Sana’a city, Yemen. A self-administered questionnaire containing open-ended and closed-ended questions was developed and distributed among 400 consumers attending 10 community pharmacies in Sana’a City. All data obtained from the questionnaires were coded, entered, and analysed using Chi-square test and multiple logistic regressions. Prevalence of self-medication was found to be 90.7 %. The majority of respondents stated that they do not trust the health care services provided by physician (68.8%), community drug dispensers (78.2%), Ministry of Health (70.5%) or the quality of medicine dispensed by community pharmacies (59.7%). The trust of health care services provided by physicians and community drug dispensers were found to be significant predictors of self-medication practice. Those who did not trust health care services provided by physicians were more likely to use self-medication compared to those who did not (OR= 21.212, CI 95% 2.678-168.001, p= 0.004). Those who did not trust health care services provided by community drug dispensers were more likely to use self-medication compared to those who did not (OR= 2.746, CI 95% 1.048-7.195, p= 0.04). Consumers in Sana’a City have a negative overall perception of the services provided by community drug dispensers, physician and Ministry of Health and the quality of medication. An urgent intervention from health care authorities to adopt and to implement a new national drug policy with necessary laws and regulations is needed
Self-medication ; Trust ; Health Care Providers ; Community Pharmacy consumers ; Sana&rsquo ; a City ; Yemen

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