Schneider D
Health Serv Res. 1979 Spring;14(1):77-87.
A medical classification system for coding a patient's reason for visit has been developed for use in the National Ambulatory Medical Care Survey and for ambulatory care settings. The code is developed in a modular structure and includes modules for Symptoms; Diseases; Diagnostic, Screening and Preventive Procedures; Therapeutic Procedures, Process Problems and Counseling; Injuries and Adverse Effects; Follow-ups for Test Results; and Administrative Reasons for Visits. The system was evaluated in coding tests, through review by medical societies representing the major specialties, and by other health care providers. An extensive coding index is available.
已开发出一种用于对患者就诊原因进行编码的医学分类系统,供国家门诊医疗护理调查及门诊护理机构使用。该编码采用模块化结构,包括症状模块、疾病模块、诊断、筛查及预防程序模块、治疗程序、过程问题及咨询模块、损伤及不良反应模块、检查结果随访模块以及就诊管理原因模块。该系统通过编码测试、由代表主要专业的医学协会及其他医疗服务提供者进行审查等方式进行了评估。同时还提供了一份详尽的编码索引。