Background: Emergency departments (EDs) in Malaysia play a critical role in healthcare delivery, managing a wide range of conditions. Developing diagnosis-related groups (DRGs) for emergency care requires a comprehensive understanding of the patterns of disease presentation. This study examines the use of International Classification of Diseases, 10th Revision (ICD-10) codes in EDs across Malaysia to inform DRG development.
Methods: This cross-sectional study was based on a functional exercise conducted by the Ministry of Health Malaysia over a 6-week period from June to July 2022. Data were collected from 13 public hospitals, including various hospital types (state, major specialist, minor specialist, and non-specialist hospitals) across Peninsular Malaysia, Sabah, and Sarawak. Systematic random sampling was used to select emergency care episodes, resulting in 9,942 records. Ethical approval was obtained from the Medical Research and Ethics Committee, Ministry of Health Malaysia (approval dated 29 June 2022). The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. Sample size calculation using OpenEpi determined a minimum requirement of 1,512 records with a 99.99% confidence level, adjusted to 1,814 samples to account for a 20% attrition rate.
Results: Respiratory diseases were the most frequently reported conditions, accounting for 21.2% of cases. The analysis identified 946 unique ICD-10 codes, with a significant number used infrequently. Codes with fewer than five presentations constituted 73.7% of all codes, while the top 20 diagnoses represented 42.9% of all records. Systematic ICD-10 coding revealed key areas where DRGs could be developed to enhance resource allocation in emergency care.
Conclusions: The study highlights the diversity in diagnoses within Malaysian EDs and underscores the need for tailored DRGs to optimize healthcare resources. Future research should expand data collection to capture seasonal trends and refine the development of principal diagnosis lists to support DRG categorization.
