Clinical coders' work engagement under China's healthcare payment reform: A cross-sectional study.

Authors

Yicong Xu, Jingya Zhou, Zhenghua Liu, Naishi Li, Dong Cai, Shengdong Pan

Published in

Health information management : journal of the Health Information Management Association of Australia. Pages 18333583261476770. Sep 28, 2026. Epub Sep 28, 2026.

Abstract

The accuracy of clinical coding, which is essential for supporting managerial and policy decisions such as funding formulas, is closely tied to the work engagement of clinical coders.
This paper aimed to evaluate the level of work engagement and associated factors among clinical coders through a nationwide survey in China.
Thirty-one tertiary public hospitals in China were selected via convenience sampling, and 354 clinical coders were surveyed with Question-star software. Work engagement was measured using the 17-item Chinese version of the Utrecht Work Engagement Scale (UWES), with each item rated from 0 to 6. Twenty-two potentially related variables were collected. Descriptive statistics and one-sample t-tests (vs UWES norms) were used to assess work engagement levels. Cluster analysis was performed to identify engagement patterns. Independent-samples t-tests or one-way analysis of variance were used to examine engagement differences across the 22 variables. Variables with p < 0.05 in univariate analysis were entered into multiple linear regression to identify associated factors.
The mean work engagement score among clinical coders was significantly lower than the UWES-17 norm (3.26 vs 3.82; t = -8.378, p < 0.001). The participants were classified into three engagement groups: high (29.5%), moderate (50.7%), and low (19.8%). Multiple linear regression analysis revealed seven variables that were significantly associated with work engagement (F (7, 331) = 11.493, p < 0.001, R² = 0.196): region, continuing education, ideal clinical coding software, work position, perceived leadership support, physician-coder communication and sex.
Clinical coders in China demonstrated moderate-to-low work engagement, shaped primarily by objective career development conditions, along with their perceived software support and organizational support.Implications for health information management practice:Enhancing work engagement requires managerial focus on continuing education, software usability, and perceived leadership support.

PMID:
42803428
Bibliographic data and abstract were imported from PubMed on 28 Sep 2026.

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