Contents lists available at ScienceDirect European Journal of Integrative Medicine journal homepage: www.elsevier.com/locate/eujim Research paper Traditionally trained acupuncturists’ views on the World Health Organization traditional medicine ICD-11 codes: A Europe wide mixed methods study ☆ John Hughes a, ⁎ , Peter Fisher b , Stéphane Espinosa c , Benno Brinkhaus d , Vinjar Fonnebo e , Elio Rossi f , George Lewith g a Royal London Hospital for Integrated Medicine, UCLH NHS Trust, 60 Great Ormond Street, London, WC1N 3HR, UK b Deceased Royal London Hospital for Integrated Medicine, UK c World Health Organization, Switzerland d Charité Universitätsmedizin Berlin, Germany e Tromso University, Norway f Hospital Campo di Marte, Italy g Deceased University of Southampton, UK ARTICLEINFO Keywords: Traditional medicine International classification of diseases Clinical utility Pilot field test ABSTRACT Introduction: The diagnostic categories used in Traditional Medicine (TM) that originated in China and are now used around the world have been classified for inclusion as a chapter within the World Health Organization’s International Classification of Diseases (ICD). As a new chapter in ICD, the TM ICD codes were subject to in- ternational field testing. A pilot field test of the TM ICD codes was conducted to investigate their clinical utility in the European context. Design: Amixedmethodsapproach,includingaEuropewidesurveyofpractitionerviewsonTMICDcodes;and investigating the coding process of case study vignettes to explore coders’ experiences of using TM ICD codes. Results: Survey: The majority of participants felt TM ICD codes provide a meaningful way to classify TM dis- ordersandpatterns;felttheirpatients’diagnosescouldberepresentedwithinthecodes;andfeltthecodeswould be important in their clinical practice. Coding of vignettes: In 60.7% of cases the specificity of the assigned code was perceived as ‘just right’. Participants experienced difficulties assigning a single TM ICD disorder and pattern code, due to multiple codes being viewed as appropriate for the case. Conclusions: TheEuropeanTMpractitionerswhoparticipatedinthisstudylargelyperceivetheTMICDcodesas valuable, conceptually accurate, and incorporating the range of TM diagnoses utilized within clinical practice. The TM ICD codes could be improved for European TM practitioners by expanding the scope of TM ICD codes, andadoptingamultidimensionalapproachwherebymorethanonedisorderand/orpatterncodecanbeapplied to single patients. 1. Introduction The International Classification of Diseases (ICD) is the standard international classification for epidemiology, health management and clinical purposes. This includes the analysis of the general health si- tuation of population groups. It is used to monitor the incidence and prevalence of diseases and other health issues, providing a picture of the general health situation of countries and populations [1]. ICD is used by physicians, allied health professionals, researchers, health information managers and coders, health information tech- nology workers, policy-makers, insurers and patient organizations to classifydiseasesandotherhealthproblems.ICDdiagnosesarerecorded on many types of health and vital records, including death certificates and health records. In addition to enabling the storage and retrieval of https://doi.org/10.1016/j.eujim.2018.11.009 Received 6 June 2018; Received in revised form 28 November 2018; Accepted 28 November 2018 ☆ We dedicate this paper to the excellent researchers and our good friends Professor George Lewith and Dr Peter Fisher who both sadly passed away before this study was complete. ⁎ Corresponding author. E-mail address: John.Hughes8@nhs.net (J. Hughes). European Journal of Integrative Medicine 25 (2019) 49–54 1876-3820/ © 2018 Published by Elsevier GmbH. T