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Dr KEES VAN BOVEN Dutch College of General Practitioners

The Dutch Family of International Classifications: ICPC-2, ICD-10, and ICF. Dr KEES VAN BOVEN Dutch College of General Practitioners. Roles of the Dutch family members. In general practice electronic patient records diagnostic ordering principle for the GP: ICPC-2

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Dr KEES VAN BOVEN Dutch College of General Practitioners

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  1. The Dutch Family of International Classifications: ICPC-2, ICD-10, and ICF Dr KEES VAN BOVEN Dutch College of General Practitioners

  2. Roles of the Dutch family members In general practice electronic patient records • diagnostic ordering principle for the GP: ICPC-2 • diagnostic specificity: ICD-10 (combined in one tool: ICPC2-ICD10 thesaurus) • additional data on functioning and disability: ICF

  3. INTERNATIONAL CLASSIFICATION OF PRIMARY CARE ICPC-1: 1987 ICPC-2:1998 ICPC-2-E: 2000

  4. A classification is the ordering principle of a defined domain

  5. ICPC: THE DOMAIN OF FAMILY PRACTICE… quantitatively…..

  6. SYMPTOMS DIAGNOSES ICPC: > 1 PER 1000 PPY 200 400 600 10.000 ICD: <1 PER 1000 PY

  7. and qualitatively…..

  8. DESCRIBES THE CONTENT OF PATIENT-FP ENCOUNTERS • localization before etiology • symptoms AND diagnoses • -28 impairment category • -27 fear of .. category • -64 category (FP’s initiative) • social problems • patient and FP oriented

  9. What is the unit of observation in family medicine? • Patients? • Doctors? • Encounters? • Diagnoses? • Episodes: the patient with his/her problem over time

  10. episodeof care health problem from the first encounter for it with a health care provider till the last one

  11. EPISODE OF CARE Perceived health problem Perceived need for care RFE, demand for care Diagnosis Process RFE, demand for care Diagnosis Process RFE, demand for care Diagnosis Process

  12. ICPC • bi-axial structure • 17 alpha-coded chapters based on body systems/problem areas • 7 identical components, with rubrics bearing a two-digit numeric code

  13. ICPC Chapters (Systems) A General and unspecified B Blood/bloodforming organs, lymphatics (spleen, bone marrow) D Digestive F Eye (Focal) H Ear (Hearing) K Circulatory L Musculoskeletal (Locomotion) N Neurological P Psychological R Respiratory S Skin T Endocrine, metabolic and nutritional (Thyroid) U Urological W Pregnancy, child bearing, family planning (Women) X Female genital (X-chromosome) Y Male genital (Y-chromosome) Z Social problems

  14. ICPC Components Components (standard for each chapter) CODES 1. Complaints and symptoms 1-29 2. Diagnostic and preventive 30-49 3. Treatment, procedures and medication 50-59 4. Test results 60-61 5. Administrative 62 6. Referral and other reasons for encounter 63-69 (64!!) 7. Diagnoses/diseases: 70-99 - infectious diseases - neoplasms - injuries - congenital anomalies - other

  15. Episode of care • Core Elements • Reasons for encounter • Health problems/diagnoses = Episode Title • Process of care/interventions • (Outcomes) • Transitions • One or more encounters, including changes in their relations over time

  16. Episodes of careReason for encounter (RFE) • The agreed statement of the reason(s) why a patient enters the health care system, the demand for care by that person. • Symptoms or complaints (headache, tiredness, feeling depressed, having fear of cancer) • Known diseases (diabetes, hay fever) • Requests: for preventive or diagnostic services (a blood pressure check or an ECG), a request for treatment (repeat prescription), getting information, or test results, or administrative procedure (a medical certificate). • It is the PATIENT’S statement, clarified by the doctor.

  17. Episodes of careReason for encounter (RFE) • This is a true primary care concept • Primary Care is RFE driven, not diagnosis driven

  18. Episodes of care • Health problem: the diagnosis • Certainty • Status • Clinical findings • No coding (yet) for everything in primary care

  19. TOOLS • ICPC-2 • 1404 terms including all process codes • Acts as ordering principle • Common entities have distinct codes • Surprisingly complete given small size • Context of episode adds specificity • ICD-10 • 14,000 terms • Adds clinical specificity to ICPC

  20. Episodes of care • Processes of care • Diagnostic/preventive procedures • Treatment, procedures and medication • Tests and results • Administrative • Referrals • Outcome • Functional status, ICF, WONCA/COOP indicators • Severity of illness, DUSOI

  21. Episode example • 23 yr old woman typist, tennis player • RFE: pain R elbow for 10 days, and can’t use R arm at work: ICPC code? • L10 & L28 • Process: Tenderness R lat. Epicondyle: ICPC code? • L31 Partial examination • Diagnosis: Tennis elbow: ICPC code? • L93 • Process: Steroid injection: ICPC code? • L55

  22. Health Problem fatigue RFE feeling tired RFE test result Health Problem anemia RFE test result Health Problem Ca colon Episode of care Intervention Hb 1st visit Intervention barium enema 2nd visit Intervention referral 3rd visit

  23. Episodes of care • Transitions • An episode may occur over many encounters • Diabetes is a lifelong episode • Each encounter may have more then one episode assessed • Many to many relationship between episodes and encounters

  24. Possibilities for data on functioning & disability Classification of Body Functions • in patients’ Reasons for Encounter, as symptoms and complaints, • in GP’s clinical observations, as extension of ICPC process mode Classification of Activities and Participation • involves clinical consequences of a specific episode of care, resulting in limitations, as extension of ICPC process mode Qualifiers for Function and Activities & Participation • might be quite useful for family practice

  25. Health condition (disorder or disease) Body function Activities Participation and structures Environmental Personal Factors Factors

  26. COPD (ICPC/ICD code) Breathlessness Can`t get upstairs No work Poor condition Living in a flat Smoking

  27. Case history Mr De Vries, age 72 • Present complaints • Shortness of breath • Palpitations • Findings • Hypotension • Bradycardia • Can’t get upstairs • Walking difficulties • ICPC code • R02 • K04 • ICPC - ICF code • K43 - B4201 • K43 - B410 • K48 - D460 • K48 - D450

  28. Relation ICF and ICPC

  29. Activities and Participation and ICPC chapters • Learning/knowledge • General tasks • Communication • Mobility • Selfcare • Domestic life • Interpersonal interactivity • Major life areas • Community, social life • Chapters K,N,P and Z • Chapters F,K,N,P and Z • Chapters F,H,K,N and P • Chapters F,K,L and N • ? • ? • Chapters P and Z • Chapters P and Z • Chapters P and Z • ?

  30. Future • University of Ghent: relation between ICF-functions and components 1 and 2 of ICPC • University of Amsterdam: relation between ICF-activities/participation and component 2 of ICPC • WICC: relation between ICF-external factors and chapter Z of ICPC?

  31. Data Model Basic Unit: The episode at an encounter RFE: Sympt.Complt.Problem RFE: Inter-vention Intermediate Intervention Subsequent Inter-vention Clinical Findings ICF? Health Problem + Certainty & Status OutcomeCOOP ICF DUSOI Repeated for each episode at that encounter Repeated at each encounter for that health problem

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