Dr KEES VAN BOVEN

Dutch College of General Practitioners

The Dutch Family of International

Classifications: ICPC-2, ICD-10, and ICF

Roles of the Dutch family members

In general practice electronic patient records diagnostic ordering principle for the GP: ICPC-2diagnostic specificity: ICD-10

(combined in one tool: ICPC2-ICD10 thesaurus)

additional data on functioning and disability: ICF

INTERNATIONAL CLASSIFICATION OF PRIMARY CARE

ICPC-1: 1987ICPC-2:1998

ICPC-2-E: 2000

A classification is the ordering principle of a defined domain

ICPC:

THE DOMAIN OF FAMILY PRACTICE…

quantitatively…..

200

600

400

10.000

SYMPTOMS DIAGNOSESICPC: > 1 PER 1000 PPY

ICD: <1 PER 1000 PY

and qualitatively…..

DESCRIBES THE CONTENT OF PATIENT-FP ENCOUNTERS

localization before etiologysymptoms AND diagnoses-28 impairment category-27 fear of .. category-64 category (FP’s initiative)social problemspatient and FP oriented

What is the unit of observation in family medicine?

Patients?Doctors?Encounters?Diagnoses?

Episodes: the patient with his/her problem over time

episode of care

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

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

ICPC ICPC

bi-axial structure17 alpha-coded chapters based on body systems/problem areas7 identical components, with rubrics bearing a two-digit numeric code

ICPC Chapters (Systems)A General and unspecifiedB Blood/bloodforming organs, lymphatics (spleen, bone

marrow)D DigestiveF Eye (Focal)H Ear (Hearing)K CirculatoryL Musculoskeletal (Locomotion)N NeurologicalP PsychologicalR RespiratoryS SkinT Endocrine, metabolic and nutritional (Thyroid)U UrologicalW Pregnancy, child bearing, family planning (Women)X Female genital (X-chromosome)Y Male genital (Y-chromosome)Z Social problems

ICPC ComponentsComponents (standard for each chapter) CODES

1. Complaints and symptoms 1-29

2.Diagnostic and preventive 30-493.Treatment, procedures and medication 50-594.Test results 60-615.Administrative 626.Referral and other reasons for encounter 63-69

(64!!)7. Diagnoses/diseases: 70-99

- infectious diseases- neoplasms- injuries

- congenital anomalies- other

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

Episodes of care Reason 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.

Episodes of care Reason for encounter (RFE)

This is a true primary care concept

Primary Care is RFE driven, not diagnosis driven

Episodes of care

Health problem: the diagnosis Certainty Status

Clinical findings No coding (yet) for everything

in primary care

TOOLSICPC-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

Episodes of careProcesses 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

Episode example23 yr old woman typist, tennis playerRFE: pain R elbow for 10 days, and can’t use R arm at work: ICPC code?ICPC code? L10 & L28L10 & L28

Process: Tenderness R lat. Epicondyle: ICPC code?ICPC code? L31 Partial examinationL31 Partial examination

Diagnosis: Tennis elbow: ICPC code?ICPC code? L93L93

Process: Steroid injection: ICPC code?ICPC code? L55L55

Episode of care

Intervention

HbIntervention

Hb

Interventionbariumenema

Interventionbariumenema

Intervention

referralIntervention

referral

RFE

feelingtired

RFE

feelingtired

Health Problem

fatigue

Health Problem

fatigue

RFEtest

result

RFEtest

result

Health Problem

anemia

Health Problem

anemia

Health Problem

Ca colon

Health Problem

Ca colon

RFEtest

result

RFEtest

result

1st visit

2ndvisit

3rd visit

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

Possibilities for data on functioning & disability

Classification of Body Functionsin 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

Health condition

(disorder or disease)

Body function Activities Participationand structures

Environmental PersonalFactors Factors

COPD (ICPC/ICD code)

Breathlessness Can`t get upstairs No workPoor condition

Living in a flat Smoking

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

ICF ORDENING ICF

RELATION WITH ICPC

Body Functions Physiological

Chapters

In each chapter:

1st component: -28 code as RFE;

2nd component, the -43 code as process code

Body Structures Anatomical

Chapters

None

Activities & Participation 9 domains In each chapter:

2nd component, the -48 code as process code

Contextual Factors

(environmental and personal)

5 domains Chapter Z: social problems; especially as RFE

Relation ICF and ICPC

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

• ?

GG

EE

NNEERRAALL..

PP

RR

AA

CC

TT..

REFERRAL WITH ICPC2-ICD10-DIAGNOSIS AND A SELECTION OF THE ICF CLASSIFICATION:

BODY FUNCTIONS AND ACTIVITIES/PARTICIPATION

PHY

S

.

T

H

E

R

A

P

I

S

T

INTAKE, SELECTION OF B.F. and A/P, ADDITIONAL INFORMATION

RESULTS ADDED

FINAL REPORT

POSSIBLY: REQUEST FOR FURTHER TREATMENT

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?

Data ModelBasic Unit: The episode at an

encounter

RFE:

Sympt.Complt.Problem

RFE:

Inter-vention

Clinical Findings

ICF?

Health Problem

+ Certainty

& Status

Intermediate Intervention

Subsequent Inter-

vention

Repeated for each episode at that encounter

Repeated at each encounter for that health problem

OutcomeCOOP

ICF

DUSOI