Transcript Document

Recent advances in the
field of Family Medicine
classifications
ICPC into WHO-FIC
J K Soler
Wonca International Classification
Committee
International Classification of Primary Care
Why do we need ICPC?
A classification is the
ordering principle of
a defined domain
The International Classification of
Primary Care is the ordering
principle of the domain of primary
care and family medicine
 Rubrics
code mutually exclusive concepts
 Inclusion and exclusion criteria: definitions
 Covers the breadth of the domain
 “Granularity” appropriate for the domain
 Classification based on empirical data
SYMPTOMS DIAGNOSES
200
400
600
10.000
ICPC:
> 1 PER 1000
PPY
ICD:
<1 PER 1000
PPY
ICPC and ICD structure





ICPC (WONCA)
Conceptual
construct
Localisation
About health
problems and
patient complaints
Patient centred

ICD (WHO)
 Historical
construct
 Etiologic
 About diseases

Provider centred
ICPC and ICD relationships
All included
in UMLS
ICD9
ICPC
ICD10
All linked to
Snomed-Ct
UMLS
 National
Library of Medicine - Unified
Medical Language System
 Develops and distributes electronic
knowledge sources and lexical programs
 Facilitate development of software that
understands medical terminology
 Metathesaurus, SPECIALIST lexicon and
Semantic Network
WHY DO WE NEED AN ICPC2-ICD10
THESAURUS?
Because
ICPC does order the domain of
family medicine..
..but has insufficient granularity to
document all individual patients’ diagnoses
.... thus a thesaurus would allow easy, semiautomatic double coding, using:
 ICPC-2 as an ordering principle based
on the high prevalence of common
diagnoses in family practice
 and ICD-10 as a nomenclature based
on the wide range of known diagnoses
Example:
In the Search text box, you type ‘pneumonia’,
there are many types of pneumonia in ICD-10,
..and the various types by aetiology show.
(Note: the cursor jumps to J18.9; the list starts with J12.0)
Say we want to select ‘pneumonia; Haemophilus
influenzae’ (typing ‘pneum;h’ will do)..
..double click, and the export box shows.
Suppose you want to add a new type (e.g., ‘Amsterdam’).
You can add that term, and also you may add this new type
to your Thesaurus.. just click ‘Export and add’…
..and now the label is added to your personal Thesaurus.
Relationships to other
classifications
CONVERSIONS WITH ICPC-2
ICPC-2
ICD-10
ICD-9-CM
ICIDH-2/ICF
Snomed-CT
Read
MESH
UMLS browser examples
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
WHO FIC
 Reference
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International Classification of Diseases (ICD)
International Classification of Health
Interventions (ICHI)
International Classification of Function,
Disability and Health (ICF)
Anatomical Therapeutic Chemical (ATC)
 Related

classifications
classifications
ICPC, ICD-O-3, ICECI
ICPC within WHO-FIC
ICPC is the ordering principle
of the domain of primary care
and acts as the link between
other classifications in the FIC
Thesaurus
UMLS
ATC
DDD
ICHI
ICPC
WHO-FIC
ICF
ICD
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
Research into diagnostics
 Collecting
data on all elements of the
encounter
 Structuring data within episodes of care
 Using a classification with the correct
granularity
 Using Bayesian statistical methods to
study non-linear relationships
 The Transition Project
REASONS FOR ENCOUNTER AT START
OF EPISODE BY ICPC-CHAPTER (%)
NETH
JAPAN
POLAND
MALTA
SERBIA
40
30
20
10
0
A B
D
F
H K
L
N P R
S
T
U W X Y
Z
NEW EPISODES OF CARE
BY ICPC-CHAPTER (%)
NETH
JAPAN
POLAND
MALTA
SERBIA
40
30
20
10
0
A B D F H K L N P R S T U W X Y Z
SOB as a predictor of diagnosis of asthma
Crosstab of new episode with start-RFE
Row %
Row %
Episode R96
with RFE R02
with other RFE
Total
Sens: 0.20
Spec: 0.99
with RFE R96
with other RFE
Total
LR+: 25.17
LR-: 0.81
int.: 19.40-32.64 int: 0.77-0.85
Other epi
Total
183
73.5
249
23403
98.9
23675
23586
98.6
23924
PV+: 0.27 Odds: 31.03
Pretest 0.01
PV-: 0.99 int.: 22.86-42.13 Posttest: 0.36
Episode R02
Other epi
66
272
338
0
16
16
26.5
1.1
1.4
0
0.1
0.1
8
23900
23908
Total
100
99.9
99.9
8
23916
23924
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
Recent advances
 Entry
into WHO-FIC
 Research into diagnostics
 ICPC-3
ICPC-3

Work has started recently
 ICPC structure will probably be maintained due
to relationships with ICD within WHO-FIC
 New types of data one can record?


Classification of objective findings and investigations
Data elements for classification and for EPR
 Linkages to other classifications yet to come