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 diagnostic specificity: ICD-10 (combined in one tool: ICPC2-ICD10 thesaurus) additional data on functioning and disability: ICF

INTERNATIONAL CLASSIFICATION OF PRIMARY CARE

ICPC-1: 1987 ICPC-2:1998 ICPC-2-E: 2000

A classification is the ordering principle of a defined domain

ICPC:

THE DOMAIN OF FAMILY PRACTICE…

quantitatively…..

SYMPTOMS DIAGNOSES

200 400 600 ICPC: > 1 PER 1000 PPY

10.000

ICD: <1 PER 1000 PY

and qualitatively…..

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

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 RFE, demand for care RFE, demand for care Diagnosis Process Diagnosis Process Diagnosis Process

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

ICPC Chapters (Systems)

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

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 5. Administrative 60-61 62 6. Referral and other reasons for encounter 7. Diagnoses/diseases: - infectious diseases - neoplasms - injuries - congenital anomalies - other 63-69 (64!!) 70-99

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

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

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

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

Episode of care

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

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 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

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

COPD (ICPC/ICD code) Breathlessness Can`t get upstairs No work Poor 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

Relation ICF and ICPC

ICF Body Functions Body Structures Activities & Participation Contextual Factors (environmental and personal) ORDENING ICF Physiological Chapters Anatomical Chapters RELATION WITH ICPC In each chapter: 1st component: -28 code as RFE; 2nd component, the -43 code as process code None 9 domains 5 domains In each chapter: 2nd component, the -48 code as process code Chapter Z: social problems; especially as RFE

• • • • • • • • •

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 ?

G E N E R A L .

P R A C T .

REFERRAL WITH ICPC2-ICD10-DIAGNOSIS AND A SELECTION OF THE ICF CLASSIFICATION: BODY FUNCTIONS AND ACTIVITIES/PARTICIPATION INTAKE, SELECTION OF B.F. and A/P, ADDITIONAL INFORMATION RESULTS ADDED FINAL REPORT POSSIBLY: REQUEST FOR FURTHER TREATMENT I S T P H Y .

S T H E R A P

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 Model

Basic Unit: The episode at an encounter

RFE: Sympt.

Complt.

Problem RFE: Inter vention Intermediate Intervention Clinical Findings ICF?

Health Problem + Certainty & Status Subsequent Inter vention Outcome COOP ICF DUSOI

Repeated for each episode at that encounter Repeated at each encounter for that health problem