who - family of international classifications network annual meeting

Introduction

The growing tree of Functioning Interventions within ICHI

12 – 18 October 2013 Beijing, China

C601

WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2013

Almborg A.H.1,4, Salvador-Carulla L.2, Sykes C.3, Berg L.4, Cumerlato M.2, Fortune N.2, Madden R.2, Martinuzzi A.5. 1National Board of Health and Welfare, Sweden 2University of Sydney, Australia 3World Confederation for Physical Therapy, United Kingdom 4Nordic WHO-FIC Collaborating Centre, Norway 5E. Medea Institute, Research Branch of the Italian CC, Italy

Results

The Functioning TWG defined 3 goals to be reached within 2013: • revising and enriching the ICHI axes

to enhance the descriptive capacity of the system;

• address mental health, neuropsychology, Physical therapy and Occupational therapy as areas of particular relevance and complexity;

• perform a first revision of the functioning interventions.

Goals

Acknowledgements

The results are 627 targets, 130 actions and 54 means for the whole ICHI. Targets Final count of targets is 627 distributed as following: The body functions, activities and participation and environmental factors can be used at different levels such as chapters, blocks and 2nd and 3rd level of the ICF. Actions Action codes were enriched to approp-riately capture the peculiar nature of actions performed in the functioning field. Final count of actions is 130. The actions are distributed as following: Clearer distinction between actions and means allowed the repositioning of some means as actions and vice versa. Means Final count for means is 54 at approach, techniques, method and sample.

DIGITAL, MOBILE, NOW!

Scan this to get a digital version

Methods & Materials

The goals were pursued with face to face meetings and teleconferences, in which the TWG included contributes from experts and practitioners in the selected areas, and reached agreement through discussion and audit.

The International Classification of Health Interventions (ICHI) is the third WHO reference classification, and among its scope is to provide a framework systematically describing health interventions to allow comparison in provision of health interventions, assist in the development of health policies, contribute to evaluation of effectiveness. The interventions aimed at body functions, activities or environmental factors (functioning interventions) typically delivered, e.g., in rehabilitation and mental health sectors, are growing in weight and complexity worldwide, but they are paradoxically represented in a very sketchy and non-systematic way in the intervention list of ICD9CM and in intervention classifications used in some countries.

The work of the ”technical working group(TWG) for functioning interventions commenced in Sydney Australia in 2011 and led to the first listing of functioning interventions which consistently applied the three axes (target, action, mean) upon which the ICHI framework is built. This initial list of 782 functioning interventions was included in the ICHI alpha draft presented at the 2012 Brasilia WHO-FIC annual meeting. We here describe the further steps completed in ICHI-FI and the state of its development.

Interventions The alpha 2 version include 1490 interventions, which are distributed as follows: Issues raised during the revision process include: •Need for extensions to represent variations in a given intervention •Editorial rules to insure balance of granularity •Position of non surgical interventions to specific systems or organs within the classification •Overlap/relationship with interventions in public health

At the end of this first round of refinement, 782 functioning interventions are listed. The Alpha 2 version of ICHI functioning includes 1490 interventions. A process for systematically checking of the present list for completeness and significance is now planned, with the goal to bring the functioning intervention list to a degree of stability.

The work of the Technical Working Group (Andrea Martinuzzi, chair, Ann-Helene Almborg, coordinator) and that of all collaborating experts from various professions and Centres are gratefully acknowledged

Mental Health Interventions 67 Interventions on Body functions 389 Interventions on Activities and Participation 770 Interventions on an Individuals Environment 71 Public Health Interventions (incl Behaviours) 193

Anatomy 307 Body functions 111 Activities and participation 110 Environmental factors 75 Behaviours 21 Others 3

Diagnostic 16 Therapeutic 76 Managing 14 Preventing 24

Abstract The International Classification of Health Interventions (ICHI) is the third WHO reference classification. The interventions aimed at body functions, activities or environmental factors (functioning interventions) typically delivered, e.g., in rehabilitation and mental health sectors, are growing in weight and complexity worldwide. The work of the “technical working group” (TWG) for functioning interventions here describe the further steps completed in ICHI-FI and the state of its development. The results for the whole ICHI are 627 targets, 130 actions and 54 means. The alpha2 version of ICHI functioning includes 1490 interventions. Conclusions. At the end of this first round of refinement, 782 functioning interventions are listed, which were doubled to the alpha2 version. A process for systematically checking of the present list for completeness and significance is now planned, with the goal to bring the functioning intervention list to a degree of stability.

Introduction

The Family Development Committee (FDC) has been tasked by the WHO to work towards understanding how the WHO-FIC is used in casemix systems, and towards generic principles for the use of the WHO-FIC ‘core’ classifications (ICD, ICF and ICHI) in casemix specifications internationally. This was discussed by FDC members at the 2013 mid-year meeting in Uddevalla, Sweden. At the meeting is was agreed that a template for collecting some preliminary information would be developed and distributed to FDC and other WHO-FIC members. The results once compiled would then inform the work of the FDC on casemix issues generally, and more specifically on work to develop a guidance document on the use of WHO-FIC classifications in casemix. It could also inform related work to develop principles and possibly specifications for an international casemix classification/grouper.

Stocktake of the current uses of the WHO-FIC in Casemix internationally

Abstract

The WHO-FIC Family Development Committee has been asked by the WHO to work towards understanding how the WHO-FIC is used in casemix systems, and towards generic principles for the use of WHO-FIC in casemix. A first step is to do a stocktake of how WHO-FIC ‘core’ classifications (ICD, ICF and ICHI) are being used in the different casemix specifications internationally. Once the results are compiled they will inform the work to be done on principles for use of the WHO-FIC in casemix and, potentially, an international casemix grouper specification as a reference. This paper describes the task and requests input for the stocktake by Collaborating Centres and others. A sample of preliminary information is also provided.


C602


Jenny Hargreaves (FDC co-chair, Australian Collaborating Centre), Huib Ten Napel (FDC co-chair, Netherlands Collaborating Centre), Jodee Njeru (FDC secretary, Australian Collaborating Centre)

FDC and casemix The Template

The FDC had a long discussion about WHO-FIC and casemix, and the intent of the FDC’s consideration of this topic. The topic was considered to be important, as casemix is a very important use case for ICD at present; and it is envisaged that ICHI will also have an important role to play in casemix in the future, particularly if it is used by countries that currently use the US ICD-9-CM. Recent work also indicates that ICF could also be important into the future, particularly if casemix systems are designed to focus on the care needs of patients rather than the care that is provided to them. FDC was also interested to explore how this work could eventually lead to reference specifications (but not software) for an international grouper. Issues such as costing and pricing are out of scope. An international grouper specification could facilitate international comparisons, for example in work to compare health systems by the OECD. An international grouper specification could have, for example, about 400 groups and national groupers could build on it with complexity splits but with the same basics.

Discussion at the mid-year FDC meeting identified the need for a simple template to collect base level information which could later be expanded upon if needed. It focuses on the use of diagnosis, functioning and procedure information in current casemix arrangements, and issues of scope and purpose.

Draft template for information on country use of WHO-FIC in casemix – and example Australian answers

The Family Development Committee intend to: •Continue discussions on the applications of the WHO-FIC in the area of Casemix during its annual meeting •Distribute the template, once finalised, via the WHO-FIC Network channels, with clear instructions and examples to ensure that responses are comparable •Compile the responses •Present summary compilation of the data to the next FDC meeting The FDC co-chairs would like to thank all the FDC members for their valuable contributions to this work activity .

Next steps

Question Answers for Casemix classification 1 Answers for Casemix classification 2

Which Casemix classifications (name and version number) are in use in your country?

Australian Refined-Diagnosis Related Groups Version 7.0 (AR-DRG V7.0)

Australian National Subacute and Nonacute Patient Classification version 3.0

Which types of hospital patient care is the Casemix classification used for (admitted acute care, sub-acute care, ambulatory, emergency)?

Admitted acute care Subacute care

Which classification is used for disease codes for this Casemix classification? Please include details of national modifications (e.g. ICD-10-Australian Modification 8th edition)

ICD-10-Australian Modification 8th edition

ICD-10-Australian Modification 8th edition

Which classification is used for interventions / procedures codes for this Casemix classification? (e.g. ACHI 8th edition)

Australian Classification of Health Interventions 8th edition

Australian Classification of Health Interventions 8th edition

Does the Casemix classification incorporate functioning information? If so list the ‘functioning’ related data variables and functioning classification used (if applicable).

No Functional Impairment Measure (FIM score)

Is the Casemix classification used for funding hospitals? Does this apply to all hospitals?

Activity based funding for publically funded hospitals

Activity based funding for publically funded hospitals

Is there other information about the Casemix classification that is relevant to the use of WHO-FIC in Casemix?

The types of care classified are defined using the concepts and terminology of the ICF.

Introduction

As can be read in the Q&A section of WHO’s website on Universal health coverage; “Universal coverage is based on the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma-Ata declaration in 1978. Universal health coverage has a direct impact on a population’s health. Access to health services enables people to be more productive and active contributors to their families and communities. It also ensures that children can go to school and learn. At the same time, financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets. Universal health coverage is thus a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities.” The Family Development Committee has considered how to ensure that the WHO-FIC can assist in measuring progress towards UHC.

Universal health coverage; classifications

Abstract


C604


Authors: Huib Ten Napel (WHO-FIC Collaborating Centre in the Netherlands1); Jenny Hargreaves and Jodee Njeru (Australian Collaborating Centre2)

Title

Universal health coverage (UHC) is a global WHO initiative which covers three dimensions of who is covered, services provided and what is the cost. When it comes to measuring universal health coverage is it about identifying health care needs and interventions. The WHO-FIC classifications (ICD, ICF and ICHI) can be used to measure these dimensions but may need to be tailored to provide internationally comparable and timely information on whether people are receiving affordable, accessible and available health care according to the UHC goals.

Definition of universal health coverage

Essentials of universal health coverage

Universal health coverage as an ideal?

WHO-FIC as a suite of classifications for measuring

universal health coverage

Possible outcome

Reference

Although universal health coverage requires a more elaborated explanation (which can be found on WHO’s website on the topic), in short and understandable form it is stated as: “Universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.” This requires: • a strong, efficient, well-run health system; • a system for financing health services; • access to essential medicines and technologies; • a sufficient capacity of well-trained, motivated health workers.

There are six essentials named for the coverage of universal health: -Health system financing, such as by; - raising funds for health; - reducing financial barriers - allocating or using funds in an efficient way and in equity. -Health workforce

- a professional, and motivated health workforce.

-Essential medicines and health technologies

- access to essential medicines and health products.

-Health information and resources - health information systems.

-Governance - in the health sector this refers to

a wide range of steering and rule-making related functions carried out by governments/decisions makers.

-Health systems service delivery - People-centred and integrated

health services.

Universal health coverage can be seen as an ideal, something to strive and set goals for. In reality there will be frontiers for each of the goals depending on the possibilties within each country/ society. The goal then will be to push back the boundaries from a global perspective and as a global effort to attain accessible, available and affordable care for everyone on the planet.

Universal health coverage: http://www.who.int/universal_health_coverage/en/ Authors: (1) National Institute for Public Health and the Environment in the Netherlands and WHO Collaborating Centre for the Family of International Classifications in the Netherlands (2) Australian Institute of Health and Welfare

Universal health coverage is a principle that is based on primary health care. One possible outcome may be the development of appropriate primary care linearizations of ICD, ICF and ICHI. This needs to be discussed and worked on further within the FDC.

measuring the level of universal health coverage and assessing the frontiers. ICD, ICF and ICHI can possibly be used to capture the three dimensions (population, services and costs), but first it needs to be clear to what extent these classifications cover the different aspects of universal health coverage and how this can be done. There also is a need to determine what will be useful in fulfilling the long term information needs required to support universal health coverage. The Family Development Committee (FDC) plans to start to assess how the WHO-FIC can be useful for UHC by considering the indicators/objectives of the UHC, and by considering indicators that are currently used by countries that could be relevant to UHC. The data and classifications used for the indicators can then be assessed against the WHO-FIC to determine what changes could be made. Collaborating Centres will be asked to assist the FDC in identifying and assessing relevant indicators in use in their countries.

When it comes to measuring universal health coverage it is about identifying services and interventions or in fact aspects of all six essentials as summed up earlier. The WHO-FIC suite of classifications can play an important role in

http://www.who.int/universal_health_coverage/en/

http://www.who.int/universal_health_coverage/en/

Current conceptual frameworks for the Who-FIC

The three reference classifications have conceptual underpinnings and content models that vary in their maturity. • ICD-10 does not apparently have a formal content model, except as migrated to the ICD-11 environment. • ICD-11 has a well-developed content model, supplemented by material such as the X chapter extension codes. • ICF does not apparently have a formal content model. However, it does include a diagram of the interactions between

the components of the ICF and with health conditions that helps to explain the content and structure. • ICHI has a content model within its alpha draft.

Integration of the Family: a unified conceptual framework

Abstract


C605


Jenny Hargreaves, Australian Collaborating Centre, Australian Institute of Health and Welfare

This poster presents considerations about a method of integration of the Family with a focus on a unified conceptual framework that could underpin further development of ICD, ICF and ICHI in a harmonised manner. The approach could have benefits for re-use of concepts and classification entities, use of classifications together and for further development of content models for ICHI and ICF.

ICD-11 Content Model main parameters

1. ICD Entity Title

2. Classification Properties

3. Textual Definitions

4. Terms

5. Body System/Structure Description

6. Temporal Properties

7. Severity of Subtypes Properties

8. Manifestation Properties

9. Causal Properties

10. Functioning Properties

11. Specific Condition Properties

12. Treatment Properties

13. Diagnostic Criteria

An analysis of the relationships of the concepts within the reference classifications and their ‘content models’ enables a picture to be developed about how a unified conceptual framework could be constructed, and what efforts could be required to align concepts that may differ slightly between classifications, and/or to align the classifications of those concepts between the classifications. The analysis grouped the concepts and classifications embedded within the reference classification into the three main broad concept groups relevant to information about health and health and related care: health condition, risk factor/determinants/causes, and interventions. Within those broad groups, general concepts/classifications were identified, and the way in which they are represented in each of the reference classifications was detailed. The table below presents a snapshot of the analysis of the broad concept group of health conditions. The concepts in the ICD entries are a mix of ICD-10 (and ICD-10-AM) and ICD-11-based material. This information in the table is meant to be an illustrative, not exhaustive list. It does not include concepts such as temporal factors and personal factors. The table illustrates that there is a large amount of overlap in concepts between the classifications, and the way in which the same or similar concept is represented can differ quite markedly.

Analysis of concepts and classifications in the reference classifications

This work is preliminary and are not intended to be comprehensive or complete. It is provided only to inform further thinking and discussion of how a unified conceptual framework could have benefits for further development of content models for ICHI and ICF. Further detail was presented at the Family Development Committee mid-year meeting in Uddevalla, Sweden in June 2013, and is available on request. Thanks to Jodee Njeru for assistance with this poster.

Broad concept group Concept/classification ICD ICF ICHI

Health condition Disease/injury Yes

Severity in ICD-11 content model

Severity in extension codes

Detail in extension codes

Manifestation properties in ICD-11 content model

Not included, by design

However, the classifications of body structure and body function, used with the qualifiers, overlap with the concepts of disease and injury

Not included, by design

Health condition Health status other than a disease or injury

Chapter 21 eg carrier of infectious disease, pregnant state

Body structure or body function used with qualifiers

Health condition Body function Linearisations reflect body functions variously with body structures and systems

Body systems/body structure in ICD-11 content model


Functioning properties in ICD-11 content model

Yes Anatomy as a target

Linearisation reflects body structures and functions

Health condition Body structure Linearisations based on body structures and systems

Body systems/body structure and morphology in ICD-11 content model


Yes Anatomy as a target

Linearisation reflects body structures and functions

Verdana 36 Bold

Title

Title

Conclusions

The development of ICHI began in 2007 and this work has become increasingly important especially for those countries who will be in need of an interventions classification when ICD-9-CM Volume 3, the interventions classification adopted by many countries, is no longer maintained . The demand for international comparisons of health interventions is ever growing, as focus on efficiency, structure and quality of health systems increases. Therefore ICHI, will provide a strong basis for international comparisons. Work continues to progress on ICHI content and encompasses interventions across all functional sectors of the health system, covering primary care, acute care, rehabilitation, functioning, traditional medicine, public health and ancillary services.

History of ICHI: past, present and future

Abstract The development of the International Classification of Health Interventions (ICHI) has been underway since 2007. Several purposes for ICHI have been identified, including to: • Provide a classification of appropriate scope and detail for use by countries without a national classification • Provide a base which can be extended to develop more finely grained national or specialty classifications. • Establish a framework for comparisons of the use of health interventions in different countries. • Provide a building block for international casemix development. • Avoid duplication of effort at national level. Work on the development of ICHI has been an international process, with members of many WHO-FIC Collaborating Centres contributing. ICHI has been built around three axes: Target, Action and Means, defined as follows: • Target: the entity on which the Action is carried out • Action: a deed done by an actor to a Target during a health intervention • Means: the processes and methods by which the Action is carried out. The ICHI framework and structure was finalised in 2010. Content development has been ongoing since then. An alpha draft was released in October 2012. This poster will outline the development of the ICHI structure and the medical and surgical, functioning and public health content, as well as next steps and challenges.


C606


Megan Cumerlato1, Albrecht Zaiss2, Susanne Hanser2, Andrea Martinuzzi3, Nicola Fortune1, Linda Best1, Richard Madden1

1National Centre for Classification in Health, University of Sydney (Australia), 2 University of Freiburg, 3 E.Medea Scientific Institute, Research Branch of the Italian CC

Title

Title

By Beijing 2013 all ICHI content will have been the result of 2 development phases. The content has been built on a sound structure, and has had regard to various national classifications. Granularity is determined by the need for ICHI to serve the dual roles of a stand alone classification and a framework for international comparisons. Those interested in assisting in ICHI development are most welcome, contact Megan Cumerlato: [email protected]

INTRODUCTION

The first task was the development of a framework for ICHI and a definition of ‘health intervention’:

A health intervention is an activity performed for, with or on behalf of a person or a population whose purpose is to improve, assess or modify health, functioning or health conditions.

The classification has been built around three axes: Target, Action and Means and the coding scheme comprises a seven-character structure for the three axes. The ICHI framework was finalised in 2010, following a trial that involved pilot content development using a range of interventions from existing classifications. With the structural development in place, attention turned to the development of content for an initial (alpha) version of ICHI. Medical/Surgical Interventions In 2011, a workshop involving 14 participants drawn from five WHO regions was held in Sydney, Australia, where all interventions in ICD-9-CM Volume 3 were converted to the ICHI structure, and adapted as necessary. Priority was given to diagnostic, medical and surgical interventions. During the Sydney workshop there was general agreement that the level of granularity of ICD-9-CM Volume 3 was largely appropriate for ICHI. This decision limits the detail that can be included in ICHI, but increases the capacity for ICHI to be a successful framework for comparisons across countries. The next step, undertaken by the Chinese Collaborating Centre and reviewed by the Australian and German centres, involved reviewing approximately 4000 concepts and making recommendations regarding content detail. This review involved comparing the draft content with a range of national classifications. Care was taken to ensure consistency across the classification and maintaining a uniform level of granularity. Functioning Interventions Development of functioning interventions for ICHI also began during the Sydney workshop. To develop the alpha version, substantial content development was undertaken by WHO-FIC network experts, covering allied health interventions and functioning assistance; relevant content in national classifications was reviewed as part of this process. A range of mental health interventions and assistance with support interventions were also added. During 2013, further development of the content and its coverage is being undertaken, along with refinement to the ICHI axes and interventions being made. Public Health Interventions Public health content for ICHI was developed during 2011-2013 . The ICHI axes include health behaviours and environmental targets necessary to describe public health interventions, as well as relevant Actions and Means. An initial list of public health interventions was generated by systematically examining combinations of Target, Action and Means categories. Further expansion and refinement of the public health interventions to produce a more complete and conceptually consistent classification is ongoing.

METHODS & MATERIALS

To date the medical/surgical interventions consist of twelve sections made up of body systems and work continues in finalising the content model for these areas. Examples of the code structure for this section includes:

AHG GD AA Partial excision of parotid gland AHG GE AA Total excision of parotid gland

Examples of Functioning interventions includes:

FAK SY BK Personal assistance with memory FGB AA AH Manual assessment of respiratory muscle function

Examples of Public Health interventions include:

MAQ PA PH Education concerning the health effects of tobacco use, delivered through the media KBK XA PB Surveillance and enforcement of air quality standards

Work is continuing on finalising the editorial and coding rules which will assist in the further development and use of ICHI. CONCLUSION

RESULTS

INTRODUCTION

Title

Title

Conclusions

Starting to create an ICHI tabular list of actually performed interventions, it was decided to use ICD-9-CM Volume 3 as the base for content. A group of 14 experts from different WHO Collaborating Centres and universities applied the ICHI coding framework to represent each class of ICD-9-CM Volume 3. Thus, a 1:1 map, ICD-9-CM Volume 3 to ICHI, was generated – an ideal prerequisite for users of the procedure classification when ICD-9-CM is no longer available. A change of the coding principles after this work went along with a decrease of granularity in the ICHI.

ICHI Transition from ICD-9-CM Volume 3

To develop content for the International Classification of Health Interventions (ICHI), it was decided to begin with the US based ICD-9-CM Volume 3, which had close original links with the WHO International Classification of Procedures in Medicine (ICPM), is in the public domain, and is at a relatively high level of granularity compared to many other national classifications. A range of countries now use ICD-9-CM Volume 3 as their national classification of health interventions. With the implementation of ICD-10-PCS in the US from October 2014, these countries need a replacement classification. A subset of the ICHI Alpha2 version has been identified which can readily be used as a replacement for ICD-9-CM Volume 3. This poster will describe the conversion process to move to this subset as the first step towards full adoption of ICHI.


C607


Susanne Hanser1, Albrecht Zaiss1, Megan Cumerlato2, Linda Best2, Richard Madden2

1University of Freiburg, Germany 2National Centre for Classification in Health, University of Sydney, Australia

Title

Title

METHODS & MATERIALS Introduction

CONCLUSION

RESULTS

With the mapping of ICHI back to ICD-9-CM Volume 3 to such a high degree, a change to ICHI would be an attractive, feasible solution for users who require a replacement interventions classification for ICD-9-CM Volume 3. Work still to be completed is the mapping of functioning interventions, miscellaneous interventions and field trials e.g. with DRG-Groupers currently using ICD-9-CM.

ABSTRACT

Mapping ICD-9-CM Vol 3 ICHIICHI Codíng

System

Intervention classesICD-9-CM vol. 3

Workshop Participants(Doctors, Classification

experts )

Hierarchical Ordering: Tabular List

Medical specialists expertise: content

Use cases: Clinical documentation andDRG-Grouping

~ 4000 ICHI classes (diagnostic, medical,

surgical)

1. Creation of a 1:1 Mapping table of ICD-9-CM Volume 3 to ICHI (Workshop in Sydney) using ICHI axes and enumerations for multiple interventions with same target, action and means.

2. Reduction: To ensure the ability of ICHI to support international comparability, the removal of ICHI enumeration provides a better framework for international comparison; detail for other kinds of information can be described by (local) extensions. For example, all types of ventricular shunt described in ICD-9-CM Volume 3 are now mapped to one code (AAC EB AA).

3. The ICHI content underwent several review phases; with the area of functioning interventions still undergoing general revision. Using the original mapping table, a mapping back to ICHI was started in July 2013.

Using the 1:1 mapping table, created during the process of applying the ICHI axes to ICD-9-CM Volume 3, a current mapping table now exists for 93% of the ICD-9-CM Volume 3 interventions (excluding Chapter 16 Miscellaneous). For Chapter 16, there is a 1:1 mapping for 55% of interventions and a 1:n mapping for the remaining 45%.

1:1

1:n

Verdana 36 Bold Title

Conclusions

Public health interventions in ICHI

Abstract


C608


Nicola Fortune and Richard Madden

Title

Title

Public health is often overlooked in describing health system activities, resulting in a view of health system activities dominated by individual interventions, and a policy focus with too little emphasis on public health. Based on the principle that ‘What is counted, counts’, the development of the International Classification of Health Interventions (ICHI) has been designed from the outset to include public health alongside the full range of individual health interventions. The inclusion of public health within ICHI will assist in raising the visibility of public health. It will provide an international standard for collecting, reporting and analysing data on population-level prevention and health promotion activities, to allow comparison between regions/countries, and over time. No such tool has previously existed.

Abstract

Public health interventions in ICHI are interventions delivered to population groups, not individuals. Envisaged applications include: Collecting, reporting and analyzing data on public health interventions Comparing between regions, countries, and over time in terms of types of public health interventions delivered Developing a standardised framework for reporting on public health expenditure and outputs ICHI has the potential to raise the visibility and profile of public health within the broader sphere of health policy. It will provide a means of characterising public health effort, to address questions such as: What types of interventions are delivered? What risk factors are targeted? How does the profile of public health interventions vary between countries? How is the focus of public health changing? The process of building ICHI public health content started by populating the Target, Action and Means axes with categories relevant to public health. An initial list of interventions was created by identifying meaningful combinations of the three axes. This list was progressively expanded and refined with reference to some existing lists of interventions, in particular the WHO’s CHOICE project, and with input from public health professionals via two rounds of consultation. The Alpha version of ICHI contained 166 public health interventions covering a broad range, for example: education about specific health issues or health-related behaviours nutrition labelling on food taxation of tobacco or alcohol surveillance and enforcement of environmental standards laws restricting the sale or use of products with associated health risks environmental decontamination

A cervical screening program was conducted in Victoria, Australia, to boost rates of screening and increase early detection of cervical cancer. The project involved training nurses as Pap test providers, providing Pap tests to ‘hard-to-reach’ women, and presentations to aboriginal women and Maternal and Child Health Nurses on the benefits of Pap tests. Components of the project can be coded using ICHI as follows:

Components of screening program ICHI codes and descriptors

Provision of Pap tests to hard to reach women

Presentations to aboriginal women Social marketing for Pap tests Speaking in community forums (e.g.

schools, women’s sporting groups) Leaflet drops Presentations to Maternal and Child

Health Nurses Liaison with health service providers to

encourage monitoring of screening needs and referrals

Raising awareness through local media

KBB VX PJ—‘Population screening’ + AJQ AD AC—‘Cervical biopsy’ + C53—Malignant neoplasm of cervix uteri (ICD code)

MAL PA PJ—‘Education concerning health screening services, delivered through health services’

MAL PA PH—‘Education concerning health screening services, delivered through the media’

MAL PA PF—‘Education concerning health screening services, delivered by other methods’

Public health interventions generally focus on modifying population exposure to risk factors as a means of preventing disease and promoting health. Targets for public health interventions in ICHI are therefore health behaviours or environmental factors. Some public health interventions are characterised by the organised mass delivery of individual interventions—e.g., an immunisation campaign. These types of interventions are recorded using the following five codes:

KBB VX PJ—Population screening KBB VB PJ—Population immunization/vaccination KEO VN PJ—Establishing health services KEO VO PJ—Marshalling health services KEO VP PJ—Improving access to health services

Where the public health intervention involves mass delivery of a specific individual intervention the ICHI code for that intervention should be recorded, plus any relevant ICD or ATC code (to record disease and pharmaceutical).t

ICHI contains a strong draft list of public health interventions. It is now necessary to test this list against practice in the field, by applying ICHI at a community, regional or national level to record interventions delivered, or by mapping past records/reports of interventions to the ICHI list. Comments received during consultations indicate that further development work will be needed, for example, to ensure that ICHI can be used to describe contemporary ‘dynamic systems’ approaches to delivering public health interventions. Opportunities for testing the public health component of ICHI are sought, and input and collaboration is welcomed.

Images sourced from Oxfam (www.oxfam.org.uk), Medecins Sans Frontiers (www.doctorswithoutborders.org), FHI 360 (www.fhi360.org/), Wikimedia commons (commons.wikimedia.org)

http://www.oxfam.org.uk/

http://www.doctorswithoutborders.org/

http://www.fhi360.org/

http://commons.wikimedia.org/

Introduction

Introduction

Title

Title

Conclusions

A disease or disorder is defined as rare in Europe when it affects less than 1 in 2000 (EURORDIS). There are between 6000 and 8000 rare diseases. Overall, there are an estimated 60 million people living with rare diseases in Europe and North America (EURORDIS). Approximately 80% of rare diseases are of genetic origin, and are often chronic and life threatening. The number of rare diseases is growing, but it is difficult to measure the prevalence of rare diseases e.g. because frequently, the necessary resources and infrastructure are unavailable, and standard (classification) codes are often not used in care registries (Posada de la Paz and Groft, 2010). For the reasons mentioned we propose to start discussions about the relationship between rare diseases en members of the WHO-FIC and come to conclusions regarding improvements of representations and relations.

Universal health coverage including rare diseases with WHO-FIC members possible?

Abstract


C609


Authors: Nugteren, R (1); Ten Napel, H (2); de Kleijn-de Vrankrijker, M.W. (2)

Title

Title

Thousands of rare diseases do exist and millions of persons all over the world are suffering from them. Nevertheless it is a problem to identify and code them according to the current ICD. There is a need as well for describing in a uniform way the aspects of functioning and disability connected with rare diseases (ICF) and to take them into account in the development of the classifications of health interventions (ICHI) . This poster intends to ask attention for this cluster of problems and discussions related to this area.

ICD

ICF

Examples from the Orphanet list of Rare Diseases

ICHI

Recommendations

References

According to the information of experts about 500 out of 8000 rare diseases can be found and coded in the ICD-10. Several can only be found by using the alphabetical index (Part III of ICD-10). Other rare diseases can be classified at a too general level, but are often misclassified. For diagnostic- and research purposes this situation should be improved regarding ICD-10 and ICD-11 if we want to be able to gather more knowledge on rare diseases. ORPHANET is comparing ICD-10 with the Orphanet list and preparing a new version including rare diseases using existing ICD-10 chapters. This should be coordinated with the work done by the WHO-FIC URC. Related activities by ORPHANET should lead to a consistent representation of rare diseases in ICD-11. The question is if all rare diseases will be covered and how this will be visible in the new classification.

Improvement of treatment and care for persons with rare diseases can be obtained by standardization of measuring functioning according to the ICF. Nowadays there is no standardized measurement instrument available. Development of a new measurement instrument is not feasible because of practical reasons (8000 rare diseases!). We recommend to explore the possibility of applying the General ICF core set and the existing instrument called IMPACT (based on A and P of the ICF), and evaluate the coverage of the instruments regarding functioning aspects of persons with rare diseases. This work can lead to a better understanding of rare diseases and also lead to ICF update or revision proposals.

The examples below are randomly taken from the Orphanet list. Nr 901 Wells syndrome = in ICD-10 L98.3 Eosinophilic cellulitis [Wells] and as a synonym in the alphabetical index (Wells disease) Nr 902 Werner syndrome = in ICD-10 E43.8 other specified endocrine disorders. Literally it is not in ICD, it is included as such via the index Nr 3392 Tularemia = A21 Tularemia with 5 more specified subclasses. Which one is meant in the Orphanet list? Nr 3309 Tetrasomy is not to be found in ICD-10. Nr 828 Stickler syndrome is not to be found in ICD-10 as well. Spinocerebellar ataxia with 36 variants on the type can only be included in a code like G11.1 Early onset cerebellar ataxia, if that would be the right place-holder, given the meaning of spinocerebellar ataxia in the list itself.

IMPACT: http://www.ncbi.nlm.nih.gov/pubmed/19020695 EURORDIS: http://www.eurordis.org/about-rare-diseases ORPHANET, List of rare diseases: http://www.orpha.net/orphacom/cahiers/docs/GB/List_of_rare_diseases_in_alphabetical_order.pdf Posada de la Paz, Manuel, Groft, Stephen C. Advances in Experimental Medicine and Biology, Volume 686, Springer Science Business Media B.V., 2010 http://link.springer.com/content/pdf/10.1007%2F978-90-481-9485-8.pdf ICF Core Sets: http://www.icf-research-branch.org/download/finish/5/136.html Authors: (1) National Institute for Public Health and the Environmentin the Netherlands, (2) WHO Collaborating Centre for the Family of International Classifications in the Netherlands

The WHO-FIC network is recommended to consider how to improve the present situation concerning rare diseases from the perspective of the existing or coming international classifications in the light of Universal Health Coverage

Early detection and prevention of rare diseases are generally recognized as important. We therefore recommend to study the relationship between rare diseases and laboratory interventions presented in ICHI. Because of the importance of functioning we also recommend to check whether interventions focusing at functioning (relevant to rare diseases) are clearly presented in ICHI.

http://www.ncbi.nlm.nih.gov/pubmed/19020695

http://www.ncbi.nlm.nih.gov/pubmed/19020695

http://www.eurordis.org/about-rare-diseases





http://www.orpha.net/orphacom/cahiers/docs/GB/List_of_rare_diseases_in_alphabetical_order.pdf



http://link.springer.com/content/pdf/10.1007/978-90-481-9485-8.pdf










http://www.icf-research-branch.org/download/finish/5/136.html






Title

Title

Examples of Coding Rules •Ordering of Codes

Code in the following sequence Interventions to respond to the main condition/functioning limitation (health condition, body function impairment, activity limitation or participation restriction) Interventions to treat the additional condition(s)/functioning limitation(s) Interventions to determine the main condition(s)/functioning limitation(s) Interventions to determine the additional condition(s)/functioning limitation(s)

•Rules specific for Public Health Interventions that involve organised mass delivery of individual interventions:

‘Population screening’ should be coded when the primary individual intervention delivered is a screening intervention aimed at detection of disease/risk factors where the subject is asymptomatic. The individual intervention should also be coded. ‘Population immunization/vaccination’ should be coded when the primary individual intervention delivered is a specific immunization(s). The specific immunisation(s)/vaccination(s) should also be coded.

ICHI Editorial and Coding Rules


C610


Authors: Linda Best, Megan Cumerlato, Richard Madden

Title

Title

Abstract For an international classification to be implemented there must be sound editorial and coding rules to explain the structure and intent of the classification. ICHI has been developed as a list of interventions, each with a title (i.e. the name of the intervention) and a code representing the Target, Action and Means for that intervention. For each intervention included in ICHI, the appropriate unique axis combination is specified. Not every possible combination of the three axes represents a valid intervention. Extensions may be used in combination with an ICHI code to provide additional detail (such as laterality, typography, revision procedures). Editorial rules and coding guidelines have been developed progressively as ICHI has been developed. The editorial rules provide the basis for development of the code structure for ICHI while the coding rules are being progressively developed as ICHI becomes more stable in its development. This poster provides an outline of the editorial and coding rules developed to date.

Introduction Editorial rules explain the construction of interventions in ICHI and the basis of the code structure; specify how particular axis codes were chosen where a choice had to be made to avoid ambiguity or more than one axis code could apply. Coding rules provide guidance on the use of ICHI to code health interventions. These rules have been developed progressively as ICHI has been developed. The coding rules are being progressively developed as ICHI becomes more stable in its development. Extension codes allow additional detail (such as laterality, typography, revision procedures) to the existing ICHI code. Extension codes are generic, allowing them to be applied to a range of interventions. Extension codes are included in ICHI to allow users to specify additional detail while limiting the size of the classification.

Methods & Materials ICD-9-CM Vol3 was used as a base to develop the content for ICHI, due to its high level of granularity and availability in the public domain. Editorial rules were progressively developed to respond to issues that arose during the conversion of ICD-9-CM Vol3 codes into the ICHI structure. Some were designed to clarify the scope of ICHI, in line with the agreed intervention definitions; others were designed to assist with selection of an axis code in situations of ambiguity or where alternative choices existed. Coding rules are an important for any classification to ensure consistency by all users in selecting the correct and most appropriate code. The Index may have coding rules ‘in-built’ to direct the user to the correct code assignment. The Tabular makes use of coding directives (e.g. exclude notes, code also notes, etc.). The coding rules include guidance in the use of other classifications alongside ICHI e.g. ICF. Extension codes are provided to allow users to describe additional detail about an intervention, in addition to the relevant ICHI code. A range of extension codes have been developed as part of the ICD-11 revision process (Refer: WHO ICD Revision Information Note 14), some of which are applicable to interventions, e.g. laterality; maximum consistency has been sought with ICD extension codes. Extensions codes will have sanctioning rules developed so that users will understand where and how these extension codes can be applied. Rules will also be written for the use of other classifications alongside ICHI e.g. devices and pharmaceuticals. Results Examples of Editorial Rule Target axis •Anatomical site is to be used as Target when it is specified. •When there is a choice of anatomical site, a rule is needed to determine which one is to be the Target in the ICHI code, for example:

Target for fistulas - . If female genital tract involved, target is female genital tract. If urinary tract involved, target is urinary tract except when female genital tract involved.

Any other fistulae, target is the first mentioned site. • Where an intervention concerns several anatomical locations, the deepest location or the closest to the cephalic extremity should be selected. Action axis •Where an intervention includes multiple actions, the main action or the first one mentioned should be selected. •For Actions that have been structured hierarchically, exclusion notes guide in the construction of ICHI items, e.g. Psychotherapy, therapeutic counselling and supportive conversation. Means axis • ‘Open’ is the default surgical approach unless otherwise specified in the intervention title.

Examples of Extension codes Typography Staged interventions Revision and Multiple procedures Identification of converted procedures Abandoned/incomplete procedures Emergency/elective procedures

The importance of having Editorial and Coding Rules and Extension codes, has been acknowledged from the beginning of the ICHI development project. The ICHI Alpha 2 will contain a more developed set of Editorial and Coding Rules than the Alpha version released in 2012, as well as Extension codes. Further additions and updates will continue throughout the ICHI revision process. Feedback on what has been developed to date would be most welcome. Contact: Linda Best [email protected]

Conclusion

mailto:[email protected]

Introduction

Title

Title

Conclusions

The development of an International Classification of Health Interventions (ICHI) has been progressing since 2007. Since 2010, when the definition of the overall structure of the classification was achieved, the focus of the work lay on the population of a tabular list of interventions. The fields presently covered by ICHI involve primary care, acute care, rehabilitation, functioning, traditional medicine, prevention and ancillary services. We describe the state of the medical/surgical content, which has already undergone several reviews by medical and classification experts and constitutes a classification of 3529 interventions in 12 chapters.

ICHI content development for surgical and medical interventions

Abstract

The development of the International Classification of Health Interventions (ICHI) encompassed the development of a Conceptual Model, a Coding Framework and Rules for Editors and Coders. Since 2007, a growing tabular list of interventions for the practical use is in progress: This poster describes the state of the ICHI medical/surgical content.


C611


Susanne Hanser1, Albrecht Zaiss1, Megan Cumerlato2, Linda Best2, Richard Madden2

1University of Freiburg, Germany 2National Centre for Classification in Health, University of Sydney , Australia

Title

METHODS & MATERIALS

Introduction

Fundamental for the development of medical/surgical content were: •a stable version of the ICHI coding framework

- a multiaxial classification for target, action and means of a health intervention

- in accordance with pr EN ISO 1828 for surgical procedures

•a widely used procedure classification in the public domain (ICD-9-CM Volume 3) as a source for descriptions of interventions in use and, for comparison, other important national health intervention classifications (CCI, CCAM, ACHI etc.) Using the three-axial ICHI coding framework, all interventions in ICD-9-CM Volume 3 were represented with a 7-letter-code; the titles were adapted to meet the requirement of unambiguity. This work resulted in the necessity to expand the first draft of the axes (i.e. adding entities for missing anatomical detail, actions or means) to match the granularity needed. Discussing the arising questions resulted in a growing set of Editorial and Coding Rules.

• A set of 3529 diagnostic and therapeutic interventions from the medical and surgical interventions field, sorted in Sections, Chapters and anatomical entity. Ready for a practical testing and feedback by users.

• The granularity of information on anatomy, actions and approach/technique corresponds to the granularity in ICD-9-CM Volume 3. A Mapping to ICD-9-CM Volume 3 exists for approximately 90%.

• Data stored on excel sheets and in database tables. • Printable Document based on database content: easily adapted in case of changes.

In only a few years (2010 – 2013) the ICHI coding framework has been populated with the growing content already covering primary care, acute care, rehabilitation, functioning, prevention and ancillary services. A group of experts from a broad range of WHO Collaborating Centers and Universities provided classification skills, IT and medical knowledge during workshops, phone conferences, and as “homework”. The Result is a tabular list of approximately 4000 interventions. The largest part of ICHI, the medical/surgical interventions, underwent several review cycles; the next step for the medical/surgical part will be a review by medical experts in the respective areas.

INTRODUCTION

RESULTS

Several review cycles followed: Review with focus on completeness: comparing the draft content with a range of national classifications, updating descriptions, where necessary, and proposing additional content. Inclusion of missing entities under consideration of the granularity (required detail) intended for ICHI. Further ‘review’ by the original proponents from the Sydney 2011 workshop. Latest review (August 2013, Gland) included quality checks on titles, annotations and other instructional notes, and spelling, as well as assigning ICHI codes to excluded interventions.

RESULTS

CONCLUSION

Introduction

The China National Health Development Research Center (NHDRC) has contributed to the development of Chinese Classification of Health Intervention (CCHI) since 2009. In order to improve its applicability, utility and reliability before implementation, one of NHDRC’s main objectives referred to the review of health intervention classification system between China and Canada. Consequently, NHDRC performed a project of comparing and contrasting surgical intervention between CCHI and CCI.

The purpose of this project was to identify and analyse similarities and differences of surgical intervention across two countries for improving the appropriateness of CCHI.

A Comparative Study of Health Intervention

Classification Between China and Canada

Abstract: With the aim of identifying similarities and differences regarding to health intervention classification between China and Canada, China National Health Development Research Center conducted a comparative research focusing on the surgical intervention of CCHI (Chinese Classification of Health Intervention) and CCI (Canadian Classification of Health Intervention) . Qualitative analysis and alternative approaches for comparison resulted in further improvement of standardisation of CCHI.


C612


Zhenzhong Zhang, Qin Jiang, Lihua Yu, Wei Liu, Tong Li

Methods & Materials

Results

Conclusion

This cross-national comparison identified and analysed differences of surgical intervention between China and Canada by using respective classification system of health intervention. It helped the researchers to explore intervention systems across two countries and interpreted concerning problems of current patterns.

Considering the present situation of health industry in China, it is appropriate to use CCHI as the primary coding and classification system currently. However, it may be beneficial to further modify and intensify its structure by adding more qualifier codes to facilitate statistical analysis.

Materials: CCHI version 2013 – Section 5 Surgery (including obstetrical and gynaecology)

Inpatient & outpatient

Casemix Payment, Reimbursement, Research, Decision-making

Based on ICHI & EN1828

CCI version 2012 - Section 1 Physical/Physiological Therapeutic Interventions & Section 5 Obstetrical and Fetal Interventions

Inpatient

Research, Decision-making

Based on EN1828

Methods

Translating CCI into Chinese

Compare and contrast the architecture

Code number & length

Code format & structure

Nomenclature

Content module

Hierarchy

Similarities:

Multi-axiality

Alphanumeric code

Major code + extra elements

Differences:

Scope

Definition of systems

Vocabulary of procedure description

Levels of hierarchy

Axis of content module

CCHI Section 5

CCI Section 1 & 5

Code number 5477 15428

Code length 8 characters - fixed 6-10 characters - unfixed

Code format Alphanumeric structure (eight-character code composed of digits and letters)

Alphanumeric structure (use‘.' to connect between axes and use ‘-’ to connect between qualifiers)

Code Structure Section + system + site + intervention + approach+ sequential number

Section + group + intervention + qualifier

Nomenclature (Procedure description)

Medical terminology i.e. Appendicectomy (Open)

Formal (plus clinical) i.e. Excision total, appendix, using open approach

Content module 3 axes: • Target • Action • Means Approach

3 axes plus 3 qualifiers • Target • Action • Means Approach/technique/method Device/agent Tissue

Extra elements Modifier (under test) Attributes (SLE)

Example: Transplant, scalp (Open) (autograft)

HYS89312 1.YA.83.LA-XX-A

Hierarchy 1. Field (therapeutic, surgical) 2. Body system (16 systems) 3. Anatomical site(482 sites) 4. Intervention type (44 types) 5. Approach type (9 types)

1. Field (therapeutic) 2. Body system (18

systems)+anatomical site (255 sites)

3. Intervention type (108 types) 4. Qualifiers (Approach/technique/method 749,

Device/agent 525, Tissue 14)

Verdana 36 Bold

Title

Title

Conclusions

Challenges in Implementation of International Casemix Grouper (UNU-CBG) to Support Efforts Towards Achieving Universal Coverage in Asian Countries

Introduction

•Universal coverage is the new target set by many developing countries after the 58th World Health Assembly in 2005.

•Main prerequisite for universal coverage is sustainable health financing system.

•Casemix or DRGs is a disease classification system that has been used as a tool to enhance quality and efficiency of healthcare services in many developed countries.

•Casemix system is used as prospective provider payment method in many social health insurance schemes.

•Use of casemix system in developing and resource challenge countries is erratic due to the lack of awareness among health decision makers, low technical capacity and inaccessibility to low cost and reliable casemix groupers.

•UNU-IIGH in collaboration with International Centre on Casemix and Clinical Coding of UKM has developed an international casemix grouper targeted for use in developing countries. The grouper was launched in 2010

What is International Casemix Grouper?

•Casemix grouper system based on generic disease, procedure and functional classification system available in public domain to produce reliable and homogenous casemix groups than can be used in many countries with or without modification to the basic structure of the grouping algorithm”

Countries working with UNU-IIGH in Development of International Grouper in Asia

•Malaysia, Indonesia, Bhutan, Vietnam, Philippines, Mongolia

•Yemen, Saudi Arabia, UAE, I.R of Iran

Components of International Grouper

Ideal Features of International Grouper •Use WHO-FIC diseases, procedures and functional classifications •Transparent and uncomplicated Algorithm •Use MDS available in both advance and less advance economy •Easily customised to suit each country needs •Based on Open Source Concept/Sharing of Source codes •Own and maintain by UN related agency •Has strong capacity building programme

Characteristics of UNU-CBG Casemix Grouper

•Universal (Cover Acute, Sub-acute and Chronic Conditions)

•Dynamic (Can be customised for local need)

•Advance (Upgradable to ICD-11 and ICHI)

Code Structure of UNU-CBG Grouper

Challenges In Implementing International Grouper

•Unhealthy competition with commercial groupers

•Low quality of disease coding

•Lack of updated procedure classification system

•Inadequate reliable costing information

•Lack of technical knowledge and skills in Casemix


C613


Syed Aljunid 1,2 Amrizal M Nur1,2, Zafar Ahmed1,2 and Sharifa Ezat Wan Puteh 1,2

Title

Title

International Grouper

ICD

ICHI ICF

UNU-GROUPER ACUTE

SUB-ACUTE

CHRONIC

EXPENSIVE PROCEDURES

SPECIAL PROSTHESES COSTLY

DRUGS

SPECIAL INVESTIGATIONS

DENTAL

Ambulatory Package

Nine Major Groups In UNU-CBG

A 1 2 3 III

CMG CBG Type Resource Intensity Level Case Type

CONCLUSION •Casemix is health system tool to enhance social health insurance programme for universal coverage •International grouper is required to support global implementation of casemix system •UNU Casemix grouper is an example of an attempt to develop and deploy an international grouper •Urgent need to build human resource capacity to ensure smooth implementation of casemix system in developing countries

Implementation of Casemix System in Developing Countries: UNU-Model

Disease & Procedure Codes

Costing Data

CCM

UNU Grouper

Cost-Weights

CUSTOMISED Casemix

GROUPER

Hospital Base

Rate

HOSPITAL TARIFF

Casemix Index

Affiliations: 1UNU-International Institute For Global Health (UNU-IIGH) 2 International Casemix and Clinical Coding Centre of National University of Malaysia (ITCC-UKMMC)

UNU-CBG

Mn-DRGs

INA-CBG

MY-DRG

Ph-DRGs

Ur-DRGs

Vn-DRGs

Saudi-DRGs

UAE-DRGs

Chile-DRGs

A B 1 2 V ACUTE SUB-ACUTE & CHRONIC

Verdana 36 Bold Title

Conclusions

A use case for ICHI—developing a monitoring tool for CBR

Abstract


C614


Nicola Fortune1, Ros Madden2, Sally Hartley2,3,4, Sue Lukersmith2, Richard Madden1

1National Centre for Classification in Health, University of Sydney (Australia), 2Centre for Disability Research and Policy, University of Sydney (Australia), 3School of Allied Health Professions, University of East Anglia (UK), 4The London School of Hygiene and Tropical Medicine (UK)

Title

Title

Community-based rehabilitation (CBR) is a community development strategy recommended by WHO to reach people with disabilities and facilitate improvements in their health and participation; it offers a means of inclusive development particularly suitable in low income countries1. The CBR Monitoring Menu and Manual (MM&M) project is a collaborative endeavor aimed at developing a prototype monitoring tool and method for use by local CBR programs. The Alpha draft of the International Classification of Health Interventions (ICHI) is being used to assist in developing a set of intervention data items for inclusion in the Monitoring Menu. This work is also contributing to ICHI development and providing opportunities to increase its relevance in low resource settings.

Abstract

It is generally agreed that evidence on the efficacy and effectiveness of CBR needs strengthening. Better monitoring and evaluation will facilitate the assessment of outcomes for people with disabilities, inform the improvement of CBR programs, and develop a stronger evidence base for CBR2. The CBR MM&M project is developing a Monitoring Menu that will consist of useful data items from which CBR programs can select for their own evaluation purposes and information needs. As a starting point for developing the Monitoring Menu, a literature review identified a wide variety of existing CBR monitoring tools and methods3. Information items were extracted from these published sources. A collaborative process involving CBR program leaders from Asia and the Pacific region generated additional information items and informed the structure of the Menu. Many of the information items relate to ICF domains and categories, particularly Activities and Participation and Environmental factors4. Those that do not have been grouped as items relating to: the person (e.g., economic status, client history), the organization (e.g., philosophy, organization goals), staff (e.g., training, reimbursement), or services. Items relating to ‘activities of service provision’ within the ‘services’ group, were sorted to identify items relating to interventions in scope for ICHI. These items were mapped to ICHI axes and interventions. This generated a list of ICHI interventions and axis categories of potential relevance to CBR, accompanied by comments concerning the ‘fit’ between ICHI and the CBR information items, e.g., in terms of granularity and underlying concepts.

The CBR information items are currently expressed in language and at a level of detail that is meaningful to CBR researchers and program providers, and will be further refined as the Menu is developed. Some items use terms such as ‘rehabilitation’, ‘therapy’, ‘early intervention’, and ‘empowerment’, which embody an element of purpose. ICHI explicitly does not classify the purpose of an intervention, or where it is delivered. Mapping the CBR information items to ICHI has been an informative exercise, and the analysis will be used to enhance the CBR Monitoring Menu, including potentially using some ICHI Target and Action categories to structure and specify items in the menu. This work highlights the need for ICHI to be adaptable for use at varying levels of granularity. This issue is being addressed as the development of ICHI progresses, including by the addition of ICF chapter-level Target categories in the Alpha-2 draft of ICHI to enable the description of interventions at a broader level.

Many interventions in the functioning and public health components of ICHI are relevant to the CBR ‘activities of service provision’ information items. However, in most cases ICHI interventions are described in more detail than the CBR items, so that many ICHI interventions would potentially be relevant for each CBR item. Often it is possible to identify ICHI Actions relevant to CBR information items, e.g., ‘Education’, ‘Provision’, ‘Referral’, ‘Community development’.

1. WHO, UNESCO, ILO, International Disability Development Consortium. Community-Based Rehabilitation (CBR) Guidelines. Geneva: WHO; 2010.

2. WHO, World Bank. World Report on Disability. Geneva: WHO; 2011. 3. Lukersmith S, Hartley S, Kuipers P, Madden RH, Llewellyn G, Dune T. Community-based

rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disabil Rehabil 2013; Early Online: 1–13.

4. Madden RH, Dune T, Lukersmith S, Hartley S, Kuipers P, Gargett A, Llewellyn G. The relevance of the International Classification of Functioning, Disability and Health (ICF) in monitoring and evaluating Community-based Rehabilitation (CBR). Disabil Rehabil 2013; Early Online: 1–12.

Images are sourced from the World Health Organization (http://www.who.int/) and CBM international (http://www.cbm.org/)

Example CBR information items Example ICHI interventions Practical daily living skills training Activities of daily living and Braille

training for blind children

Training—carrying out daily routine Training—preparing meals Training—washing Training—using communication devices

and techniques Provide counselling Giving moral support Advise on health and rehabilitation

Emotional support Counselling in pain management Counselling about decision making Counselling—looking after health needs

Parent-driven community centres for

intellectually disabled children focusing on skills training and care

Organizing parental support networks Empowering whole community

ICHI Action categories: ‘Community development’—Community engagement and empowerment; building awareness and mobilizing the community around specific health-related issues ‘Advocacy’—Mediating or pleading in favour of a client

http://www.who.int/

http://www.cbm.org/

INTRODUCTION

Title

Title

Conclusions

The National Board of Health and Welfare has been commissioned by the Government to intensify the efforts to develop the processes for open comparisons data and to improve access to high quality data regarding the various operational areas of the social services and home nursing, in collaboration with the Swedish Association of Local Authorities and Regions (SALAR). The lack of a nationally established classification of interventions conducted by the social care means that each municipality uses its local terms and descriptions of interventions, which makes it difficult to provide high quality reporting for the national statistics requested. The lack of uniformity can also lead to misunderstandings when information is to be shared between professions and operational areas. The lack of uniformity also limits the quality of the data used in evidence-base practice. The aim is to develop a classification of social interventions within the social services. The objective is for there to be a clear and uniform description of social interventions. These improve the quality and comparability of: •local documentation •information transfer for local operational follow-up •the basis for national statistics •open comparisons •the development of evidence-based practice The classification can also be used to describe, in a uniform manner, interventions described in laws, regulations and general advice and guidelines. The target group of the classification of the interventions used within the social care is professionals, representatives of the social care sector, business developers and people responsible for development and monitoring at national level.

Development of national classification of interventions in social care using ICHI- structure

Abstract The National Board of Health and Welfare has been commissioned by the government to develop a classification of interventions for social care. The Swedish national classification will be based on the structure of the International Classification of Health Interventions (ICHI). The first Alpha version includes 473 therapeutic interventions. The targets to activities and participation and at 2nd level are most frequently used. The next step will be to assure the quality, perform field tests and continue to develop the diagnostic , managing and preventing interventions .


C615


Almborg A-H Nordic WHO-FIC Collaborating Centre, Norway; National Board of Health and Welfare, Sweden

Title

Title

METHODS & MATERIALS

RESULTS

CONCLUSIONS

The work to develop the classification is conducted through the collection and analysis of source material from municipalities, official and national statistics and relevant regulations. The development of interventions is based on the three axes of the ICHI. What is the target for the intervention?

• e.g. activities & participation, anatomy, body functions, environmental factors and behaviour

Which is the action of the intervention? • e.g. observation, test, counselling,

education, training?

Which is the mean of the intervention? • e.g. method, technique, approach,

sample used to perform the intervention

The work is carried out in consultation with operational representatives, experts from the National Board of Health and Welfare and representatives of Swedish Association of Local Authorities and Regions. During 2013, the first version of the classification is going to be assured in terms of its quality and usefulness, and field tests are planned during 2014.

Nine actions are used for therapeutic interventions The means have not been specified in the first version. Preliminary results show positive perception of the professionals to use the interventions in their structured EHR documentation.

Ann-Helene Almborg [email protected]

The conclusions are the following: •The ICHI structure using the three axes supports the development of a national classification of social care interventions. •The targets to activities and participation and at 2nd and block level are the most frequently used. •The actions cover the needs in the social care sector. •The means are not very developed for the social care area.

The future work, involving testing of the validity and usefulness as well as field tests, will be important to obtain knowledge about the usability of the classification in the EHR and as a basis for data for national statistics. The work also includes to develop the diagnostic , managing and preventing interventions of social care.

The first version of the classification included 473 therapeutic interventions (100 at chapter level and 292 more specific interventions) (Table 1). The targets to activities and participation at 2nd and block level are mostly frequently used (Table 2).

RESULTS

Actions code Actions

LS Supporting conversation PA Education PB Counselling PC Training PG Therapeutic counselling SA Provision SB Care giving SY Personal assistance SZ Personal support

Table 1. Interventions to each component and level Component chapter block level 2nd 3rd-4th Activities & participation 71 81 165 28 Bodyfunctions 6 11 5 Environmental factors 15 43 Behaviour 8 general level 40 specific

Table 2. Number of targets to each component and level Component chapter block level 2nd 3rd-4th Activity & participation 9 16 31 6 Bodyfunctions 1 3 2 Environmental factors 3 11 Behaviour 1 general level 10 different

behaviour

Introduction

Every year the WHO-FIC collaborating centers meet at the annual meeting, after having submitted tenths of abstracts followed by posters, and in the past, papers. The process of sending, awaiting notification, resubmitting posters on one side, and receiving, sending notifications and receiving again posters on the other side is time-consuming and prone to mistakes, lost files, etc. For this reason this year for the first time a prototype web-based submission system has been tested, after its proposal during ITC work at the Brasilia network meeting. The present poster briefly describes the work behind.

The WHO-FIC Annual Network Meeting submission system

Abstract The present poster is aimed at describing the work done to provide a web-based submission system for the WHO-FIC Annual Network Meeting.


C616


Della Mea V.1 1 University of Udine, Italy and Italian Collaborating Center

Results

The selected system is based on an open source platform, OpenConf. which in turn has been developed using PHP and MySQL. Openconf is provided as free community edition, as professional edition mandatory for congress organizing companies, and as hosted service. The community edition has been chosen and installed on the web server of the Medical Informatics Lab at the University of Udine, Italy (2). Due to the peculiar requirements of WHO-FIC, only few features of the system are really used, while on the other side a method to set manually chosen poster identifiers was missing. For this reason, a couple of extra functions have been implemented to allow: •setting WHO-FIC poster identifiers; •downloading the whole set of posters together, renamed after the WHO-FIC identifiers and compressed in a single ZIP file. On the other side, a number of Openconf features have been considered very useful: •large size file download, that circumvents issues when sending large files through email; •email communication module, able to notify receipt of abstracts and files, and eventually to communicate to all Authors; •"paper topics", that in our system became committee names to tag poster content; •summary views like submissions per topic (committee) or per country. Further features were not fully exploited this year, but will be in the next, like program committee access to let committee chairs see submitted posters of their interest.

Conclusions

This first experimental year had 120 submissions, with no particular problems registered. While using it on the organization side, a number of possibilities have been understood to better use the system also for congress organization. For example, appropriately tagging abstract content might help in collecting posters by their topic, not only referring to committees and reference groups but also, for example, to the specific classification involved. During this first annual meeting comments also from Authors will be gathered to enhance the system in view of its regular adoption.

Acknowledgements

We thank Zakon Group LLC, developers of the Openconf platform.

References

(1)OpenConf: http://www.openconf.com

(2)WHO-FIC Annual Network meeting submission system: http://mitel.dimi.uniud.it/whotools/submission



Methods & Materials

The management of the annual WHO-FIC meetings is slightly different from the management of a scientific conference, due to the facts that it is invitation only, there is no strict peer review, and the final document is a poster going to be printed by meeting organizers. However, there are many similarities in particular for what regards communications among Authors and organization. For this reason, attention has been paid to conference management systems. To avoid duplication of efforts, a brief review of available web-based conference management systems has been preliminarily carried out. A number of open- and closed source, free or paid systems and services have been identified. Among those, OpenConf (1) has been chosen because it is an open source system, written in PHP, and this allows some customization to fit the needs of WHO-FIC.

http://www.openconf.com

http://mitel.dimi.uniud.it/whotools/submission

http://mitel.dimi.uniud.it/whotools/submission

Introduction

For a modern classification, it is essential to have a web-based platform. Such a platform enables collaborative development, consistent maintenance, and easier and more effective reviewing and commenting. The platform should include a number of basic features such as navigation and search functionality, user comment facility, entity creation and modification, as well as advanced features including linkage to other classifications and terminologies, and a URI-based API. This is what in the last years has been developed for ICD10 and ICF (browsers and update platforms), and later ICD11 (iCat and Revision platform) (1). Aim of the present poster is to describe a similar prototype platform that has been developed for ICHI too.

ICHItool: a prototype system for ICHI development and maintenance

Abstract For a modern classification, it is essential to have a web-based platform. Such a platform enables collaborative development, consistent maintenance, and easier and more effective reviewing and commenting, like those available for ICD11, ICD10 and ICF. Aim of the present poster is to describe a similar prototype platform that has been developed for ICHI too.


C617


Della Mea V.1, Donada M. 1, Best L. 2, Cumerlato M. 2, Madden R. 2 1 University of Udine, Italy and Italian Collaborating Center; 2 Australian Collaborating Center

Results

The Italian Collaborating Centre has developed a prototype tool (ICHItool) designed to have the look and feel of the other WHO-FIC platforms. This has been very useful for content review and revision. The ICHItool currently has the following features: •Storage facility for all required information that makes up ICHI •Content box for code titles and to have fields for definition, includes, excludes, and code also notes •Content box for axis titles and to have fields for definition, includes, and excludes notes •Deletion/retiring of concepts capability •Access/password for limited users in the development period •Ability to download files to xls or txt •Ability to download either small sections, individual chapters or the whole of ICHI •Accessible to reviewers to enable commenting during the revision process •Format that will enable commenting, storage and revision of comments during the revision process. Three user profiles access the system: •guest users may only browse and search ICHI entities, •registered users may also comment, •administrators can create and modify ICHI entities. The platform, developed using PHP and MySQL, is hosted at the Medical Informatics Lab of the University of Udine, Italy, on a Linux Web server (2).

Conclusions

The presented platform is currently only a prototype, yet is usable. Additional features to be added include: • Ability to ‘attach’ a comment to an entity being created/updated to provide reasons for the change •A change history record to see the changes to a concept over time •Ability to search includes and excludes notes and annotations, as well as code titles •Parameter field for addition of modifiers and qualifiers applicable to specific interventions •Ability to output to CTK Birch •Ability for an URI API system for automated access from other software programs •A tool to be developed to allow terminology/ontology comparison with other classifications •A linerarisation function to permit production of various subsets. These additional features would allow the ICHItool to act as a production platform for ICHI development. Such a platform is urgently required as the scope of ICHI expands and additional reviewers need to be accommodated (there is little prospect of capacity being available to adapt iCAT for this purpose in the short term). To date, the resources to allow ICHItool to be developed as a production platform have not been available.

References

1) Tudorache T. et al. Supporting the Collaborative Authoring of ICD-11 with WebProtégé. AMIA Annu Symp Proc. 2010 Nov 13;2010:802-6.

2) ICHItool. http://mitel.dimi.uniud.it/ichi/



Methods & Materials

To experiment with above mentioned features in the case of ICHI, the Australian WHO-FIC Collaborating Centre developed a list of requirements for an ICHI platform, based on the already known experiences that are at the basis of ICD11. The Italian WHO-FIC Collaborating Center translated this list into a working prototype. Iterations have been made among development team and ICHI management, including people from the Australian and German Collaborating centres, to ensure requirements were met.

http://mitel.dimi.uniud.it/ichi/









ICNP is a standardized terminology that can support nursing practice and patient care worldwide. ICNP is built on a formal Web Ontology Language (OWL) description logic foundation, which accommodates both interface properties (to facilitate use at the point of care) and reference properties (for secondary use of data and harmonization with other terminologies). ICNP interventions were partitioned into four broad groups using automated reasoning on the ICNP ontology to cluster concepts: Informing (109 interventions), Determining (228), Managing (115) and Performing (28). ICNP interventions were mapped to ICHI. Where no equivalent ICHI intervention could be found, relevant Target and Action axis categories were identified.

As an established classification of nursing practice, ICNP provides a strong starting point from which to develop nursing interventions for ICHI. On the basis of the mapping exercise, new interventions and Target and Action categories are being proposed for inclusion in ICHI. Consultation with nursing professionals will be undertaken to review the mappings and proposed new interventions and axis categories. The aim will be to ensure that the full spectrum of nursing interventions is covered, and that they are described in a way that is meaningful in a nursing context. The next step will be to field test a draft list of ICHI nursing-relevant interventions in a range of different contexts.

Of the 480 ICNP interventions, an equivalent ICHI intervention was identified for 23% (Table 1). For a further 25%, relevant Target and Action categories were available, making it possible to construct new ICHI interventions (Table 2).

In 2012 there were 29 million nurses and midwives globally1. Despite its importance and significant cost, nursing is not well represented in casemix systems. Several countries reimburse nursing as part of a fixed daily ‘room rate’. However, this has been shown to underestimate actual nursing costs — by over 30% in one study2. Some countries adjust for variations in nursing care by applying an average nursing resource weight to Diagnosis Related Groups (DRG). This accounts for variations between DRGs, but does not reflect different intensities of nursing care within a particular DRG. Combining nursing data with DRGs can improve the explanation of variance in a range of indicators — from 30% for length of stay to 146% for hospital death in a further study3. This approach has been used to characterise and compare nursing care activities and costs, and to demonstrate the value of nursing4,5. A wide range of potential applications are envisaged for ICHI, including as a building block for international casemix development. Inclusion of nursing interventions in ICHI is essential to ensure that nursing is represented in the international health information infrastructure of the future.

INTRODUCTION

Abstract Nurses are the largest group of health workers in most health care systems. In some parts of the world, nurses may be the only health professionals that people see throughout their lives. While data-based information might be used to characterise nursing care activities and costs, and to demonstrate the value of nursing, the actual use of data-based information for these purposes has been patchy, making local, national or international comparisons difficult to impossible. If nursing is not adequately represented in routinely collected data, one of the very significant costs of health care will not be reflected in today’s casemix systems. The International Council of Nurses (ICN) is contributing to the development of the International Classification of Health Interventions (ICHI), using the International Classification for Nursing Practice (ICNP) to suggest possible nursing content.

Making nursing visible in health information systems


C618


Nicholas R Hardiker, Nicola Fortune, Claudia C Bartz, Richard Madden

RESULTS

References

ICNP intervention ICHI Target (T) and Action (A) Monitoring Blood Glucose T = Blood

A = Monitoring Counselling About Alcohol Use T = Alcohol use

A = Counselling Managing Urinary Incontinence T = Urination function

A = Other managing action Administering Insulin T = Unspecified site

A = Application [of pharmaceutical] Administering Pain Medication T = Sensation of pain

A = Application [of pharmaceutical] Maintaining Ventilation T = Function of the respiratory system

A = Ventilation Irrigating Bladder T = Urinary bladder

A = Irrigation

Table 2: ICNP interventions mapped to ICHI axes—examples

CONCLUSIONS

1. World Health Organisation (2013) World Health Statistics 2013. World Health Organisation: Geneva. 2. Welton J, et al (2006) Nursing intensity billing. Journal of Nursing Administration 36 (4), 1–9. 3. Welton J, Halloran E (2005) Nursing diagnoses, diagnosis related group, and hospital outcomes. Journal of

Nursing Administration 35, 541–549. 4. Sermeus W (2006) De Belgische ziekenhuisfinanciering ontcijferd. ACCO: Leuven. 5. Baumberger D, et al (2013). Nursing care data from patient records for DRG data comparisons between

hospitals. In: Proceedings of ACENDIO 2013, Dublin.

METHODS & MATERIALS

Table 1: ICNP interventions mapped to ICHI interventions—examples

ICNP intervention ICHI intervention Assessing Cognition Assessment of intellectual functions (FAC AA AH) Counselling About Fears Emotional support (FAM PB BK) Teaching About Pain Pain management education (FDG PA ZZ) Managing Peritoneal Dialysis Peritoneal dialysis (AHY FB AE) Dressing Patient Personal assistance – dressing (HED SY BK) Positioning Patient Positioning of the body (ATR LG ZZ) Inserting Vascular Access Device Endovascular procedures on blood vessel (AEZ AZ AF)

For many ICNP interventions an appropriate ICHI Target category could not be identified, e.g., ‘Assessing knowledge of disease’, ‘Monitoring fall risk’, ‘Teaching about infant care’, ‘Discontinuing wound drain’. A list of new Target categories has been developed to consider for inclusion in ICHI.

who - family of international classifications network annual meeting

Documents