Dr KEES VAN BOVEN

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

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INTERNATIONAL CLASSIFICATION OF PRIMARY CARE
ICPC-1 1987 ICPC-21998 ICPC-2-E 2000
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A classification is the ordering principle of a
defined domain
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ICPC

• THE DOMAIN OF
• FAMILY PRACTICE

quantitatively..
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SYMPTOMS DIAGNOSES
ICPC gt 1 PER 1000 PPY
200
400
600
10.000
ICD lt1 PER 1000 PY
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and qualitatively..
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DESCRIBES THE CONTENT OF PATIENT-FP ENCOUNTERS

• localization before etiology
• symptoms AND diagnoses
• -28 impairment category
• -27 fear of .. category
• -64 category (FPs initiative)
• social problems
• patient and FP oriented

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What is the unit of observation in family
medicine?

• Patients?
• Doctors?
• Encounters?
• Diagnoses?
• Episodes the patient with his/her problem over
  time

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episode of care

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

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

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ICPC Chapters (Systems)

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

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ICPC Components

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

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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

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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 PATIENTS statement, clarified by the
  doctor.

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Episodes of care Reason for encounter (RFE)

• This is a true primary care concept
• Primary Care is RFE driven, not diagnosis driven

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Episodes of care

• Health problem the diagnosis
• Certainty
• Status
• Clinical findings
• No coding (yet) for everything in primary care

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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

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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

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Episode example

• 23 yr old woman typist, tennis player
• RFE pain R elbow for 10 days, and cant 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

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Episode of care
Intervention Hb
1st visit
Intervention barium enema
2nd visit
Intervention referral
3rd visit
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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

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Possibilities for data on functioning disability

• Classification of Body Functions
• in patients Reasons for Encounter, as symptoms
  and complaints,
• in GPs 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

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Health condition (disorder or disease)
Body function Activities
Participation
and structures
Environmental Personal
Factors Factors
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COPD (ICPC/ICD code)
Breathlessness Cant get upstairs
No work Poor condition
Living in a flat Smoking

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Case history Mr De Vries, age 72

• Present complaints
• Shortness of breath
• Palpitations
• Findings
• Hypotension
• Bradycardia
• Cant get upstairs
• Walking difficulties

• ICPC code
• R02
• K04
• ICPC - ICF code
• K43 - B4201
• K43 - B410
• K48 - D460
• K48 - D450

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

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

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