fdrg bcn-006 - barcelona poster booklet

Poster Booklet

C101-C109 Committees & Reference Groups

C201-C219 WHO Collaborating Centres

C301-C321 ICD-11

C401-C438 ICD-10

C501-C ICF 541

C601-C ICHI 610

C701-C722 Other

WHO ID Topic

C101 Report from the WHO-FIC Network Advisory Council

Berg; Hargreaves

C102 Family Development Committee Annual Report 2014

Hargreaves; Ten Napel; Macpherson

C103 Informatics and Terminology Committee (ITC) Annual Report

Carvell; Della Mea

C104 EIC annual report Buchalla; Walker C105 URC Annual Report Vogel; Gongolo; Moskal C106 Functioning and Disability Reference

Group Annual Report 2013-2014 Sykes; Martinuzzi

C107 Mortality Reference Group: Annual Report, 2013-2014

Hoyert; Wood; Johansson

C108 Work plan update - Functioning Topic Advisory Group (fTAG)

Selb; Stucki; Kennedy

C109 Quality & Safety TAG Southern; Quan; Ghali

WHO ID Title Authors

C101-109 Committees & Reference Groups

Introduction

During 2008, the Council agreed toestablish a Small Executive Group(SEG) to prepare recommendations fordiscussion by the Council and identifyother issues for Council discussion anddecision.The SEG includes the co-chairs of theCouncil, two additional committee orreference group co-chairs (AndreaMartinuzzi and Patricia Wood), anetwork member nominated by theWHO (Lyn Hanmer) and WHOHeadquarters staff.

Report from the Council

Abstract During the 2007 annual meeting of the Network, a WHO-FIC Council was established to accommodate the need for broader participation in the core decision-making processes of the WHO-FIC Network and, in 2013, role of the Advisory Council was confirmed in the Network’s ‘Conduct of the WHO Family of International Classifications Network’ paper.

The functions of the Council are 1) to develop a Strategic Work Plan for the Network, which is presented at the annual WHO-FIC Network meeting, 2) to monitor and follow up progress of the Strategic Work Plan, 3) to establish and revise, as needed, procedures for the conduct of annual meetings of the Network, 4) to participate in planning the annual meetings, and 5) to review action items from each meeting and address new action items that arise.

11-17 October 2014Barcelona, Spain

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WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014

Authors: Lars Berg and Jenny HargreavesCo-Chairs

Work during the last year

Both Council Co-Chairs are membersof the Revision Steering Group (RSG)of the ICD Revision towards ICD-11.Monthly Telephone Conferences of theRSG were attended by both co-chairs.One Co-chair (Lars Berg) joined phoneConferences and face-to-face meetingsof the RSG-SEG.The SEG provided advice to the WHOabout engagement of the Network inthe process and on WHO plans toevaluate country transitionrequirements.

Acknowledgements

ICD revision

The Council convened twice during theannual WHO FIC Network meeting inBeijing in October 2013.Stefanie Weber had served twoconsecutive terms as council co-chairand was not available for re-election.The Council elected Jenny Hargreavesas a new Council co-chair and LarsBerg was re-elected, both for a two-year period.During the working period October2013 - September 2014 the Councilconducted three telephoneconferences, in February, April andSeptember 2014.The Small Executive Group (SEG) meetin monthly teleconferences, and alsoface-to-face at WHO in Geneva in April2014. The principal focuses of thesemeetings were to follow up on actionitems from the Beijing meeting, toreview the status of the Strategic WorkPlan and to explore ways to enhanceparticipation in the Network.The SEG and Council focus has been:A. Paper on Conduct of the WHO-FICNetwork:The paper is a compilation of existingand approved papers about theNetwork. In an interactive process thepaper was compiled, aligned andupdated in 2013 and presented in theAnnual Network meeting in Beijing.The compiled paper was approved bythe Council in Beijing October 18 2013,subject to some minor corrections anda final review by the WHOHeadquarters. The final paper

Development of ICHI

Acknowledgements to Stefanie Weber for her excellent 4-year period as Council Chair, ending in Beijing 2013.

(Conduct_of_WHO-FIC_Network-version1.pdf) was posted on the WHOweb site 17 February 2014.The document is open for changes atthe annual meeting every year.Proposals for changes to thegovernance document should besubmitted before the Septemberteleconference of the Council.Track changes will be circulated in thefuture to the council members fortransparency, whereas online only afinal version is posted.B. Alignment of the Strategic WorkPlan (SWP):During 2013 teleconferences with thesix committees/reference group co-chairs were undertaken. The StrategicWork Plan (SWP) for the WHO-FICNetwork was reviewed in order to alignit to a complete and comprehensiveWork Plan that reflects the full work ofthe Network. The work plans werecompiled into one single sheet in Excel.As a continuation of this work theCenter Heads, the WHO RegionalAdvisors and the WHO-FICHeadquarter staff had a pre-meeting inBeijing 11 October before the AnnualMeeting 2013 to better align the WHOCollaborating Centre’s resources withthe WHO-FIC Network’s SWP.Further alignment and updates to theSWP for committees and referencegroups were undertaken at the mid-year meetings in 2014.Important aspects are the itemsincluded in the workplan, how they linkto the different committees andgroups, and what resources areavailable. It was clarified that SWPsconsidered at mid-year meetings andpresented at each annual Networkmeeting should be for the workplan forthe year following the annual meeting.C. Election rulesDue to the change of committeestructure 2012 there are WHO-FICcommittees having both co-chairscoming to the end of their secondterms of office in 2014. Current WHO-FIC rules do not allow co-chairs toserve more than two two-year terms.There may be also other reasons thatwould result in change of both co-chairs of one committee or reference

group. In such cases, the Councildecided that pragmatic mechanismswill ensure continuity rather than rulechanges:- Former co-chairs are available for consultation - Former co-chairs acting as a secretariat- WHO focal point providing continuity

ICF ontology

The Council and SEG, with the FDRG,FDC and ITC, have liaised with WHOabout the need to proceed withsystematic ontological work on ICFwith the goal of improving integrationof ICF with other health informationsystems and harmonization with theother WHO classifications. Liaison hasfocussed on the WHO's work towardsestablishing a project to meet theseneeds, and Network support of theproject.

The Council and SEG, with the FDC,provided advice to the WHO for itswork towards development of anInternational Classification of HealthInterventions, as the work moves froma pilot alpha development to a formalWHO project. Advice has includedmechanisms for continuing use of thetechnical expertise of all the teamsfrom the WHO-FIC network thus farinvolved.

Introduction

The Family Development Committee (FDC) was established in 1999 to ensure the WHO-FIC has a logical structure with health classifications identified for each health parameter and setting within the health system.

The Committee met twice during the year, in October at the Annual Meeting in Beijing, China, and then again in June for the mid-year meeting in Chicago, USA. The mid-year meeting was held in conjunction with meetings to progress work on the International Classification of Health Interventions (ICHI) convened by the WHO and hosted by the American Medical Association. The photo on this poster is a view of the central area of Chicago near to the meeting venue.

The FDC co-chairs would like to thank all the FDC members for their valuable contributions to the FDC work-plan activities during the year.

Progress against each of the Strategic work plan activities is outlined here.

Family Development CommitteeAnnual Report 2014

Abstract

The Family Development Committee aims to develop the World Health Organization’s Family of International Classifications (WHO-FIC) as an integrated and comprehensive suite of classifications. It also aims to ensure that the WHO-FIC has a logical structure so that the classifications needed for each component and setting within the health system can be identified. This poster presents a summary of the activities of the FDC from October 2013 – September 2014.


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Jenny Hargreaves (Co-chair, Australian Collaborating Centre); Huib Ten Napel (Co-chair, Netherlands Collaborating Centre); Brooke Macpherson (Secretary, Australian Collaborating Centre)

Title

Strategic Work Plan review

As part of the Committee’s work on applications of the WHO-FIC, a stocktake of the use of the WHO-FIC being used in casemix systems around the world was undertaken.

Responses from different nations were collated and results presented to the Committee at the mid-year meeting in Chicago, USA. Responses showed varying practices amongst countries, and identified gaps in classification usage, especially around measuring functioning.

The FDC used these responses to influence the development of ‘draft principles for an international casemix classification system’. This draft document contains potential considerations of a framework for an international grouper, that could be used for international comparisons and as a basis of more detailed, national groupers, used for funding and other management processes.

Task 3: Applications of the WHO-FICThe Committee had opportunities to

review the Strategic Work Plan at both FDC meetings this year. Changes to wording and focus areas were agreed to by members based on discussion and feedback at these meetings.

The agreed future work plan is to be tabled with Council at the Annual meeting in Barcelona.

Task 4: WHO-FIC support for Universal Health Coverage (UHC)

After consideration of how the WHO-FIC could support the WHO’s UHC initiative, the FDC investigated the extent to which the classifications could support measurement of certain indicators for the UHC initiative.

At the mid-year meeting in Chicago, the ability to capture the WHO-World Bank’s 12 illustrative UHC prevention and treatment indicators using the WHO-FIC reference classifications was assessed. Results highlighted that there were gaps in the classifications that made coding difficult, and incomplete aspects of the definitions of the indicators also affected the ability to code accurately.

The results of the analysis will be fed back to the WHO and relevant Network committees.

Task 2: Integration of the Family

For this task the FDC progressed the re-drafting of the 2007 WHO Family paper, which describes the Family, principles of classifications and the processes of adding, updating and maintaining classifications in the Family.

The Annual meeting saw the agreement of FDC members on a new document structure for the paper. The new structure was used to present a new draft to members at the mid-year meeting in Chicago. Discussion of the new draft focussed on the need to reflect a shift to a more unified approach – how the classifications link together and are harmonised through comparisons of content models and ontologies, but with the paper still retaining the essence of what “the family” is. Further work was also done on the nature and place of ‘related’ and ‘derived’ classifications in the family.

The revised draft family paper will be presented to Council at the Annual meeting in Barcelona.

Task 5: Assess the need for additional members of the Family

Task 1: International Classification of Health Interventions (ICHI)

As the Focal Point for the WHO-FIC Network for the ongoing ICHI development work, the FDC held coordination meetings for ICHI. These meetings ran in conjunction with the FDC’s Annual meeting in Beijing, China and, as noted above, with the mid-year meeting in Chicago, USA.

The meetings provided an opportunity for the ICHI development teams to report details of work undertaken, for FDC to provide advice, and for joint work between the project and FDC.

Task 6: Alignment of members of the Family

The FDC gave consideration to the inclusion of the Dutch Institute of Logopedics and Phoniatrics’ ICF-logopedie as a national or specialty linearisation of ICF. Members also suggested that the additional content could be added to the URC update process for ICF.

FDC considered a report on progress towards harmonisation of the ICF environmental factors with ISO 9999. The work was reported to have been completed by the relevant ISO group and the FDC will now seek a copy of it for review.

Chicago, USA

Introduction

Title

The Informatics and Terminology Committee (ITC) was established in 2010, combining the Electronic Tools Committee and the Terminology Reference Group into one WHO-FIC committee.

.

INFORMATICS AND TERMINOLOY COMMITTEE - ANNUAL REPORT



Karen Carvell1, Vincenzo Della Mea21Canadian Institute for Health Information and North-American Collaborating Center;

2University of Udine, Italy and Italian Collaborating Center

Title

Classifications and Revision Platforms

A multi-language framework is required to enable the translation of content of WHO classifications.

WHO HQ has developed a tool for this and the seven WHO languages have been loaded into memory. It features a translation memory to track movement in the classification and enables workflow for approval and comment on another person’s translation.

In parallel to this effort, the Korean Collaborating Centre continues to work on the translation of ICD-11 to Korean and Chinese.

Acknowledgements

Multilingual Support

WHO headquarters and collaborating centres work to enable standardized maintenance, update and revision of WHO classifications. Priorities in this area include maintaining and enhancing browsers for ICD, ICF and ICHI. Work has continued on the classification update platforms and on the ICD Revision Platform, which now provides a section for proposals.

Formal Knowledge Representation

ITC wishes to acknowledge the work of the WHO HQ and collaborating centres for their contributions over the past year.

Another focus of the ITC is to enhance formal knowledge representation of WHO classifications and their linkages to related terminologies. This is a multilateral item requiring coordination with other committees, reference groups, and external participants.There were several activities in the area over the past year:

WHO-IHTSDO harmonization process – A number of ITC members are also members of the WHO-IHTSDO Joint Advisory Group (JAG). During the last year, JAG refined the architecture for harmonization and carried out the mapping of equivalences between ICD11 and SNOMED-CT in the Circulatory System chapter, and then started with a number of other chapters, as a preliminary work towards the Common Ontology.

ICF Ontology – ITC Co Chairs participated in the FDRG mid-year meeting to begin discussions and work on the development of an ontology for ICF.

Abstract

This poster presents annual report of the Informatics and Terminology Committee (ITC), highligting activities of since the Beijing meeting in October 2013.

Standards

Administration

Technical standards are developed to enable the electronic exchange of WHO classifications. In 2013 the WHO developed a Uniform Resource Identifies (URI) scheme to identify ICD-11 entitles and a web interface. The URI API has been further consolidated and now also includes proposals. Correspondingly, the social apps used as a test case for the API have been updated to also publish proposals on Facebook and Twitter.

The German Collaborating Centre has finalized the ICD-O-3 stylesheets and published the German version online. It is also possible to generate pdf, ClaML and Metadata. It is fully implemented in CTK and can be used by other Collaborating Centres, if needed, as well as by WHO.

Other Activities

1. The web site for poster submission has been maintained the 2014 WHO-FIC meeting.2. During the mid-year FDRG meeting, preliminary work was carried out on the mICF project, aimed at the development of a mobile app for ICF.3. Work is in progress on a web-based system for the ICD11 field trials.

Ad-hoc meetings of the co-chairs have throughout the year; however, due to the lack of resources, no face to face mid-year meeting could be held.

An ITC web page was developed by the Italian Collaborating Centreto contain documents and basic information on the committee such as minutes, membership, reports, etc. This would enhance communication for the committee and other members of the WHO-FIC network. http://mitel.dimi.uniud.it/who-fic-itc . A mailing list for ITC members has also been set up.

The Strategic Workplan was updated following the Beijing meeting to include feedback from Council. This poster highlights work completed in the past year and underway within each of the ITC strategic priorities.

C103

Introduction

Title

The Education and Implementation Committee was created in 1999 and since this time has been working to improve the level of classification use and the quality of coded health data.

During 2013-2014 the EIC had two teleconferences (February and September) and a face-to-face meeting in April in Lyon, France. The status of the EIC activities for this period is presented here.

The EIC Resources for the WHO-FIC Network

Abstract


C104


Cassia Maria Buchalla, Sue Walker and the Education and Implementation Committee members

Title

WHO-FIC database

The EIC has worked on standard exam questions to allow testing of the knowledge of morbidity and mortality coders who use the WHO version of the ICD-10.

The exams are available to Ministries of Health, Collaborating Centres and other Organisations.

There is a requirement that the exams are offered under the terms and conditions established by the EIC.

Although no certification is possible for individuals who pass the exam, coders interested assessing in their skills against an international coding benchmark will be issued letters of acknowledgement. Where to find EIC Products

The EIC supports the development and completion of data in the WHO-FIC implementation database. During this period the tool has been improved and it being populated by countries. WHO Regional offices are also supporting the data collection.

The aim of the database is to provide information to support the Global Health Observatory (GHO) by providing metadata about the classifications used to populate the GHO.

The EIC has been asked to support the level of completion and currency of the data in the database. Materials will be developed to support user completion of the database.

The current version of the database is available at http://beta.who-fic.nl

Best Practices

INFORMATION SHEETS (IS)- thefollowing IS are available:

•Training and Certification to Promote HighQuality Data

•International Statistical Classification ofDiseases and Related Health Problems,10thRevision (ICD-10)

•International Classification of Functioning,Disability and Health –ICF

•What You Should Know about ClinicalDocumentation in Acute Care Hospitals

•Uses of Coded Clinical Data

•Mortality (Cause of Death) Data

•Civil Registration and Vital Statistics

•International Classification of Diseases(ICD) and Standard Clinical ReferenceTerminologies: A 21st Century InformaticsSolution

The following are being created:

•Automated Systems for Coding Cause-of-Death Data•New International Death Certificate•ICHI•ICD and ICF Implementation Database

BRIEFING KIT (BK)A collection of updated documentsregarding the WHO FIC network hasbeen created for new CollaboratingCenters.

This kit includes the EIC products,information on all designatedCollaborating Centers and other usefulinformation for those who are new tothe WHO FIC Network.

The ICF e-learning tool has been finalised and will be available soon. It has been developed as an introductory training package with further educational materials planned.

The current version is available at http://icf.ideaday.de/

ICF PRACTICAL MANUAL

This important product on ICF was made available for 12 months on the WHO website as an exposure draft. Feedback has been incorporated and the Manual is now updated and available as version 1.

Educational Material

TRAINING TOOLS

The EIC has been engaged in the development of web-based training tools for both the ICD and ICF.

The ICD-10 Training tool has recently been updated with more international coding examples, and is available at: http://apps.who.int/classifications/apps/icd/icd10training/

The EIC also provides a training tool support group that allows users of the ICD training tool to submit questions relating to the training materials.

The EIC aims to improve the quality of health data and the use of the WHO Family of International classifications. Activitiesrelated to these objectives, and listed in the EIC strategic work plan, are reported according to their level of development.

Assessment materials

ICD -11

The EIC has provided case summaries for both the training for the ICD-11 field trials and for the field trials themselves.

The EIC also discussed the need for ICD-11 implementation support documents.

http://www.cdc.gov/nchs/icd/nacc_education_committee.htm

Introduction

Title

Purpose of the Update and Revision Committee (URC) is to support WHO and WHO-FIC Network in keeping the WHO Family of International Classifications “Reference Classifications” up to date in line with current knowledge. The functions of the URC are the development of Update policies, Update coordination & decision making and the participation in the revision work in order to ensure synchronization from one revision to the other and consistency within the members of Family of International Classifications.

Abstract This poster represents the Update and Revision Committee (URC) 2014 annual report as submitted September 5, 2014 for the Barcelona WHO-FIC annual meeting.


C105


Methods & Materials

Annual updates: the URC ratified 121 recommendations at the WHO-FIC Network 2013 Annual Meeting held in Beijing, China for updating the ICD-10 and 40 recommendations for updating the ICF (Fig. 1 and 2). At the moment, in 2014, 74 proposals have been moderated for ICD and 48 proposals have been reviewed and put to vote for ICF. Functions, activities and completeness of deliverables are represented in the latest version of the Strategic Work Plan submitted to the WHO-FIC Council (Tab 1).An intensive restructuring of the content of the ICF update platform was carried out in coordination with FDRG. Using the features of the ICF update platform, all the proposals in the Open Discussion Layer were checked for consistency and then clustered together according to the relevant topic/block. Under every cluster, all the comments related to the different proposals were compiled and edited thus greatly simplifying the work of updating ICF carried out by the URC.

Acknowledgements

Results

The URC work currently focuses on the 10th Revision of the International Classification of Diseases (ICD-10) and the International Classification of Functioning Disability and Health (ICF) and is mainly conducted through the update and revision platforms. These platforms are workflow engines designed to facilitate communication within expert workgroups and ensure transparency of the processes. Work and communication is also carried out via e-mail, conference calls and meetings, including an annual meeting during the WHO-FIC Annual Meeting. The key deliverable of the URC work is the lists of annual updates for WHO-FIC member classifications.

Conclusions

Members of the Committee:R. Anderson, S. Bang, C. Barral, H. Brear, A.Brooke, D. Caulfeild, L. Clarke, T. Crawford,V. Dimitropoulos, C. Van Gool, H. Di Nubila,A. Elsworthy, L. Frattura, Olivier Guye, J.Hargreaves, D. Hoyert, R. Jakob, J. Jelsma,L.A. Johansson, J. Kasamatsu, N.Kostanjsek, R. Laurenti, R. Madden, D.Murphy, E. Oikawa, D. Pickett, M. Renahan,M. Robinson, H. Rocha, J. Rust, E. Sauls, P.Saxena, K. Seo, O. Steinum, H. Ten Napel,P. Tonel, U. Trinks, M. Virtanen, P. Wood, Y.

The achievements of the Committee, made possible by the generous efforts of members and relative institutions, show an increasing engagement of the Collaborating Centres both in maintaining the ICD-10, particularly in view of the synchronization from one revision to the other, and in realizing a foundation ICF, with the implementation of the update proposals coming from the ICF-CY.

DIGITAL, MOBILE, NOW!

Scan this to get a digital version

References

1. Terms of Reference for WHO FIC Update andRevision Committee (URC) version Dec 2012

2. URC SWP, March 4, 20133. The WHO Updating & Revision Committeehttp://www.who.int/classifications/committees/UR

C.pdf4. The ICD update platformhttps://extranet.who.int/icdrevision/nr/login.aspx?ReturnU

rl=%2Ficdrevision%2FDefault.aspx5. The ICF update platformhttps://extranet.who.int/icfrevision/nr/loginICF.aspx

URC Annual Report

Gongolo F.1, Vogel U.2, Moskal L.31 Central Health Directorate of Friuli Venezia Giulia Region – Italian WHO-FIC Collaborating Centre URC Co-chair; 2German Institute of Medical Documentation and Information (DIMDI) German WHO-FIC Collaborating Centre – URC Co-chair; 3Canadian Institute for Health Information (CIHI) – North American WHO-FIC Collaborating Centre, URC Secretariat.

Proposal ID& update type

Affected Code

Original version Update version

ID # 55Major: Addition of a new code and addition of

exclusion

b114

Orientatio

n

functions

b1565 Visuospatial perception

Mental function involved in

distinguishing by sight the

relative position of objects in

the environment or in relation

to oneself.

b1143 Orientation to objects

Mental functions that produce

awareness of objects or

features of objects.

b1565 Visuospatial perception

Mental function involved in

distinguishing by sight the

relative position of objects in

the environment or in relation

to oneself.

Exclusion: orientation to

objects (b1143)

ID # 56Major: Addition of a new code

b114

Orientatio

n

functions

b1144 Orientation to space

Mental functions that produce

awareness of one’s body in

relation to the immediate

physical space.


b1670

Reception

of

language

b16703 Reception of body

language

Mental functions of decoding

messages in body gestures

made by hands and other

movements, in order to obtain

their meaning.


b1671

Expressio

n of

language

b16713 Expression of body

language

Mental functions necessary to

produce messages using body

gestures made by hands and

other movements.

Fig. 2 – Snap shot from the ICF annual updates document v. 2014

Tab. 1 – The URC relevant part of the WHO-FIC SWP (August 22,2013 v, simplified):

Deliverable Activities Start Date

End Date (plan)

%

Annual updates to ICD-10

Submission, review, decision and implementation of update proposals for ICD-10.

nov-13 oct-14 0,8

Realize a Foundation ICF implementation of ICF proposals

Submission, review, decision and implementation of ICF-CY related update proposals for ICF. Due to the difference in submission process and lack of supporting rationale additional work is required.

nov-10 oct-12 0,8

Provide annual updates to ICF

Submission, review, decision and implementation of update proposals for ICF.

nov-12 oct-13 0,8

Overall coordination of the update process

Secretariat. Participation in the works, meetings and teleconferences of Initial Review Group and FDRG.

nov-12 oct-13 0,8

ICD-10 related itemsICD-11 related items ICF related itemsoverall coordination

Instruction Tabular list entries SourceURC #

Appr. Date

Major /

Minor

Sugg. impl. Date

Revise list of three character categories

Arthropod-borne viral fevers and viral haemorrhagic fevers (A90A92-A99)A90 Dengue fever [classical dengue]A91 Dengue haemorrhagic feverA97 Dengue

1971WHO

October 2013

Major January 2016

Revise list of three character categories

Exposure to inanimate mechanical forces (W20-W49)…W26 Contact with knife, sword or dagger

other sharp objects

2001Australia

October 2013

Major January 2016

Delete categories at chapter level

Arthropod-borne viral fevers and viral haemorrhagic fevers (A90A92-A99)A90 Dengue fever [classical dengue]

Excl.: dengue haemorrhagic fever (A91)A91 Dengue haemorrhagic fever

1971WHO

October 2013

Major January 2016

Add categories, codes and text

Revise code in excludes note

A97 Dengue Dengue is a viral disease transmitted

by bite of mosquito infected by dengue viruses. It is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome. Most patients recover following a self-limiting non severe clinical course like nausea, vomiting, rash, aches and pains, but a small proportion progress to severe disease, mostly characterized by plasma leakage with or without haemorrhage, although severe haemorrhages or severe organ impairment can occur, with or without dengue shock.

A97.0 Dengue without warning signsDengue fever (DF)Dengue haemorrhagic fever Grades 1 and 2Dengue haemorrhagic fever without warning signs

A97.1 Dengue with warning signsClinical warning signs are: abdominal pain or tenderness, mucosal bleeding, lethargy and /or restlessness, rapid decrease in platelet count, increase in hematocrit. Other signs can include: persistent vomiting, visible fluid accumulation, liver enlargement more than 2 cm.

Dengue haemorrhagic fever with warning signs

A97.2 Severe DengueClinical signs include: 1. Severe plasma leakage leading to shock (Dengue shock syndrome - DSS) and/or fluid accumulation with respiratory distress; 2. Severe bleeding as evaluated by clinician; 3. Severe organ involvement: Liver AST or ALT >=1000, CNS: impaired consciousness (encephalitis), involvement of other organs, as myocarditis or nephritis

Severe Dengue feverSevere Dengue haemorrhagic fever

A98 Other viral haemorrhagic fevers, not elsewhere

classified Excl.: chikungunya haemorrhagic

fever (A92.0)dengue haemorrhagic fever

(A91A97.-)

1971WHO

October 2013

Major January 2016

Fig. 2 – Snap shot from the ICD annual updates document v. 2014

Background

Title

Title

The items on the FDRG component of the WHO-FIC strategic plan are reported on below. The co-chairs met bi-monthly by teleconference. FDRG members and collaborators were informed of progress on the projects during the year and met by teleconference in March, July and September. A mid-year meeting was held from 1-3 May 2014 at the WCPT offices in London, attended by 30 participants from collaborating centres.

Conclusions

FDRG Annual Report

Abstract

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Catherine Sykes^, Andrea Martinuzzi*^World Confederation for Physical Therapy (WCPT), United Kingdom* E. Medea Insitute, Research Branch of the Italian Collaborating Centre, Italy

Title

Title

This poster describes the activities of the Functioning and Disability Reference Group in the 12 months from October 2013 to October 2014. Four main streams of work are reported; 1 ICF updates, 2 ICF education, 3 Measurement, 4 Harmonisation and development.

ICF Updates

Harmonization and development

Measurement

ICF Practical Manual

Collaborative work between URC and IRG moderators to cluster 84 proposals to have 26 new proposals, and updates workshops, have been instrumental in the progress on ICF updates. A total of 41 proposals were passed to the URC for voting. Only 11 proposals remain in the Open Discussion Layer.

Comments on the exposure draft of the ICF practical manual were accepted between October 2013 and May 2014. These have been considered and, where practicable without major redrafting, incorporated. Substantial comments have been retained for subsequent editions. The ICF Practical Manual exposure draft will be remain on the WHO web site until WHO has completed the final internal publications process. There will be no printed copies of the publication.Collaborating Centres are encouraged to translate the practical manual.The writing group led by Ros Madden and including Andrea Martinuzzi, Judith Hollenweger, Diane Caulfeild, Jennifer Madans and Mitch Loeb are thanked for their tireless efforts to produce the manual. Thanks also go to those members of FDRG and EIC who commented on drafts and to WHO staff for their input.

Education and Implementation Committee (EIC)A survey intended to find out about the ICF education needs of FDRG members and collaborators was carried out in the first quarter of 2014. The results were reported to EIC and the FRDG mid-year meetings. The results indicate the direction for a future education strategy for ICF. Interested WHO-FIC delegates are requested to attend the EIC session dedicated to ICF education to work on the strategy. The results of the survey are reported in a separate poster.

ICHI development groupAndrea Martinuzzi chairs the technical working group for functioning interventions. FDRG members and collaborators have contributed to the development of the axes and tabular list of functioning interventions in an updated Alpha 2. New developments in the ICHI project will be reported in separate posters.

Informatics and Terminology Committee (ITC)In addition to working on ontology development the FDRG is working with ITC on a mobile application, named mICF, for the collection of functional status data. The mICF project will be reported in separate posters.

Building on the work of John Hough in 2013, see posters at http://www.who.int/classifications/network/meeting2013/en/a small group has been working on a paper on the criteria for selecting quality ICF literature. Significant progress was made during the mid-year meeting and is reported in a separate poster. The draft paper will be considered during the annual meeting, after which this project will be dropped from the WHO-FIC strategic work plan. The paper is due to be completed for publication by the end of 2014.

Summary of ICF updates in 2013-2014

ICF Ontology

Towards a common ontology for ICFThe acknowledgment that work towards an ICF Ontology is needed and that this is the time to act was shared by WHO and by the relevant committees (ITC, FDC).The effort aims at a more ambitious project towards a common seamless integration of all health information to allow complete representation of health and functioning in the digitalized world. Building blocks in the project will be:

• Modelling• Content linkages• Terminology linkages• Content development • Review of qualifiers

•Leadership of the project will sit in WHO, but FDRG will substantially contribute to its realization. Possible initial steps involving FDRG will include: •shortlisting of ICF use cases•Stocktake/term beating for functioning relevant terms and concepts•Contribute to the model development

11 – 17 October 2014Barcelona, Spain

For further information contact the co-chairs: Andrea Martinuzzi [[email protected]] and Catherine Sykes [[email protected]] or the Secretariat Stefanus Snyman [[email protected]].

Introduction

Title

This is the 16th annual report of the Mortality Reference Group (MRG), established at the 1997 meeting of the Centre Heads as part of an updating mechanism for ICD-10.

The MRG has dealt with hundreds of issues related to updating and clarifying ICD-10 as it applies to mortality classification and coding. The MRG has settled over 500 issues selected largely from the Mortality Forum (an international mortality classification discussion network) and submitted 349 recommendations to the Update and Revision Committee (URC) for consideration.

This report describes the background of the MRG and the issues decided in the 16th year.

Mortality Reference GroupAnnual Report, 2013-2014

Abstract This poster presents the activities and status of the Mortality Reference Group (MRG) for 2013-2014. The WHO created the MRG as a component of the International Classification of Diseases (ICD) updating process. Comprised of members from Collaborating Centres and regional offices, the MRG meets in person to review problems faced in the application of ICD to mortality. In its 16th year, the MRG deliberated about 80 issues related to both updates to ICD-10 and development of the ICD-11 revision and made recommendations to the Update and Revision Committee for further action.


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DL Hoyert1, P. Wood2, LA Johansson3

(1) NCHS, (2) Statistics Canada, (3) Swedish Board of Health and Welfare

Title

Basis for the MRG

The MRG met in Lyon, France, April 2-4, and in Barcelona, Spain, October 11-12, 2014. A smaller table group also met around then to work through issues concerning ACME decision tables where MRG decisions left details open.

The MRG conferred about 80 issues, and submitted 36 recommendations (20 major and 16 minor) to the URC (Table).

Conclusions

Decisions during the 16th year

Provisions for the MRG are described in two documents: the WHO long-term strategy document (WHO/HST/ICD/ C/97.39) and the Centre Heads’ Report for 1997 (WHO/HST/ICD/C/97.65). Briefly, for updating ICD-10, WHO- -working with the Centre Heads- -established two separate bodies: the MRG and URC. The MRG discusses issues raised in the Mortality Forum or those referred from other sources including the Centre Heads and WHO. The MRG can make decisions regarding the application and interpretation of ICD to mortality and submit a subset as recommendations to the URC for a vote on ICD updates and changes. The decisions requiring no change in the ICD are forwarded for the URC's information and for documentation.

Decisions during the full 16 years

In the 16th year, the MRG met in April and in October, communicated by e-mail, posted proposals and comments on the ICD-10+ Platform, did considerable work on a number of issues outside the committee meetings, circulated documentation for issues under consideration; and comprehensively documented all activities. During the sixteenth year, a total of about 80 issues were reviewed by the MRG and about 140 issues were reviewed by the MRG’s Table Group. Closure was reached for many of these and 36 decisions were submitted to the URC in 2014. All of these were recommendations for change.

In the 16 years (1998-2014), the MRG reached over 500 decisions. The left panel of the graph shows the subset of the decisions that were sent on to the URC for information as well as for voting. The MRG forwarded 349 decisions to the URC: 238 recommendations for changes in the ICD and 111 decisions requiring no change in the ICD. The total number of issues either withdrawn by the MRG, referred back by the URC for additional work, or rejected by the URC during the first 16 years was 18 and is shown in the right panel of the graph.

Introduction

Title

The functioning Topic Advisory Group(fTAG) was formed by WHO in 2010and is currently made up of 10members including two Co-chairs anda Managing Editor.

At the fTAG meeting held during the2013 WHO-FIC meeting in Beijing, 26enthusiastic participants addressed thework plan tasks on populatingfunctioning properties, mirror-codingand z-codes.

In addition, regular executive groupand periodic fTAG teleconferences wereheld. fTAG has been represented atregular Revision Steering Group (RSG)teleconferences throughout the year.

Work Plan Update – Functioning Topic Advisory Group (fTAG)

Abstract This poster reports on the ongoing work of the functioning Topic Advisory Group or fTAG. The main areas of fTAG work are populating functioning properties, identifying and reconciling mirror coding between ICF and ICD, providing a paper arguing for ICD-ICF joint use that includes use cases, and suggesting possible a structural and content revision of the Z-codes. This poster provides an overview of fTAG’s 2013-2014 activities.


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Selb M1,2, Stucki G1,2,3, Kennedy C41ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI), Nottwil, Switzerland;

2Swiss Paraplegic Research, Nottwil, Switzerland;3 Department of Health Sciences & Health Policy, University of Lucerne, Lucerne & Nottwil, Switzerland;

4 Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington DC, USA

Title

Possible mirror coding i.e. conceptualand terminological overlaps betweendisease entities in the ICD-11 beta-version with the ICF, has beenexamined for:• Disorders of vision and visual

functioning• Deafness• Disorders of intellectual develop-

ment• Developmental learning disorders• Tetraplegia

Two fTAG members independentlyreviewed the ICD-11 codes for the

One task of the fTAG is to “populate”or identify functioning properties (FPs)i.e. ICF categories in the component ofactivities & participation for selectedhealth conditions.

Based on discussions at and after the2013 Beijing meeting, the list of healthconditions designated for populatingFPs was re-evaluated and adjusted anda suggestion for clustering the healthconditions was implemented.Subsequently, FPs for 101 healthconditions were entered into the ICD-11 revision electronic system callediCAT, and since March 2014 these FPshave been visible in the ICD-11 beta-browser. fTAG has been coordinatingwith WHO to optimize the visualizationof the FPs in the ICD-11 betabrowser.An example of acquired hearing loss isgiven in figure 1. The poster entitled“Functioning properties - A first steptoward ICD-ICF joint use” providesmore detailed information onpopulating on FPs.

A paper following up on the 2012publication Towards the joint use ofICD and ICF: A call for contribution hasbeen submitted to a peer-reviewjournal.

Conclusions

At the 2013 Beijing meeting the Z-codes working group presentedpossible re-assignment of former Z-codes to either contextual factors,ICHI-related categories or ICD-11post-coordination. Codes that were notre-assigned was reviewed by themeeting participants and feedback wasgiven. Since then WHO reorganized thestructure of the Z-codes based onICPC-2, the feedback from Beijing andinternal discussions. This new structurecan now be seen on the ICD-11 beta-browser.

Examples of non-US application of theICF was integrated in a revised versionof the paper that will be sent to WHOfor approval after getting finalfeedback at the Barcelona meeting.

Figure 1: Functioning properties in the ICD-11 beta-browser for acquired hearing loss

Task 1: PopulatingFunctioning Properties

Task 2: Mirror Coding

Task 3: Paper “Case for ICD-ICF Joint Use”

Task 4: Evaluation of Z-Codes

aforementioned health conditions formirror coding with relevant ICFcategories and, after comparison oftheir respective results, came to aconsensus on whether mirror codingexists.

One challenge faced by the fTAG wasthe ever-changing linearization of theselected health conditions in the beta-browser. For example, paraplegia wasinitially designated for the mirrorcoding task. Until mid-2014 paraplegiawas not found on the beta-browser,but re-appeared in September 2014.

The outcome of the consensusdiscussion will be presented at thefTAG meeting in Barcelona.

Total impairmentof visualacuity

b2100Visualacuity

functions

Question: Does mirror coding exist?

Decision: Yes, terminological mirror coding exists, but only when the ICF category is quantified with a qualifier of 4 (complete impairment). Since no description is given for the ICD-11 code, no decision about conceptual mirror coding was made.

fTAG Members: Solvejg Bang, Francesco Gongolo, Cille Kennedy (Co-chair), Haejung Lee, John Melvin, Jane Millar, Marcelo Riberto, Melissa Selb (Managing Editor), Gerold Stucki (Co-chair) and Catherine Sykes; WHO Liaison to fTAG: Molly Meri Robinson Nicol

TASKS

Title

• Horizontally crossing all ICD-11 chapters to advise on optimizing the entire classification’s content, structure and coding rules for enhanced application in both existing.

• Developing an inventory of existing quality of care and patient safety indicators and potentially novel quality and safety indicators.

• Assessing potential uses of ICD-11 for health services, quality and patient-centered outcomes research.

• Reviewing and critiquing the ICD-11 beta draft from the perspective of the quality and safety use case.

• Reviewing and critiquing Volume II work from the perspective of quality and safety use case.

• Designing field trials for the beta version of ICD-11.

Quality & Safety TAG

Abstract


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Authors: Danielle Southern, Hude Quan, William Ghali for the Quality & Safety TAG

Title

MEETING ATTENDEES

We have held meetings in both New York, NY and Washington, D.C. US• Reviewed the status of discussions

around coding rules (main condition, diagnosis timing, coding field).

• Reviewed chapter 19&20 content and associated clustering mechanisms and presented these concepts in emails to WHO.

• Prepared to undertake a granular review of the content in chapters 1-20 and will devise a committee work plan to do this.

Published ManuscriptsOverview TAGMain ConditionNumber of diagnoses fields

Progressing ManuscriptsThe editorial team of the International Journal for Quality in Health Care is welcoming a series submission (i.e. intermittent submission of papers as they are completed). Timing of diagnosisNew PSI project 19&20/concepts

Completed Field TrialsSurveyWith the overriding goal for the TAG (& thus the WHO) to collect info on user needs from ICD-11 in advance of the next TAG meeting (in September) to inform ICD-11 refinements. We developed and executed a survey for the field trial. A manuscript or the results has been drafted and circulated for TAG member comments.

Progressing Field TrialsThe QS-TAG has devised a matrix model for considering potential ICD-11 field trials. The matrix categorizes cross-tabulates topic areas (e.g., validity of coded concepts, completeness of capture of critical patient safety and quality concepts, reliability and feasibility of various coding rules, opinions of stakeholders on various issues) against the methodologies that would be used for the field trials (i.e., code-recode studies using real medical records, coding studies assessing completeness of capture of key safety/quality concepts, surveys of stakeholders, heuristic evaluations of ICD-11 on various user interfaces, etc).

ACKNOWLEDGEMENTS

ACTIVITIES

Australia: James Harrison, Vijaya SundararajanUS: Marilyn Allen, Chris Chute, Ginger Cox, Donna Pickett, Harold Pincus,, Patrick Romano, Brigitta Spaeth-Rublee,Canada: Susan Brien, Alan Forster, William Ghali, Yana Gurevich, Lori Moskal, Hude Quan, Danielle SouthernSwitzerland: Bernard Burnand, Jean-Marie JanuelFrance: Cyrille Colin Germany: Saskia DroeslerWHO: Nenad Kostanjsek, Bedirhan Ustun.

Conclusions

Q&S TAG was funded by the Agency for Healthcare Research and Quality (AHRQ), Canadian Institute of Health Canadian Patient Safety Institute (CPSI), and Canadian Institute for Health Information (CIHI).

Mapping of existing patient safety indicator We have begun a mapping exercise, whereby we have attempted to map the Calgary PSI list, the International ICD-10 AHRQ PSI list as well as Patient Safety concepts in ICD-11-Beta.

Code-recode testingObjectives• To assess, from a healthcare

leader’s perspective, the utility of patient safety information encoded using the following classification systems: AHRQ Common Format, WHO-ICD 10-CA, and WHO-ICD11 (Beta)

• To evaluate the inter-rater reliability of raters classifying patient safety events

• To determine the face validity of event classification

• To assess the coding practice for classifying patient safety events

The Quality and Patient Safety TAG is charged with reviewing ICD-10, ICD-10CM and progressive drafts of ICD-11 to inform the development of the ICD-11, focusing on identifying practical modifications for ICD 11 drafts that would enable better measurement of quality and safety. Ultimately, an enhanced classification system will permit expanded use of coded health data for large-scale quality and safety surveillance in health care systems internationally.


C201 Australian Collaborating Centre Annual Report 2014

Hargreaves; Metz; Macpherson; Njeru

C202 WHO Collaborating Centre for the FIC in Brazil-Annual Report

Buchalla; Laurenti; Di Nubila

C203 2013-2014 activity report of the CC Inserm-EHESP for the WHO-FIC in French

Lamarche-Vadel; Cuenot; Rodrigues

C204 Report from the German Collaborating Centre Weber

C205 Human Resource Development for effective implementation of FIC (ICD-10 & ICF) In India by Central Bureau of Health Intelligence

Raikwar; Singh; Sharma; Prasad

C206 Updates on the performance monitoring plan of the Italian WHO-FIC Collaborating Centre: a new reporting way on annual activities

Frattura

C207 Korean Collaborating Centre Annual Report 2014 Park; Hur; Roh; Kim

C208 Annual Report from the Mexican Collaborating Centre (CEMECE) Jan 2013-Jan 2014

Torres; Jimenez; Navarro; Yañez

C209 Dutch WHO-FIC Collaborating Centre annual report 2013-2014

van Gool; ten Napel

C210 WHO-FIC Collaborating Centre for North America Pickett; Renahan; Wood

C211 Annual report from the Nordic WHO-FIC Collaborating Centre 2013

Berg

C212 WHO-FIC COLLABORATING CENTRE IN SOUTH AFRICA: 2014 REPORT

Hanmer; Bradshaw

C213 THAI WHO-FIC CC Annual Report 2014 Paoin; Yuenyongsuwan; Suvapan

C214 Activities of the WHO-FIC Asia-Pacific Network Endo; Kim; Paoin; Yuenyongsuwan; Hong; et al.

C215 A NETWORK WITHIN A NETWORK: THE IBEROAMERICAN EXPERIENCE

Giusti; Jimenéz

C216 Building ICD-11 Terminology Services Using the CTS2 Standard

Jiang; Solbrig; Chute

C217 Activities of the Stanford WHO Collaborating Center

Musen; Nyulas; Tudorache; Tu

C218 WHO Collaborating Centre in Calgary, Canada Quan, Ghali

C219 WHO Collaborating Centre in Venezuela - CEVECE: Towards their sixty years

Cordero; Villegas; Ortega; Regalado; Moreno; et al.

C220 Activity Report from the WHO-FIC in Japan ICD Office Japan

C201-220 WHO Collaborating Centres

Introduction

The Australian Institute of Health and Welfare (AIHW) in Canberra, Australia, has hosted the ACC since April 1991. Re-designation of the ACC for a four-year period occurred on 7 May 2014. The Head of the Centre is Jenny Hargreaves, Senior Executive,Hospitals, Classifications and Performance Group at the AIHW.

The ACC is a collaboration of Australian and New Zealand experts and organisations with an interest in classifications. Through the combined efforts of the organisational and individual members of the ACC, the use of the International Classification of Disease (ICD), the International Classification of Functioning, Disability and Health (ICF), the International Classification of External Causes of Injury (ICECI) and the International Classification for Primary Care, Version 2 (ICPC-2) is facilitated.

Thank you to all the ACC members and organisations for their valuable contributions to the ACC work-plan activities during 2013- 2014. Many of the activities occur through in-kind support from these individuals and organisations.

Australian Collaborating Centre Annual Report 2014

Abstract

The Australian Institute of Health and Welfare has hosted the WHO-FIC Australian Collaborating Centre since 1991. The membership of the ACC is Australian organisations that have an interest and experience in working with classifications. This poster summarises the activities of the Australian Collaborating Centre that occurred between October 2013 and October 2014.


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Jenny Hargreaves (Centre Head) and Katie Metz, Brooke Macpherson and Jodee Njeru (ACC Secretariat)

Other contributions by ACC members to committees included:

• Mortality Reference Group - Sue Walker and James Eynstone-Hinkins

• Education and Implementation Committee – Sue Walker (co-chair) and Ros Madden

• Revision Steering Group - Richard Madden and James Harrison

• Family Development Committee - Richard Madden, Megan Cumerlato, Brooke Macpherson (Secretary), Nicola Fortune and Luis Salvador-Carulla

• Functioning and Disability Reference Group – Ros Madden, Xing-yan Wen

• ICHI Development advisory group - Richard Madden (Co-Chair)

• Update and Revision Committee Ros Madden and Anne Elsworthy

Contributions to WHO and Network committees

The Head of the ACC served as Co-Chair of the WHO-FIC Network’s Advisory Council and of the Council’s Small Executive Group (SEG), as Co-chair of the Family Development Committee and a member of the Revision Steering Group (RSG). She also participated in the WHO’s informal ICHI development advisory group.

Conclusions

Ros Madden facilitated the workshop, which provided an opportunity for people familiar with the ICF and interested in contributing to its updating and improvement to discuss the proposed updates and to contribute to the ICF updates process.

The next day, an ‘ICF Network forum’ was convened with people interested in the use of ICF. Presentations were made about current uses of ICF in Australia and discussions were held about how to improve dissemination and exchange of information about ICF in Australia.

This is the annual report of the ACC to the Network and summarises activities which occurred during the period of October 2013 to October 2014.

It incorporates information relevant to the ACC Terms of Reference as agreed with the WHO, and information on specific activities of the ACC and its member organisations.

ICD

The National Centre for Health Information Research and Training hosts the Australasian Mortality Data Interest Group. The Group held its annual workshop in November 2013 with the theme of ‘Bringing Mortality Data to Life’. It was hosted by the Australian Bureau of Statistics and the Australian National University in conjunction with the National Centre for Classification in Health, University of Sydney.

The workshop aims included highlighting advances in data methods and data linkage; identifying international developments in mortality data; and highlighting the links between research and the development of health policy.

The National Centre for Classification in Health progressed work on the ninth edition of ICD-10-AM, and members of the ACC collaborated to provide comments for the URC’s ICD update process.

ICF

A ICF updates workshop was hosted by the University of Sydney, in collaboration with the ACC in Sydney on 5 June 2014.

ICHI

Richard Madden has continued to provide leadership for the development activities relating to the ICHI. Several staff of the University of Sydney have provided valuable inputs.

International Group for Indigenous Health Measurement

The IGIHM is holding a meeting in Vancouver, Canada in early October 2014 to focus on progressing measures of infant and child mortality, Indigenous identification, maternal mortality and indicators of wellbeing from an Indigenous perspective in the four countries (Australia, Canada, New Zealand, and the United States ).

The AIHW will be presenting on the infant mortality estimates and mapping of primary health care services and Indigenous populations in Australia.

The ACC continues to actively promote the development and use of the WHO classifications in Australia, and through contributions to the WHO-FIC Network. In addition to the activities described above, the ACC provides information and updates to relevant government agencies in Australia, including through the AIHW’s newly established Australian Health Classifications Advisory Committee. This will ensure that Australia is well placed to continue participation in development and implementation of the WHO-FIC into the future.

Title

WHO Collaborating Centre for the FIC in Brazil –Annual Report

Abstract The activities developed during the period of 2013- 2014 in the training area, include ICD-10 courses, as well as the quality of health statistics in the country, and the improvement in the ICF dissemination by lectures, researches and conferences at Seminars and Congress. The Brazilian CC has had many activities in order to implement the FIC in Brazil, and has a routine activity with Mortality Information Systems in Brazil.


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Brazilian CC for WHOFIC, University of Sao Paulo, Brazil

Title

ConclusionsActivity 1 – Work on Revision of ICD 11

. regular encounters (each 2-3 months) with Health Surveillance Secretary of Ministry of Health, together with some collaborators of State Health Secretaries of Rio de Janeiro(SouthEast Region), Mato Grosso do Sul(CentralWest Region), Alagoas and Bahia (NorthEast Region), and Municipalty Health Secretary of São Paulo (PRO-AIM – Programade Aprimoramento das Informações emMortalidade – Program for Improvement of Mortality Informations) - “Health Statistics Nucleus”

. participation in Committees and Reference Groups – MRG, FDRG, ICD-URC and ICF-URC, EIC, and FDC

. contributions to EIC - protocols for coding more complex situations for coders (as Maternal deaths, Perinatal Deaths, Procedures Complications, Cancer and External Causes), translating and reviewing the New “ICF Practical Manual” and the ICF e-Learning tool translation in progress.

.m-TAG and GURM-TAG

.meetings with Brazilian Ministry of Health regarding how to proceed with ICD-11 translation and participation in the field trials.

.Ibero-American Workshop on Interoperable Systems for Health - February 201- Ribeirao Preto Faculty of Medicine – University of Sao Paulo: presentation on what is expected for ICD-11.

. “ Binomial Mother-Children” study -Morbidity and Mortality in pregnant women and newborns

. contact with the coders of causes of death, through Health Surveillance Secretary / Ministry of Health regarding correct coding of fetal/ perinatal and neonatal deaths

. evaluation of the registers of ill-defined causes or incomplete diagnoses in the death certificates

.results presented in meetings, conferences and discussions with the Regional Councils of Medicine

. researches/studies to evaluate the question whether external causes, specially accidents, could be consequences of natural causes.

. “Instructions Manual” for national use -coding cancer and complications of procedures for mortality coders

. Collaboration with Health Surveillance Secretary, and heads of State and Municipality Health Secretaries - to evaluate the quality of Health Information Systems for Mortality-SIM and Liveborns-SINASC (SIM – Sistema de Informação sobreMortalidade and SINASC – Sistema de Informação sobre Nascidos Vivos)

Activity 5 –Coordination of national WHO FIC activities

Activity 6 –Strengthening of national workgroups and WHO-FIC network activities

Activity 4 - Improving quality of vital statistics using ICD

Activity 2 – Implementation support for WHO-FIC in Brazil and other countries

. program “IRIS” dictionary of medical terms in Portuguese and their respective ICD-10 codes - Doctorat work of the post-graduation student Renata Martins (code and select the underlying cause of death in 96% death certificates)

. workgroups to provide to the Ministry of Health subsides for improving the SCB (software SCB / Seletor da Causa Básica –Underlying Cause Selector)

.evaluation of Consistency Tables for Mortality

. workgroups for evaluation of coders and others.

. PAHO / RELACSIS (Red Latinoamericana y Caribeña para el Fortalecimiento de los Sistemas de Información de Salud – Latin American and Caribean Network for Enhancing Health Information Systems).

. review and validation of the SCB (Underlying Cause Selector) software and its decision tables used in Brazil. Work with Health Surveillance Secretary of Brazilian Ministry of Health, and collaborators of State Health Secretaries of Rio de Janeiro, MatoGrosso do Sul, Alagoas and Bahia, and Municipalty Health Secretary of São Paulo (PRO-AIM – Programa de Aprimoramento das Informações em Mortalidade – Program for Improvement of Mortality Informations) -“Health Statistics Nucleus”

. project using ICF concepts and framework for identification of disabilities in an area of São Paulo city - Foundation for Support to Research of São Paulo State (FAPESP)

. concluded a study on odonthologicalabsenteeism using ICF

. support for a study using ICF codes for projects on Deafness in aged people and children

. acquisition of new version of software Lectora

.looking for solution on how to include the translation files

. EIC activities in person meetings and also by teleconference, by skype and by e-mail meetings during 2013.

. courses in Training for Coders in the use of ICD-10 for Morbidity and Mortality

. training of coders and multipliers, and a Forum for questions and discussion about coding with coders and other users of ICD-10 - activity with the Brazilian Ministry of Health

. training and use of ICF - workshops for the Education area; work meetings with Social Security Ministry about ICF definitions of impairment/disability; roundtables about possible uses of ICF in Social Security Work Disability evaluations; habitual lectures about ICF in Work Medicine Specialization Course; courses and workshops about ICF and ICF-CY

. routine activity in the area of evaluation and validation of information in the Mortality Information Systems in Brazil (Sistema de Informação em Mortalidade-SIM)


Activity 3 – Work Groups and PAHO collaboration


Introduction

2013-2014 activity report of the CC Inserm-EHESP for the WHO-FIC in France

Abstract This poster presents the highlights of the annual report of the Collaborating Center Inserm-EHESP for the WHO-FIC in French. Two main organizations, based in France, fulfill the missions of the French CC: the Inserm-CépiDc (French National Institute on Health and Medical Research, since 1967) working on the ICD and the EHESP-MSSH (French National School of Public Health, since 1989) working on the ICF. Collaborations with the ATIH (technical agency for the data management in hospitals) and the University of Saint-Etienne also allow contributions to the works done on morbidity, and ontology. The collaborating center works at several levels: French, French-speaking and international.


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Agathe Lamarche-Vadel1, Marie Cuenot2, Jean-Marie Rodrigues31CépiDc-Inserm (France), 2EHESP-MSSH (France),

3 University of Saint-Etienne (France)

The ICD-11 related activities of the Center are as follows:

Promotion of the ICD-11 in French (in France and European French-speaking countries):Dr Nassim Douali coordinates the translation of ICD-11 on the WHO platform, starting with the currentversion of ICD-11. This work is basedon existing translation of ICD-10 and uses modern French referenceterminology. A call for contributorshas been posted on the French Collaborating Center website(http://www.cepidc.inserm.fr/site4/index.php?p=oms)

WHO-FIC related activities:-As Co-head of the MTAG, Gerard Pavillon continued participating to the ICD Revision Process until the Geneva meeting on the Review of the Common Linearization for Mortality and Morbidity (December 2013). Sandra Gomez participated In MbTAG.-Jean-Marie Rodrigues and NassimDouali worked in the Joint AdvisoryGroup WHO IHTSDO on Harmonisation with IHTSDO; and in the Joint Working Group IHTSDO on the Common Ontology ICD-11 SNOMED CT.

Jean-Marie Rodrigues worked on the Mapping ICD 9 CM – ICHI.

Publications

ICF related activities

Barral C., Winance M. (2013). Définitions et classifications, in INSERM. Handicaps rares. Contextes, enjeux et perspectives. Collection Expertise collective, Inserm, Paris.

The ICF-related activities of the Centerare as follows:Promotion of the ICF in French (in France and European French-speaking countries):-Courses on the ICF and the conceptual models of disability in master programs in social policies, educational sciences, physical medicine and rehabilitation, public health, special education management, in the Master degree “Situations de handicap et participation sociale” (EHESP-Rennes 1 & 2)-Participation in a 2012-2014 European Union Leonardo program (Belgium, France, Romania, Switzerland) to develop an educational material on the social participation of persons with disabilities-Participation in the commission for the monitoring of the implementation of the UN Convention on the rights of people with disabilities (2006) in France- Expertise on ‘rare disabilities’- Maintenance of the CC website (http://mssh.ehesp.fr/international/centre-collaborateur-oms/ ) and the bibliographic watch.

WHO-FIC related activities:Participation in the works and meetings of the EIC (e-learning tool, implementation database), URC and FDRG with a particular involvement in the ICF updates review process (co-moderation of the Initial Review Group).

The 2013-2014 activities of the CC for the WHO-FIC in French are presented here: the main activities are related to the ICD and the ICF. Some collaborations allow works on the ICHI.

IICD-10 related activities

IICD-11 related activities

ICHI related activities

The ICD-10 related activities of the Center are as follows:

Promotion of the ICD-10 in French (in France and French-speaking countries):-A new edition of ICD-10-FM Volume 1 has been undertaken by the ATIH in order to provide an updated version accounting for the modifications made since the 2008 edition.-The Center collaborates with the Moroccan Ministry of Health and the NCHS CDC’s collaborating organization in the North Africa-Middle East region, (EMPHNET- Eastern Mediterranean Public Health Network) to design a standard information system in line with WHO standards in Morocco, in order to improve cause of death data in Morocco. In this context, the Centerhas organized a one month training to mortality coding in France to provide expertise to the two persons who willdirect coding units in Morocco.

-WHO-FIC related activities:Participation in the works and meetings of the MRG, Table Group and URC. This allowed the Center to give its position on the ICD updates presented during this periods and to provide expertise in fields where it is experimented

Contact details: [email protected]@ehesp.fr

Introduction

Title

After its initial designation in 2003 theGerman Collaborating Centre wasagain re-designated in 2012.The German Collaborating Centre islocated at DIMDI.For the ICF work the ICF Researchbranch is joining the work of DIMDI.Twice a year DIMDI and the ICFResearch branch meet to discuss theon-going and planned work.For the work on the new procedureclassification ICHI the University ofFreiburg is joining the work of DIMDI.

Report from the German Collaborating Centre

Abstract The German Collaborating Centre (CC) is a designated WHO-FIC Collaborating Centre since 2003. Part of the German CC are the ICF Research Branch and Experts from the University of Freiburg, Germany. This poster reports on the activities that took place since the last WHO-FIC-Meeting in 2013


C204


DIMDI, ICF Research Branch and University of Freiburg, Germany

Title

Work at DIMDI

ICD-11 Revision/fTAG: Since the2013 WHO-FIC meeting in Beijing, thelist of health conditions (HCs)designated for populating FPs wasadjusted, a suggestion for clusteringthe HCs was implemented and the FPsfor 101 HCs were entered into ICD-11revision electronic system, iCAT.Although FPs have been visible in theICD-11 betabrowser since March 2014,work on optimizing the visualization isongoing. Consultation within fTAG onmirror coding has also been provided.Other activities include organizing andleading monthly teleconferences andparticipating in the monthly RSGteleconferences providing input whereappropriate. A paper following up on a2012 publication on the FPs work willbe submitted to a peer-review journalby the Barcelona meeting.ICF eLearning Tool: The status of theICF eLearning tool revision waspresented at the Beijing Meeting andat the 2014 EIC mid-year meeting.Activities included coordination withWHO, EIC and the CollaboratingCentres willing to translate the tool intheir respective languages, finalizingthe content revisions and coordinatingthe search for new software. In June2014 WHO approved the revisedversion of the tool and the acquisitionof Articulate Storyline, the newsoftware that will be used toimplement the revised version of theICF eLearning tool. The revised tool is

Conclusions

Work of the ICF research branch

ICD-10: In 2014 DIMDI worked on theadaptation and translation of the 2015updates from WHO and theirimplementation into ICD-10-GM 2015together with requirements from thenational annual submission process.Release of the pre-version of ICD-10-GM 2015 was in end of July and of theofficial version at the end ofSeptember, for implementation intohealth care systems until January 1st2015. As usual, results from thediscussions with national expertswhere fed back to the URC as well asinto the Revision process. For WHODIMDI implements the updates to ICD-10 into the ClaML database to enableWHO to generate a version 2014 inEnglish language.ICD-O-3: Translation andimplementation of the 2012 updates ofICD-O-3 has been worked out incooperation with (legal) authorities ofthe national cancer registries(epidemiological and clinical) and ofRobert-Koch-Institute as the nationalGerman Center for Cancer RegistryData. The German version of ICD-O-3including the updates was published inmarch 2014 in print format as well asin a browser version.ICF: DIMDI continued in 2014 withnational consultations on the plannedupdates for ICF. The ICF-workinggroup convened in DIMDI in March todiscuss the updates for ICF. Results ofthis meeting were presented in theUpdate workshop of FDRG in Londonright after.Mortality Coding: DIMDI trained allgerman mortality coders on the use ofICD-10 with a focus in 2014 onelectronic coding of cause of death.

Since the last Network meeting thework of the German CollaboratingCentre continued. The existingCollaboration of DIMDI, the ICFResearch Branch and the University ofFreiburg proved well suited for thesuccessful fulfilment of the Work planas agreed with WHO.

expected to be available on the WHO website by the beginning of 2015.ICF Training: Since Beijing, ICFworkshops have been held in China,India, Finland, Palestine, Poland andSwitzerland. Online tutorials on the ICFlinking methodology as well as onconducting ICF-based case studieshave been conducted.ICF Updates within FDRG: Input onupdate proposals were given includingmore intensive involvement in theupdate process within the InitialReview Group.ICF Practical Manual within FDRG:Feedback on the exposure draft of theManual was provided in May 2014. ASteering Group member has beeninvolved in finalizing changes based onthe discussions during the 2014 mid-year meeting in London.ICF Core Set work: ICF Core Sets forcerebral palsy are now available.Other activities: See posters on the1) system-wide implementation of theICF in clinical & rehabilitation practice,2) enhanced informed decision-makingin the health system using the ICF as areporting standard and 3) develop-ment of the Model Disability Survey.

Committee work: The head of theGerman Centre stepped down asCouncil Co-chair at the meeting inBeijing. Ulrich Vogel serves as URC Co-Chair since the Brasilia meeting. In thiscapacity he manages the updateprocess of ICD-10 for the Committee.Active participation in person or viaphone conference as well wasconducted for Mortality ReferenceGroup, Family DevelopmentCommittee, Update and RevisionCommittee for ICF purposes and otherWHO-FIC groups. Additionally DIMDIassisted in the ICD Revision, especiallyin the Revision Steering Group, theMorbidity TAG and the Neoplasms TAG.As the Beta Release became available,DIMDI announced this to the generalpublic and solicited participation fromthe German users.

Work at the University of Freiburg

ICHI: The University of Freiburg issupporting the developmental work onICHI by contributing especially on thestructure and content of theclassification axes, and themaintenance of an annually publisheddatabase. Focus in 2014 lay on therearrangement of the values of theICHI axes for the Alpha-2-Version.ICD-10 Alphabetic Index: Theannual work on the quality of the indexterms for the German Modification(ICD-10-GM) results in proposals forimprovements eventually impactingthe international version.

Introduction

TOTAL NUMBER OF TRAINING CONDUCTED AND MAN- POWER TRAINED

Result

Conclusion

Central Bureau of HealthIntelligence (CBHI), New Delhiunder Dte. General of HealthServices in the Ministry of Health &Family Welfare (Govt. of India) hasbeen functioning as WHO CC onFIC in India from September, 2008onwards. It has been activelyinvolved in human resourcedevelopment for effectiveImplementation of WHO-FIC (ICD -10 and ICF) in India since then.

This Descriptive Study of thehuman resource development forFIC, Performed by CBHI, was doneusing the documents available atthe CBHI headquarters and FieldSurvey Units as well as TrainingCentres.

Training Reports, Office Files &Reports of the various trainings/workshops conducted in 2013-14by CBHI were studiedretrospectively, using Checklistsdesigned for the purpose.

Through its sustained efforts, CBHIhas been able to create a pool ofmaster trainers, medical officersand paramedics trained in FIC toinitiate and effectively implementthe activities towards use of FIC bydeveloping human resources inIndia. CBHI has also been providingcollaboration and support to itsneighbouring countries of SouthEast Asia and WHO – SEARO. CBHIis committed towards its mandatefor the use of WHO FIC. It hopes tocontinue these activities in theperiod of re-designation withrenewed vigour.

Human Resource Development for effective implementation of FIC (ICD-10 & ICF) In India by Central Bureau of Health Intelligence

M. Raikwar*, Umed Singh*, R. K. Sharma* and Jagdish Prasad***Central Bureau of Health Intelligence (CBHI), WHO CC on Family of International

Classifications (ICD -10 & ICF) in India, Directorate General of Health Services; **DGHS, Ministry of Health & Family Welfare, (Govt. of India), New Delhi.

– Human Resource Development for effective implementation of FIC (ICD-10 & ICF) by Collaborating Centre on WHO-FIC in India during last one year period from September, 2013 to August, 2014 have been described is this poster.

11 – 17October, 2014Barcelona, Spain

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MEETING OF THE WHO COLLABORATING CENTRES FOR THE FAMILY OF INTERNATIONAL CLASSIFICATIONS

From September 2013 tillAugust, 2014, CBHI has conducted18 Batches of Trainings on ICD –14 & ICF and in these trainings225 persons were trained.

Conducted 4 trainings for Mastertrainers on ICD – 10 & ICF and 46more trainers were added increating a pool of master trainersIn India

Conducted 29 batches ofsensitization Workshops during theyear to promote the use of ICD –10 in Tertiary Care Hospitals &Medical Colleges (both inGovernment & private sector) andin these Workshops, 2617 personssensitized about ICD - 10.

Abstract

Methods & Material

Peer Review of WHO TrainingManuals on “HospitalInformation System” done byexperts in India conducted atFSU, Bangalore in march, 2014.

Head of the WHOCollaborating Centre on FIC inIndia along with one expert onICF attended WHO-FIC NetworkAnnual Meeting at Brasilia,Brazil from 13th – 19th October,2012.

693

455

337290

406 436

0

100

200

300

400

500

600

700

800

No.

of

Par

tici

pan

ts

Training Centres

No. of participants attended workshops on ICD-10 & ICF

3429 32

4133

42

60

010203040506070

No.

of

Par

tici

pan

ts

Training Centres

No. of Participants attended ICD-10 Training Programme

Training Center ICD-10 Workshops on ICD – 10 & ICFTraining

Total No. of Trainings Participant Workshops Participants

Bengaluru 2 34 6 693Bhopal 2 29 5 455Bhubneshwer 3 32 4 337

Jaipur 2 41 4 290Lucknow 2 33 4 406Patna 3 42 6 436RHSTC, Mohali 4 60 0 0

18 271 29 2617

Introduction

The aim of this work is to present the third-year results of the performance monitoring plan of the Italian WHO-FIC Collaborating Centre (CC) using the content of the CC annual report [1] and the Italian posters submitted at Barcelona Annual meeting.

Updates on the performance monitoring plan of the Italian WHO-FIC Collaborating Centre: a

new reporting way on annual activities

Abstract Moving from the 2011-2015 terms of reference (TORs) of the Italian WHO-FIC CC, a performance monitoring plan was defined to yearly assess the CC’s performance. The aim of this work is to present the third-year results of the performance monitoring plan of the Italian WHO-FIC Collaborating Centre (CC).


C206


Frattura L. on behalf ot the WHO-FIC Italian collaborating centre networkCentral Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC

Methods & Materials

In the third year (21 July 2013-21 July 2014), the Italian WHO-FIC CC was active on five lines of work at international, national and regional level: (i) revision of the International Classification of Diseases; (ii) IT and ontological development for WHO FIC; (iii) coordination and management of the ICD-10 and ICF update process; (iv) national work on WHO-FIC; and (v) awareness building and implementation support of WHO-FIC in WHO regions. Some results are presented in an interactive map (QR accessible) that allows browsing through all the posters presented by the CC at the 2014 WHO-FIC annual meeting (Figure 1).New projects inside the WHO-FIC network: launch of the WFABER project; coordination

AcknowledgementsResults

Moving from the 2011-2015 terms of reference (TORs) of the Italian WHO-FIC CC, a performance monitoring plan was defined to yearly assess the CC’s performance. Five main criteria were used: (i) adherence to the relevant lines of work of the WHO-FIC Strategic Work Plan (SWP); (ii) outcomes of the activities; (iii) new partnerships; (iv) communication power; and (v) resource consumption.

Conclusions

of and active participation in mICF; involvement in SNOMED-CT and ICF common ontology efforts; ISO9999 mapping to ICF; translation into Italian of the WHODAS 2.0 Manual; translation into Italian of the ICD-10 Training tool; translation into Italian the ICD-10 1996-2013 cumulative updates; transcoding administrative discharge data from ICD9-CM to ICD-10 using a new software, developed by the Italian WHO-FIC CC. Updates at national level: the CC is formally engaged, as leader of the ICD-10-related line of work, in the national project of revision of the Italian case-mix system (IT-DRG project); ICD-10 cumulative updates were translated into Italian and the relevant ClaML file was maintained both in English and Italian through the Italian Portal of Classifications, which was restyled. Updates at regional level: a third VilmaFABER field trial was carried out in the Friuli Venezia Giulia Region and a fourth field test was started in


References

ICD line IT line Disability policies lineImplementation lineICF line

Web tools and services to translate, update, browse, and publish

ICD-10

How to deal with meaning ambiguity in

international classifications on disability in five

different languages

Italian WHO-FIC CC Annual Report

Shift from ICD-9CM to ICD-10 in morbidity

coding

Workplace description using and expanding

the ICF Environmental Factors component

WFABER multicenterproject on

determinants of outcomes

“Web Activity and Participation Performance

Inventory” (WAPP.In).

How to combine standard

terminologies and ICF in epidemiological

studies

ISO9999 mapping to ICF

ITC Report

Architecture for ICD 11 and SNOMED CT

Harmonization

Developing a mobile application for ICF

ICDfit: a web-based system for ICD11 field

trials

URC Report

WHODAS 2.0 in Philippines

The activities of the Italian Collaborating Centre are linked to the relevant lines of work of the WHO-FIC SWP according to the CC’s TORs. All activities of the Centre were made possible thanks to regional and national funding.

the Liguria Region. VilmaFABER has been published on the web (Figure 2) [2].The communication power was evaluated considering presentations, seminar and meeting organization, and active users of the Italian Portal of Classifications (Figure 3).

Figure 3 – The new Italian Portal of Classificationsas a strategic communication tool of the Italian CC

Figure 1 – The Barcelona Subway Interactive Map of the Italian WHO-FIC CC 2013-2014 activities (each station is a downloadable WHO-FIC 2014 Meeting poster)

All activities carried out by the Centre were possible thanksto the deep understanding and concrete funding by FriuliVenezia Giulia Regional Administration, national and otherregional institutions and authorities.1. Agreement between Italian Ministry of Health and Friuli Venezia Giulia Region, 2010-2012; 2013-20152. “Progetto It.DRG”, founded by National Health Service 2004 to realize strategical objectives under the National Haalth Plan, accortding to art. 1, comma 34, Law n. 662/1996 (CIPE Decision 23 March 2012 for assigning to the Emilia Romagna region the amount allocated for the realization of the "It.Drg Project").

1. Italian WHO-FIC annual report, Udine 3 Sept. 20142. www.vilmafaber.eu

FDRG ReportGrouping Body

Functions (BF) and Activity and

Participation (AP) categories in children

functioning assessment

Scan this to get a digital INTERACTIVE version

Figure 2 – The VilmaFABER logo

Introduction

• The Korean government has beenstandardizing terminology, business andtechnology since 2004 for healthcare serviceimprovement. Work involving terminologystandardization in Korea was first presentedat the 2006 WHO-FIC Annual Meeting inTunis. The Korean government has beenpursuing collaborative work with WHO-FICsince then.• The Korea Health and Welfare InformationService(KHWIS) has hosted and operatedthe Korean WHO-FIC Collaborating Centersince December 2012. KHWIS is a healthwelfare organization working to improvehealthcare and welfare informatization, viastandardization, management of informationsystems, policy research, and more.• In order to carry out effective work byKCC, KHWIS has established collaborativerelationships with government offices, suchas the Ministry of Health and Welfare andStatistics Korea, as well as with medicaland academic communities. It is nowworking to improve interoperability of domesticand international health information via thedevelopment and dissemination of WHO-FICand the Korean health terminology Standardamong others.


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Methods & Materials

Acknowledgements or Notes

Results

Cross-national collaboration systemKCC has organized, and is managing, theCouncil for ‘Standardization of HealthcareInformation’, a cross-national council fordiscussion among standardization specialistsin the country. The council is comprised of 89specialists in 10 different areas of healthcare,such as diagnosis and practice.

Conclusions

Online standard platformWithout temporal or spatial constraints, itfacilitates standardization by supplyinginformation regarding revision proposals andvotes, as well as domestic and internationalstandardization data.

Collaboration with WHO and ISOBesides collaboration with WHO, the KCCis actively working with the ISO. Alongsideestablishing international terminologystandards via participating in thedevelopment of WHO’s ICD, ICF, ICHI andICTM the KCC is collaborating withISO/TC215(Technical Committee on healthinformatics within ISO) to work oninternational standardization in documentformatting and technical fields.

ICD

Supported by Korea’s advanced IT workforce,the ICD-11 multilingual support platformwas developed to facilitate the translationof ICD terms in Asian countries. Using theplatform, 3,701 ICD-11 cases have beenadapted to Korean.

ICF

Based on the latest version (including updatesin 2014) of ICF, about 1,500 codes wereadapted into Korean, and field tests wereconducted for the clinical onsite applicationof ICF. Opinions of 151 clinician from 19institutions were collected, mainly fromuniversity and rehabilitation hospitals.Clinical application cases connecting EMRinformation with ICF between orthopedics,neurosurgery, and rehabilitation departmentswere developed.

ICTM

Following WHO’s plans to include the fieldof traditional medicine into WHO-FIC, the KCCis actively participating in the development ofICTM with China and Japan. In particular,the KCC developed guidelines for codingthe beta version of ICTM and connectionfrequency analysis charts for ICTM-WHOIST,and produced sample videos for the fieldtesting and submitted it to WHO.

ICHI

Currently, a redefinition of health interventionclassification is taking place in Korea, and,due to the interchangeability between thisclassification and ICHI, the three axes ofICHI(Target, Means, Action) were applied.

Korean terminology standardizationWith the development of IT, the healthcareservice industry in Korea is increasinglyinterested in offering an informationservice that combines health data and IT.Healthcare terminology standard is thecore element in the provision of suchinformation services, KCC announced anational standard on September 2014.Approximately 180,000 terms from ninecategories as well as 340 types ofanatomy illustrations, can be used digitallyin EMR and will be used as the basis forsuch technologies as EMR, EHR, PHR.

While maximizing synergy by gathering allKorean healthcare information standardizationactivities in a single place, the KCC is alsoworking as a mediator that can increasethe interoperability of Korean standardswith international ones. It will certainly actas a catalyst for the provision of high-quality healthcare services, such as EHRand PHR, for Korean citizens, and activelycontinue its work.

We would like to thank theMinistry of Health andWelfare, Statistics Korea,the Health Insurance Review& Assessment Service, theKorean Medical Association,and related institutionsand specialists.

Korean Collaborating Centre Annual Report 2014

Kwangwoo Park, Sangsung Hur, Seonock Roh, Taehoon Kim Korea Health and Welfare Information Service(KHWIS), Seoul, Korea

Abstract The Korea Health and Welfare Information Service(KHWIS) has hosted and operated the WHO-FIC Korean Collaborating Centresince December 2012 and act as a mediator to improve interoperability of domestic and international healthcare information. Toachieve this, KCC is : developing and dissemination of national healthcare information standardization and WHO Family ofInternational Classification, Terminologies, and Standards operating network across the country cooperating with WHO andother WHO-FIC CC. This poster described the activities of KCC between October 2013 and September 2014.

• Mental and behavioral disorders 1,483

• Diseases of ear and mastoid process 356

• Diseases of the musculoskeletal system and connective tissue 1,862

Introduction

Title

CEMECE has continued promoting theuse of International Classifications inHealth in Latin America, incoordination with PAHO / WHO throughvarious projects, both training anddesign and implementation of trainingmaterials on the Classifications andfilling death certificates by physicians.The most relevant training projectsduring 2013 were:

Annual Report from the Mexican Collaborating Centre (CEMECE), Jan 2013-Jan 2014

Abstract


C208


Authors: Torres L., Jimenez A., Navarro A., Yañez M.Mexican WHO FIC Collaborative Center, Mexico (CEMECE)

Title

Methods & Materials

Online course on ICD-10: During 2013CEMECE concluded the ICD-10 trainingtool (2008 Edition), sponsored by theMinistry of Health of Mexico. Currently,the course is available on the VirtualCampus of Public Health of the PanAmerican Health Organization(PAHO/WHO). The course is open to allinterested people in the follow website:www.cursospaises.campusvirtualsp.org

Also during 2013 the CEMECEtranslated updates to ICD-10 until2012 and sent the translation to PAHO/WHO for distribution to Latin America.

The CEMECE sent comments to theEducation and ImplementationCommittee (EIC) about the contents ofthe information sheets designed bythis committee on important aspectsabout the family of classifications.During 2013, CEMECE sent informationto WHO on the state that holds theimplementation of each of theInternational Health Classificationswithin the country.

For eleventh year CEMECE coordinatedthe intentional search andreclassification of Maternal Deaths inMexico (BIRMM) in order to correct themisclassification and improve thequality of Maternal Deaths information.

The Center attended the WHO FICNetwork Annual Meeting in October inBeijing, China. The Center requestedofficially to be considered as the hostcountry to the WHO FIC NetworkAnnual Meeting in 2017.

On the other hand, two CEMECEmembers attended the MRG and EICmidyear meetings from 17th to 25thApril, hosted by PAHO/WHO(headquarters Washington D.C).

Training course for trainers in the useof the ICF: With the technical supportof PAHO / WHO in Mexico andPAHO/WHO Headquarters (WashingtonD.C), in May 20th to 31st CEMECEdeveloped the second internationaltraining course of 80 hours, for ICFinstructors. The course was held inMexico City and was attended byphysicians and another healthprofessional from: Chile (NationalCentre of Reference), Colombia, Cuba,Ecuador (National Centre ofReference), El Salvador and Mexico.

The ICF training tool (developed by theWHO FIC Network) was tested in thefirst phase of the course (virtualphase). In addition to the concepts,structure and how to use the ICF, aspecific module about ICF instruments(WHO-DAS 2.0, ICF-Core Sets) andICF implementation projects wereincluded in the core curriculum. Thisstrategy yielded observations tocorrect some editing problemsidentified by students and instructorsin the ICF training tool, which weresent to PAHO / WHO.

Training coders in ICD-10 and medicalprocedures of the ICD-9CM in Mexico:20 courses on ICD-10 coding andmedical procedures using ICD- 9-CMwere given with 832 coders, medicaland statistical staff in several states ofMexico.

Conclusions

With the support of PAHO/WHO,CEMECE attended the meeting of LatinAmerican and Caribbean Network forStrengthening Health InformationSystems (RELACSIS) from 5th toFebruary 7th, in Buenos Aires,Argentina, where the annual plan ofthe Network was agreed, including thefollowing projects:

1) Development of a Regional ICD-10e–learning training tool, based on twoonline courses: CEMECE’s ICD-10course and the training moduledeveloped by the National Center forICD from Argentina (CACE); 2) Onlinecourse on how fill out the deathcertificate for physicians, developed byUruguay, Chile and México; 3)Dissemination and implementation ofautomated coding of causes of deathadapted by the National Institute ofStatistics and Geography (INEGI) fromMexico. Focused on eight LatinAmerican countries.www.relacsis.org

The Mexican Collaborating Center of the WHO-FIC (CEMECE) was designated in January 2008. As every year,the CEMECE has continued promoting the use of International Classifications in Health in Mexico and LatinAmerica, in coordination with PAHO / WHO. These activities are so important to personal who works in theoffices of statistics in all Region. This poster briefly describes the main work and the results.

As every year, the CEMECE keepsworking in topics related with WHO-FIC. The most important activitieshave been: training and research andnowadays the important participationwith different countries. Moreinformation:www.cemece.salud.gob.mx

Abstract The Dutch National Institute for Public Health and the Environment has hosted the WHO-FIC Collaborating Centre in the Netherlands since 1998. This poster highlights the activities of the WHO Collaborating Centre for the Family of International Classifications in the Netherlands (Dutch WHO-FIC CC) that took place from October 2013 to September 2014 in relation to its newly implemented Strategic Workplan.

Title

As early as 1989, WHO appointed a predecessor of the current Dutch WHO-FIC collaborating centre (CC) as a CC for the ICIDH. Since then the Dutch WHO-FIC CC has been re-designated multiple times as a CC for the Family of International Classifications. The last re-designation was late 2013, for the period 2013 –2017. In fact, 2014 marks the quarter-centennial anniversary of our CC.

Dutch WHO-FIC Collaborating Centre annual report 2013-2014


C209


C.H. van Gool, H. ten NapelWHO Collaborating Centre for the Family of International Classifications in the Netherlands,

National Institute for Public Health and the Environment, Bilthoven, The Netherlands

Title

New Strategic Workplan

6. National WHO-FIC activities

With its re-designation a new Strategic Workplan was implemented. This poster highlights the activities of the Dutch WHO-FIC CC that took place from October 2013 to September 2014 along the six key activities in the Strategic Workplan:

1. Support revision of International Statistical Classification of Diseases and Related Problems (ICD);

2. International Classification of Functioning, Disability and Health (ICF) support, update work, guideline development and linking with ICD-11;

3. Supporting WHO-FIC related education and implementation work;

4. Supporting WHO-FIC related informatics and terminology work;

5. Support the development of other WHO-FIC Classifications, including the International Classification of Health Interventions (ICHI);

6. Coordination and management of national WHO-FIC activities.

4. Support WHO-FIC informatics & terminology

In the Netherlands, preparations have begun to implement ICD-10 in the fee schedule for services delivered by medical specialists, under coordination of the Dutch Healthcare Authority.

In collaboration with the Flemish (Belgian) Cancer Federation we made ICD-O-3 available in Dutch in ClaMlformat, and is now online browsablethrough http:class.who-fic.nl.

The Dutch Institute for Road Safety has worked – together with the Dutch WHO-FIC CC - on a national application of ICD’s transport accidents (V01-V99). This will be implemented in 2015.

The Dutch WHO-FIC CC participates in the cooperative effort of modelling an ontology for the ICF; to formalize associations between words and terms used in the ICF, together with the concepts of thought these words and terms evoke.

The Dutch WHO-FIC CC participated in Informatics and Terminology Committee meetings.

Background

1. Support Revision of ICD

One of the centre heads (HtN) serves on the Revision Steering Group, and participated in (teleconference) meetings.

ICD-11 advocacy was started in multiple domains (government, health care); since Dutch hospitals implemented ICD-10 just in 2012, hospitals are reluctant of yet another change in classification system.

Several CC collaborative parties expressed willingness to contribute to ICD-11’s Rare Diseases TAG.

2. Support ICF

The Dutch WHO-FIC CC takes responsibility in the ICF update process by commenting on and voting for ICF update proposals.

Within the Netherlands, thorough work is being done on what Personal Factors to use in ICF and how. This need for using personal factors arose from clinical practice. For more information: [email protected].

The Dutch WHO-FIC CC participated in FDRG (teleconference) meetings.

Also, the CC participates - in collaboration with Statistics Netherlands - in the Washington Group on Disability Statistics, reporting the uniform disability prevalence figures to both the UN and WHO.

3. Support WHO-FIC Education & Implementation

Over the reporting year, the Dutch WHO-FIC CC published two international WHO-FIC Newsletters (Dec 2013 and July 2014).

Several ICF training courses were taught in the Netherlands and in Belgium. Also the CC advised Statistics Netherlands with its transition to IRIS.

The Dutch WHO-FIC CC participated in EIC (teleconference) meetings.

Finally, together with WHO HQ, the Dutch WHO-FIC CC developed the WHO-FIC Implementation Database.

Address correspondence to: [email protected]

One of the centre heads (HtN) serves as FDC co-chair and therefore prepared and participated in FDC (teleconference) meetings.

Both centre heads participated in multiple ICHI meetings (Freiburg and Chicago), and HtN serves on the ICHI management board.

The Dutch WHO-FIC CC is involved in WICC/WONCA’s development of ICPC-3, including personal factors.

HtN contributed to the development of a keystone paper in Dutch on joint use of ICD-10 and SNOMED-CT.

5. Support development of other WHO-FIC classifications

Introduction

The Collaborating Centre for the WHO Family of International Classifications (WHO-FIC) for North America was established in 1976 and was most recently re-designated for four years on March 21, 2012. The North American Collaborating Centre (NACC) is located at the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, in the U.S. Department of Health and Human Services and works in close collaboration with the Canadian Institute for Health Information (CIHI) and Statistics Canada. Designation is in cooperation with the Pan American Health Organization (PAHO).http://www.cdc.gov/nchs/icd/nacc.htm

WHO-FIC CollaboratingCentre for North America

Abstract


C210


Donna Pickett, Mea Renahan and Patricia Wood

Title

Mortality Data

NACC facilitates the implementation and use of ICF in both the U.S. and Canada. NACC has held 15 conferences on ICF since 1995 and distributes a periodic ICF Newsletter, which is posted on the NACC website.• NCHS is participating actively in an

ICF Study Group convened by the Social Security Administration (SSA) to consider applications of ICF in the SSA disability evaluation environment.

• CIHI communicates Canadian activities related to ICF through Canadian Network meetings and national presentations on ICF application.

• ICF is the accepted framework for disability statistics in the U.S. and Canada.

WHO-FIC Network

Morbidity Data

NCHS and Statistics Canada promote the development and use of ICD-10 for mortality statistics in the U.S. and Canada through production of national data files and publication of reports.• NCHS published final 2011 U.S.

mortality data in June 2014 and final 2012 U.S. mortality data in September 2014.

• Statistics Canada released 2010 and 2011 deaths data in September 2013 and 2011 cause-of-death data, including detailed cause, summary list and leading causes of death, in January 2014.

• Statistics Canada plans to release 2012 deaths data and cause of death data, including detailed cause, summary list and leading causes of death, in January 2015 and 2013 deaths data and cause of death data, including detailed cause, summary list and leading causes of death, in March 2015.

Work on Electronic Death Registration Systems (EDRS) in the U.S. continues to progress. When implemented, EDRS will require inputs from two sources –the funeral director and the physician.

Statistics Canada plans to release data for 2011 and 2012 from the Canadian Coroner and Medical Examiner Database in late 2014 or early 2015.

Education, Technical Assistance and Collaboration

NACC has representatives on all WHO-FIC Network Committees and Reference Groups.• NACC co-chaired WHO-FIC

Network Council from 2007-2011. • NACC established Education

Committee in 1999 and chaired or co-chaired until 2010.

• NACC has chaired or co-chaired Mortality Reference Group and served as Secretariat since its establishment in 1998 and serves on the ancillary Table Group.

• NACC chaired or co-chaired Update and Revision Committee (URC) from 2005-2012 and continues to serve as Secretariat of the URC.

• NACC co-chairs the Informatics and Terminology Committee (ITC).

NCHS provided higher level learning opportunities for experienced mortality coding staff in the form of Targeted Training modules.• Statistics Canada is conducting basic

ICD-10 multiple causes of death coding training with in-house staff as a new keyer-coder model is established for use with Iris, the international automated mortality classification system.

• NCHS made a number of webinars and presentations during 2013 and 2014 on the impact of transition to ICD-10 code sets (ICD-10-CM/PCS), focusing on implications for public health organizations.

• In fiscal year 2013-2014, CIHI released three new Education products to support accurate and consistent code assignment. All courses are developed and delivered in both English and French. Over 5,000 HIM’s accessed coding education products in 2013/14.

• Since 2001, HIMs have posted more than 20,500 coding queries to the CIHI eQuery Service. The most current questions (2009-2014) are maintained and accessible to all in a searchable database on the CIHI website.

• Since 2010, NCHS has conducted 7 ICF Web-Seminar Series, a modular series of lectures presenting introductory- and intermediate-level material about the ICF and how to apply it in various settings.

NACC serves on the Revision Steering Group and its Small Executive Group, co- chairs and serves on the Mortality and Morbidity Topical Advisory Groups (TAGs) and serves on the Patient Quality and Safety TAG for the ICD-11 revision process.

Disability and Functioning

The North American Collaborating Centre (NACC) continues to contribute to the work on the development, dissemination, maintenance and use of the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) in both the United States and Canada for mortality, morbidity and disability classification, coding standards and statistics, to support national and international health systems, statistics and evidence. Education, outreach and collaboration are major foci.

ICD 11

The U.S. and Canada both have developed and maintain clinical modifications of ICD-10 for morbidity applications in their respective countries. The U.S. continues to use ICD-9-CM but plans to implement ICD-10-CM/10-PCS by October 1, 2015. General Equivalence Maps have been created and are updated annually.

Canada’s V2012 of the ICD-10-CA and CCI classifications and National Coding Standards are available in pdf at www.cihi.ca in English and French.

CIHI’s eQuery Coding Service launched in 2001 supports data quality and enhancement of the classifications. In 2013/2014 CIHI a conducted data quality re-abstraction study to determine the impact on coding in-patient charts following a Ministry of Health’s adoption of activity-based funding (ABF) models.

NCHS and CIHI participate in mapping activities between WHO-FIC and SNOMED CT.

Mortality Data

Introduction

Title

Nordic WHO-FIC Collaborating Centre • Established 1987 in Uppsala, Sweden as a Collaborating centre, with the name “the Nordic Centre for Classifications in Health Care”.

• In 2009 moved to Oslo, Norway, hosted by the Norwegian Directorate of Health and Case-mix tasks was referred to a new Case-mix Centre in Helsinki, Finland.

• Summary of the Nordic Centre development

• 2009-2012, see link to WHO-FIC website, poster C201: http://apps.who.int/classifications/network/meeting2012/en/

• 2012-2013, see link to WHO-FIC website, poster C209:

• http://apps.who.int/classifications/network/meeting2013/en/

Period Oct 2013 – Sept 2014The Nordic Centre work during the period October 2013 – September 2014 is described in this poster.

Annual Report from the Nordic WHO- FIC Collaborating Centre 2013

Abstract The Nordic Collaborating Centre for the Family of International Classifications was designated in November 2012 for a four-year period. There is an agreement between the five Nordic Countries to finance and run the Nordic Centre for the period 2013-2016. The Centre participates in the WHO FIC Network with members in all Committees and Reference Groups, serve as co-chairs and are members in some of the ICD revision TAGs.


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Author: Lars Berg Head of the Nordic WHO FIC Collaborating Centre, Oslo, Norway

Title

Conclusions

ActivitiesThe Centre has during the period been active in the WHO-FIC Network:

participated and extended its work in all the Committees and Reference Groups

participated in mid-year meetings:

• MRG in Lyon (Lars Age Johansson)• EIC in Lyon (Olafr Steinum, Lars Berg)

• FDRG in London (Solvejg Bang, Ann-Helene Almborg,

• FDC/ICHI meeting in Chicago (Ann-Helene Almborg, Olafr Steinum, Lars Berg)

• URC - ICF updates (Solvejg Bang, Ann-Helene Almborg)

Work during the last year

A. Cooperation within the WHO-FIC Network according to the agreed work plan and activities.

B. Cooperation with the Nordic and Baltic countries:

1) The Nordic National Classification Units within the Health Authorities in each of the five Nordic Countries.

2) The Nordic Casemix Centre (The NordDRG system is based on ICD-10 and Nordic and national procedure classifications). Web site: www.nordcase.org

3) NOMESCO (Nordic Medico-Statistical Committee) and NOSOSCO (Nordic Social Statistical Committee) Responsibilities:

• Nordic statistics• Update and use of the NOMESCO

ClassificationsWebsite: http://nowbase.org/

Conclusions

served as co-chairs in • WHO-FIC Council and as Council representative in RSG-SEG (Lars Berg)

• Mortality Reference Group (Lars Age Johansson)

participated in the ICD revision TAGs for

• functioning (Solvejg Bang) • morbidity (Olafr Steinum)• mortality (Lars Age Johansson)• neoplasm (Gunnar Henriksson)

participated in the ICHI development work, including human resources for a secretariat (Ann-Helene Almborg) for functioning interventions

National representatives from all the Classification Units/Departments in the five Nordic countries participate in Barcelona, as well as the Nordic experts in the WHO-FIC Network and national FDRG/ICF experts.

Web site

Web site of the Nordic WHO FIC Collaborating Centre: www.nordclass.se

Increased participation in the WHO FIC Network – in Council, Committees and Reference Groups and WHO-FIC Annual meeting

For the future – a mapping of the Nordic procedure classifications (NOMESCO Classification of Surgical Procedures + the national non-surgical classifications) to the ICHI structure is planned to start early in 2015.

Cooperation

The Centre is in the middle of a designation (November 2012-November 2016) and funding agreement period (2013-2016). The Centre is funded by the Health Authorities in the five Nordic Countries:

• Denmark • Finland • Iceland • Norway • Sweden

Historic development of the Nordic Health Classifications in a national and international perspective (2006):

The Nordic Centre

Introduction

Title

The base of activities of the WHO-FIC collaborating centre in South Africa (WHO-FIC SA) has been consolidated in the Burden of Disease Research Unit of the South African Medical Research Council (MRC BOD) since June 2013. Contact is maintained with colleagues in other institutions and structures involved in the development, implementation and use of the WHO-FIC, mainly in South Africa but also in other countries in the WHO/AFRO region, and with the relevant structures in WHO headquarters in Geneva and the WHO African region (WHO/AFRO).

The range of WHO-FIC SA activities relates to most components of the WHO-FIC: ICD and ICF development, implementation and use; and the development of ICD-11 and ICHI. Participation in WHO-FIC structures is strongest in the FDRG, the FDC, the MRG and in the WHO-FIC Council and Council SEG.

WHO-FIC SA benefits from the ongoing contributions of colleagues in a wide range of organisations and roles, who are committed to the effective use of the WHO-FIC in support of excellent health care.

WHO-FIC COLLABORATING CENTRE IN SOUTH AFRICA: 2014 REPORT

Abstract Colleagues associated with the WHO-FIC collaborating centre in South Africa (WHO-FIC SA) continue to participate in activities related to the development, implementation and use of ICD-10 and ICF in South and Southern Africa; the development of ICD-11 and ICHI; and in WHO-FIC network structures. There is ongoing communication with WHO HQ and WHO/AFRO as required.



Lyn Hanmer, Debbie BradshawWHO-FIC collaborating centre in South Africa (WHO-FIC SA),

South African Medical Research Council, South Africa

Title

ICF

National activities in South Africa

ICD-10 is the national standard for diagnosis coding for South Africa. WHO-FIC SA is represented on the National ICD-10 Task Team, an advisory committee to the National Department of Health, and provides regular reports on WHO-FIC activities. Membership of other national committees related to health information in both public and private sectors provides the opportunity to report on the WHO-FIC and gain an understanding of the challenges and progress in the implementation of ICD-10 as a national standard.

Research studies related to the implementation of ICD-10 mortality coding at national level, and in the Western Cape, one of the nine provinces in South Africa, provide the platform for promoting the effective implementation of ICD-10 for mortality coding, and in sophisticated analysis and modelling of the available data on mortality in South Africa.

ICD-10 beyond South Africa

A joint WHO/AFRO and WHO-FIC SA consultation on mortality coding training in support of improved Civil Registration and Vital Statistics (CRVS) was held in Pretoria, South Africa on 30 January 2014. Participants included a representative from WHO/AFRO and colleagues involved in mortality coding training from Statistics South Africa (the national statistics office), the MRC, the National Department of Health, and the private healthcare sector. Input on the implementation of ICD-10 mortality coding in Mozambique was also provided. The consultation also provided the opportunity for sharing information among multiple agencies involved in the reporting of mortality for Africa.

Input on the standardised implementation of ICD-10 to support health services in Namibia was provided at a workshop for Namibian Health Information managers and other stakeholders in Walvis Bay between 24 and 26 March 2014.

Acknowledgements

ICD-10

Members of the FDRG from South Africa, including the current FDRG secretary, continue to contribute significantly to the ICF activities of the WHO-FIC.

In addition to direct FDRG participation, ongoing training and research activities within South Africa and elsewhere in the African Region provide important insights into the challenges and opportunities related to the implementation of the ICF in low-resource settings.

The inputs from South Africa to the developing mICF project (described in detail in separate reporting) reflect the necessity for international projects to take account of as wide a range of requirements as possible to ensure effective design.

Financial support for core WHO-FIC SA activities is provided by the South African Medical Research Council.

The importance of networks of stakeholders has been reflected in the past year in multiple activities including• the expanded links with colleagues

in Namibia; • the opportunity for colleagues

involved in ICD-10 mortality coding in South Africa to meet through the joint WHO/AFRO and WHO-FIC SA consultation on mortality coding training

• ongoing ICF training in African countries; and

• multiple international activities related to the mICF project and the development of ICD-11 and ICHI.

Further opportunities for expanding the network of WHO-FIC participants and activities in South and Southern Africa and through the international WHO-FIC network continue to be sought.

New members of the WHO-FIC

Conclusions

WHO-FIC SA, as a member of the WHO-FIC network, is committed to contributing to the development of new components of the WHO-FIC.

There continues to be active participation in the development of ICD-11 through members of the MTAG, the MbTAG and several vertical TAGs. Efforts are being made to ensure that there will be significant input to the current beta review phase and in field testing of this classification.

Participation in the development of ICHI provides the opportunity to ensure that this interventions classification meets the needs of potential users in the African region.

Conclusions

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ICD Activities

Title

The major mission of the THAI WHO-FIC CC is to give support to WHO in developing ICD system in Thailand. The center also functions as the center of knowledge, information, experts for further references, for developing coder’s training courses, learning materials, supporting for the coding of ICD as well as continuously maintaining, improving and updating codes. Five main activities are;

1. Setting up, Developing, and Improving Standard Coding Guidelines

The center has set up Standard Coding Guidelines in hospitals under the standardization in medical diagnoses and common standard guidelines in coding for coders so that the out-coming information can be precise, exchangeable, and connectable throughout the whole country. The development started in 2006 with a regular revision every two years under the supervision of a team consisting of representatives from the Royal Medical College, Association of Medical Experts, Medical Schools, the Ministry of Public Health and related networks such as the Office of National Health Assurance, and the General Office of the IT for Health Services. At present the center has developed Standard Coding Guidelines -Version 2014, which covers issues concerning problems in coding and new knowledge in the form of a manual to be functionally used in both public and private hospitals throughout the country.

THAI WHO-FIC CCAnnual Report 2014

Abstract This report documents the activities of the Thailand Collaborating Center (Thai-CC) for the WHO Family of International Classifications (WHO-FIC) documented against the Thai-CC terms of reference for the period of October 2013-September 2014.


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Authors: Wansa Paoin, Maliwan Yuenyongsuwan, Daranee SuvapanThai WHO-FIC CC, Ministry of Public Health, Thailand

Title

3. Development and Improvement of the Discharge Summary Form and Coding Definitions

The center has set up the discharge summary form or the summary tag which is part of the medical record for the admittance case at the hospital which bears general information, summary of the diagnosis, operation and treatment, and status of discharge of the patient, etc. It has also set up common definitions or meanings within the form’s columns to be used in hospitals throughout the country.

4. Setting up of Simplified Version of APN ICD-10

This was the first APN meeting held independently from the WHO-FIC annual meeting besides those in Japan.In this meeting, representatives from nine countries - China (Hong Kong), India, Indonesia, Japan, Korea, Laos, Malaysia, Myanmar and Thailand attended the meeting. Three work-plans were agreed upon, i.e. 1) to proceed on making an APN module based on the education certification module of WHO-FIC Education and Implementation Committee (EIC); 2) to prepare a table of ICD training resources that each country can offer; and 3) to make a simplified version of ICD-10 for APN based on the simplified versions of ICD-10 Thailand and Japan.

5. Planning and Preparing for the Trial Use of ICD-11 in Hospitals

The center has conducted meetings to prepare for the readiness in using ICD-11 in hospitals with the translation of the ICD-11 Beta Phase into Thai language. It has also been in the process of accepting applications from voluntary hospitals for joining the ICD-11 Beta Phase.

ICD Activities (cont.)

2. Setting up of Classification of Health Intervention Coding System of ICD-10-TM (Volumes 3 and 4)The health intervention coding system of ICD-10-TM was previously called the procedural coding system. This coding system of ICD-10-TM was invented in 2007 in Thailand under the co-operation among clinicians, nosologists, epidemiologists, and statisticians form both public and private health sectors with the objectives to be used as tools for collecting hospital services data and statistic tabulations. The system was revised twice in 2010 and 2014.

ICF Activities

Thailand’s censuses of the disabled since 2008 have used the concept of ICF in setting the frame for grouping the disabled in the nation while earlier only the disability and the impairment were criteria for specification of the disabled. Nowadays, Thailand has implemented the idea of the Interactive Model which includes the daily routine, activity and participation, rather than just defects, as well as facilities which are barriers to the disabled.

Development of the ICF use in the disability folder at the national level which is also related to ICD 10 on the basic principle that the disabled who are petitioning for the approval from every single public health institution at any levels have to be processed with the ICF codes which are divided into 9 categories. Conferences with all hospitals throughout the country were conducted for general understanding with ICF manual. ICF coding for legislative people with disability was started through the whole country in October 2013. Sirindhorn National Medical rehabilitation Center developed ICF core sets for amputee and for functional evaluation. The development of the ICF Core Sets for amputee involved a formal decision-making and consensus. Relevant ICF categories were identified in a formal consensus process by international experts from different background. Twelve experts (6 physiatrists with various sub-specializations, 4 prosthetists, 2 nurses, 2 public health technical officers) attended the consensus process on amputation.

The ICF amputation core set has the potential to demonstrate activities and participation. It also showed good feasibility.

ICF core sets for functional evaluation has been developing. The ICF core sets were matched with SNMRC score (35 items) that cover all area of activity and participation. SNMRC score is used for evaluation of basic activity daily living, instrument activity daily living, communication, bowel and bladder control, mobility, ambulation, cognition and social participation.ICF core sets for children with disability has been developing from ICF and ICF-CY.

The Korean Collaborating Center as one of the member of APN has been contributed to the preparation for the field trial of the ICD-11. The items below were prepared by the experts in traditional medicine in collaboration with WHO H/Q. And the same structure is expected to be used for the field trial of other chapters in ICD-11.1. Sample video case: A medical interview

and physical examination simulating a real case was recorded. A textual script along with the movie clip file was prepared and submitted to the CTS office of WHO. This video clip shows a structured medical interview that may be adopted as a research tool in the main phase of field trial.

2. Field trial protocol (draft): A protocol of the field trial was designed and submitted to the CTS office of WHO. This protocol incorporated three research settings of research institute, primary care, and hospital. Reliability of the assessment was designed to be assessed by this protocol

3. Case summaries: A total of 33 cases were described and analyzed as a part of the preparation for the field trial. These cases are based on and modified from real clinical cases of representative patients.

4. Coding guideline (draft): A coding guideline (draft) was edited and proposed to the CTS office of WHO. This guideline may be an essential part in the ICD-11 as well as the field trial of ICD-11.

About the APN

Title

Established in Tunis, Tunisia, in 2006, to promote ICD implementation in the Asia-Pacific, WHO-FIC Asia-Pacific Network (APN) has organized six conferences and two working meetings. At 6th APN Meeting, Dr. Hiroyoshi Endo succeeded Dr. Kenji Shuto as the network co-chair, leading the second phase of its activities with co-chair Prof. Sukil Kim and initiating ICD implementation activities in target countries. The 7th APN Meeting will be in Southeast Asia in 2015, linking it with actual implementation activities in the region.

Activities of the WHO-FIC Asia-Pacific Network

Abstract The WHO-FIC Asia-Pacific Network (APN) was formed in 2006 with the objective of promoting ICD implementation in the Asia-Pacific region. There have been six network meetings so far, with the most recent one, the 6th WHO-FIC Asia-Pacific Network meeting, held in Bangkok, Thailand, in July 2013. This meeting marked the beginning of the second phase of the network’s activities, including the launch of full-fledged implementation activities. The poster reports on the network’s most recent meeting in Thailand, an activities plan that was agreed at the meeting (focusing mainly on the development of an ICD-10 simplified version for the APN), and two working meetings held to translate the plan into concrete action. Lastly, it outlines aframework that the APN will establish for it to cooperate in the Field Trials for the development of ICD-11.


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Hiroyoshi Endo, Sukil Kim, Wansa Paoin, Maliwan Yuenyongsuwan, Joon Hong, Yukiko Yokobori, Chang Shik Yin OMD, Toshio Oi

Title

ICD-11 field trial and APN

The 6th Meeting in Thailand

Two Working MeetingsTwo working meetings were held to

implement the work plan from the 6th APN Meeting.

[1st working meeting]Date: December 9, 2013 10:00-16:30Place: Japan Hospital AssociationParticipants (5): Hiroyoshi Endo (Co-Chair), Sukil Kim (Co-Chair), Wansa Paoin, Maliwan Yuenyongsuwan, Yukiko Yokobori

The participants discussed development of APN ICD-10 Simplified Version, which will be used to promote ICD-10 implementation in developing countries in the Asia-Pacific, using ICD-10 TM for PCU (Primary Care Unit), a simplified version used in Thailand, the Condensed List of Causes of Death for Japan, the ICD-10 Tabular List, and the Condensed Morbidity List for Japan, as reference.

[2nd working meeting]Date: July 11 (Fri.), 2014 10:00-15:00Place: Japan Hospital AssociationParticipants (6): Hiroyoshi Endo, Sukil Kim (South Korea), Wansa Paoin (Thailand), Maliwan Yuenyongsuwan (Thailand), JoonHong (South Korea), Yukiko Yokobori

Dr. Paoin reported on the state of development of the Simplified Version. The alpha version was released on the day of the meeting, with the beta version planned for release in January 2015. Translation and development of a training curriculum will begin in February 2015.

This was the first APN meeting held independently from the WHO-FIC annual meeting besides those in Japan. In this meeting, representatives from nine countries China (Hong Kong), India, Indonesia, Japan, Korea, Laos, Malaysia, Myanmar and Thailand attended the meeting.

Three work plans were agreed ie. 1: to proceed on making an APN module based on the education certification module of WHO-FIC Education and Implementation Committee (EIC) 2: to prepare a table of ICD training resources that each country can offer. 3: to make a simplified version of ICD-10 for APN based on the simplified versions of ICD-10 Thailand and Japan.

(Target Countries for ICD-10 PCU APN version)Myanmar, Lao, Cambodia, Vietnam, Mongolia, The Philippines, Indonesia, Bhutan, Timor Leste, Nepal, Papua New Guinea etc.

Picture 1: the 6th Asia-Pacific Network meeting, Bangkok, Thailand

APN ICD-10 Simplified Version1. The Name : ICD-10 for Primary

Health Care , APN version2. Based on ICD-10-TM for PCU as alpha

version3. Objective : become ICD-10 for PCU ,

APN version as beta version in 20144. Simplification Rules

a. Reduce number of original ICD codes i. Based on previous coding evidences orii. Data from questionnaire sent to

developing countries representatives.iii. Data from volunteered doctor works in

developing countries.iv.Expert opinion reviews of ICD-10-TM

for PCU by target countries. (see below)

b. Complexity eliminationi. Delete Dagger-Asteriskii. Pre-coordination Codesiii.Clearer Code Labels iv.Eliminate non-user friendly terms and

symbols

5. Peer reviewer’s guide (draft): A peer reviewer’s guide was edited and proposed to the CTS office of WHO. This guide may be provided to the peer reviewers of ICD-11 and may facilitate the review process based on the consensus of the principles in the review of ICD-11.

6. Peer reviewer’s reference (draft): A peer reviewer’s reference was edited and proposed to the CTS office of WHO. This reference may be provided to the peer reviewers of ICD-11 and may facilitate the review process based on the in-depth understanding of the ICD-11 project in the review of ICD-11.

Quite number of experts in both traditional medicine and modern medicine around APN member countries are ready to participate in the field trial as soon as it starts.

Year Venue Participant

1st Oct. 2006 Tunis (Tunisia) 9 countries

2nd Sep. 2007 Kyoto (Japan) 13 countries

3rd Nov. 2008 Delhi (India) 10 countries

4th Sep. 2009 Hamamatsu (Japan) 9 countries

5th Dec. 2010 Tokyo (Japan) 6 countries

6th June 2013 Bangkok (Thailand) 10 countries

Introduction

Title

The regional network was created inMexico in the context of the LatinAmerican Network for theStrengthening HIS (RELACSIS as itsacronyms in Spanish), with theparticipation of the CCs of Brazil,Mexico, and Venezuela, and the NRCsof Argentina and Cuba, as well asrepresentatives of Chile. In the lastIB-WHO FIC meeting (Mexico) therewere included Mayo Clinic, Panana,Ecuador, and Colombia and theCaribbean Public Health Agency.

A NETWORK WITHIN A NETWORK: THE IBEROAMERCIAN EXPERIENCE

The AMRO Network (now IB-WHO FIC, the Ibero-American Network for the WHO-FIC) includes the WHO-FIC Collaborating Centers (CCs) for the American Region and the National Reference Centers (NRCs) on mortality and morbidity. Was launched in 2011 and has the purposes to develop an annual WP that includes training and health data quality, to promote a collective development of tools to strengthen Health Information Systems(HIS), foster the creation of NRCs and establish common criteria among members to participate collectivelythe WHO-FIC Network and its different Committees.


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Authors: Alejandro Giusti (AMRO, Uruguay), Aline Jiménez (Health Statistical Office, CEMECE, Mexico)

IB-WHO FCI will be governed by aCommittee composed at least tworepresentatives selected among itsmembers and at least one member ofthe RELACSIS Secretariat.The PAHO/WHO unit responsible forthe topic will assume the role ofSecretariat to facilitate exchangesamong members and countries in theRegion. It will be establish taskgroups assigned to priority issues as apart of the annual plan.The RELACSIS website(www.relacis.org) will be the way ofcommunication thorough a privatesite with members access and a publicsection to use for holding publicforums, communications withmembers, dissemination of documents,and use of other tools that the systemprovides.

Further information

Management and communication

Other activities developed by CCs or NRCs (2011-2013)

ConclusionsLed by Mexico and Argentina. 2Online course for coders in (ICD-10). 1rst course: 8 countries, 94participants. Now 15 countries, 300participants.Led by Mexico, Argentina and Uruguay.Online course for properly fillingout the death certificate. 15countries, 150 medical doctors. Thecourse is now available for all countriesat PAHO virtual campus.

Led by Mexico. Spread of the Mexicanversion of the MMDS software codingcauses of death with ICD-10 from 12countries. WG to develop IRIS Spanishversion.PAHO developed a guideline fordeliberate search of maternaldeaths based on the experience ofBrazil and Mexico and disseminatedthorough the RELACSIS portal.

Develop an annual work plan thatincludes training and quality HIevaluation , promote the collectivedevelopment of tools to strengthenHIS, foster the creation of NRCs, andestablish common criteria among members to participate collectively in the WHO-FIC Network and its different Committees.

Backgroung

Purpose of the network

Membership

Its members include the WHO CCs nthe Region of the Americas, theexisting NRCs in the Region, theresponsible Area Chief in the PAHORegional Office, the RELACSISSecretariat, as well as other futurecenters to be created, and othergovernmental and nongovernmentalacademic institutions that carry outactivities related to WHO-FIC.

Management and communication Activities developed in the context of RELACSIS WP (2011-2014)

Led by CEMECE 1) Regional coursefor 25 trainers in IFC (Ecuador) forparticipants of Bolivia, Ecuador,Paraguay and Peru; 2) courses for 25coders in ICD-10 in El Salvador,Guatemala, Honduras and Nicaragua.Special sessions with interagencycommittees to promote the creation ofCNR were developed.Ecuador and Bolivia developednationals courses in ICD-10 formore than 200 coders and health careprofessionals.

. Second Meeting of the Network-FCI in Cuba, 2012. . NACC, CARPHA and PAHO developed a training course for coding mortality of 22 English Caribbean countries in Port Spain, 2012. . CEMECE and PAHO conducted the 2nd

international course for the training of trainers for the use of the ICF with participants from 6 countries in Mexico, 2013 .. Consultations and exchanges Committees and Task Reference WHO FIC Network; . Development of special sessions at regional meetings (RELACSIS 2012 and 2013; CRAES, 2012)..Participation in annual meetings of the WHO-FIC Network in Cape Town (2011), Brasilia (2012) and Beijing (2013).

Contact [email protected]; [email protected]

Abstract In this poster, we examined the existing WHO ICD-11 content services from the perspective of the Common Terminology Services 2 (CTS2) standard. We developed a prototype of the CTS2 Services Wrapper for the ICD-11, and demonstrated that the CTS2 standard is useful in exposing ICD-11 content representation through predictable and familiar services.

Introduction

Title

The beta phase of the ICD-11 revision started in May 2012, and WHO intends to accept public input through a distributed model of authoring. It is anticipated that the public reviewer community will potentially be large, as reviewers will want to be able to access and download target ICD-11 contents into their own evaluation tools and/or try alternatives in their own environment.

The Common Terminology Services 2 (CTS2) is an established Object Management Group (OMG) standard that defines the functional requirements of a set of service interfaces to allow the representation, access, and maintenance of taxonomy content either locally, or across a federation of terminology service nodes. The objective of this paper is to describe the existing WHO ICD-11 content services using the CTS2 standard specifications.

Building ICD-11 Terminology Services Using the CTS2 Standard


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Guoqian Jiang, Harold R. Solbrig, Christopher G. ChuteMayo Clinic College of Medicine, Rochester, MN, USA

Title

Methods & Materials

Code System CatalogWe identified three code systems from the existing WHO ICD content services: 1) ICD-11 Foundation; 2) ICD-11 Morbidity; and 3) ICD10. We also suggested 5 (codeSystemName, resourceType, resourceSynopsis, rights and entryState) that may be important for describing the ICD code systems. Table 1 shows the mapping results.


Results

MaterialsWHO ICD content services - The base URI of http://id.who.int has been adopted, with http://id.who.int/icd/schema as the prefix for the vocabulary terms that are related to ICD classification efforts maintained by WHO and http://id.who.int/icd/entity for the foundation entities related to ICD concepts.CTS2 Standard Specification - CTS2 is an OMG specification for representing, accessing, and disseminating terminological content. The CTS2 platform independent model (PIM) describes the formal model and semantics of the various components

MethodsWe profiled the WHO ICD-11 content services using the information models of Code System Catalog, Code System Version Catalog, Entity Description and Association from the CTS2 specification.We developed the mappings for the elements between the two service models. We also developed a prototype of the CTS2 Wrapper Services for ICD-11.

Conclusions

This work is partly supported by a Mayo-WHO Contract 200822195-1. The authors thank Can Celik from WHO for his critical input on this work.

We consider that building CTS2 services on the top of the WHO ICD-11 content services will potentially 1) provide standards-based representation of ICD-11 content; 2) provide sophisticated terminology services (e.g., lexical/semantic query services; value set definition and management services); 3) facilitate the interactions with other terminologies such as SNOMED CT; and 4) optimize the interoperability among downstream authoring applications for ICD-11 revision. First, we found that ICD-11 Foundation, as a code system from the CTS2 perspective, would need to have a versioning mechanism in the existing WHO services. Second, we identify three code systems and their corresponding code system versions from the existing WHO services, while we also find that these important terminological artifacts can be enriched by CTS2 models.Third, those ICD properties (such as Body System, Causal Agents, etc.) that will have values from external terminologies (e.g., SNOMED CT, ICF) are mapped to the CTS2 property “subjectOf”, which can be elegantly described by the Association Directory model. Fourth, CTS2 is designed to address a broad range of requirements within the ontology and terminology community.In summary, CTS2 standard specification is a very useful tool for profiling the ICD-11 terminology content. The outcome produced by this profiling would potentially enrich the WHO ICD-11 content representation and enable a robust and standards-based content services to better support the ICD-11 revision applications.

Other ModelsWe also profiled the WHO ICD-11 content services using the models of Code System Version Catalog, Entity Description and Association, suggested additional CTS2 properties that may be important for describing the ICD content (data not shown).

Prototype ImplementationBased on the mappings identified and the new properties suggested in the section above, we have initiated a prototype implementation by building a CTS2 services wrapper for ICD-11. The detailed examples of each service for the prototype implementation can be accessed at:http://informatics.mayo.edu/rest2/project/icd11/cts2/doc.

Introduction

Title

The Stanford University WHO CC has the mission to provide support for the development, maintenance, and implementation of infrastructure to author and manage WHO Classifications and their associated terminologies. The Center has made significant progress toward developing a common modeling framework and associated software tools for developing and maintaining WHO classifications. The modeling framework consists of a formal content model that defines the properties of entities in a classification and that drives the development of editing software tools, such as the web-based iCAT authoring tool. Our work promises that all WHO-FIC classifications can be modeled and maintained in a consistent framework, where they share common content model parameters and value sets, where they use similar editing tools, and where any classification can use entities from other classifications as a source for value sets.

Activities of the Stanford University WHO Collaborating Center


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Mark A. Musen, Csongor I. Nyulas, Tania Tudorache, Samson W. TuStanford University WHO Collaborating Center

Stanford Center for Biomedical Informatics Research, Stanford, CA, U.S.A.

To support the use of post-coordination in ICD-11, we extended the ICD-11 Content Model with a number of post-coordination axes (such as severity and anatomic location) and enhanced the ICD collaborative authoring tool (iCAT) with new features that allow subject-matter experts to edit post-coordination information. In particular, we added two new tabs to iCAT–the “Post-Coor-dination” tab and the “Logical Definition” tab. The “Post-coordination” tab allows iCAT users to specify the valid post-coordination axes that can be used with a given entity in each linearization. In the same tab, the user is also able to specify the possible value scales or value hierarchies that can be used to post-coordinate the entity along a given axis. For certain post-coordination axes, the definition of scale values can be overwritten at the ICD entity level. The “Logical Definitions” tab allows ICD-11 authors to give an existing ICD entity a logically necessary and sufficient definition by selecting a superclass and specifying values for some allowed post-coordination axes of that superclass. In addition, much work was done to seed the special “Chapter X” with initial sets of value set for the post-coordination axes.

For illustrative examples, please see the companion poster entitled “Implementing Post-Coordination Support for ICD-11.”

Acknowledgments

Content Model for Interventions

In conjunction with the WHO and the American Medical Association (AMA), we led the development of a prototype Content Model for health interventions. This Content Model integrates and reformulates the Action–Means–Target axes of the proposed International Classification of Health Interventions (ICHI) and the properties and characteristics of the AMA’s Current Procedural Terminology (CPT) into a coherent information model and ontological structure.

The prototype Content Model, represented as a Web Ontology Language (OWL) ontology, defines three types of parameters:

(1)WHO-FIC core parameters that are shared by all WHO-FIC classifications (such as titles, definitions, inclusions, and exclusions),

(2)Classification-specific descriptive parameters that are not inherited by children categories (such as CPT descriptors)

(3)Structural parameters (such as action and approach) that can be used to perform queries along different axes and to post-coordinate new concepts.

For more details, please see the companion poster entitled “A Content Model for Health Interventions.”

In a separate project funded by the U.S. Department of Defense, we modeled as Web Ontology Language (OWL) ontologies descriptions of functional assessments and their value sets and created data models for encoding patient-specific data for functional-assessment forms such as U.S. Department of Veteran Affairs Disability Benefits Questionnaires. We mapped the functional-assessment descriptors to ICF categories and qualifiers, and used the Semantic Web Rule Language (SWRL) to transform such form-derived structured data to ICF formats, when such transformations were possible.

We found the need to distinguish between measurements of functions, where the entities being measured are often represented by external terminologies, and assessments that are abstractions conceptually closer to the notions that ICF codes are designed to represent. Detailed coding requires that we add additional qualifiers, such as whether a range of motion is measured after repetition of motions. Such qualifiers can be added as attributes in a semantic model of the data elements that allows us to formulate these qualified assessments as specialized types of ICF domains (e.g., “range of motion of a joint after repetition of such motion”). Such qualifiers are lost when data are mapped to generic ICF codes.

Abstract The Stanford University WHO Collaborating Center (CC) collaborates with WHO and other organizations to create an informatics infrastructure for developing and maintaining international classifications. In the past year, we workrd on all three reference WHO-FIC classifications: We enhanced iCAT authoring to support post-coordination of ICD-11 entities; we helped to develop an extended content model for health interventions; and we investigated the use of ICF to encode clinical functional assessments performed as part of disability evaluation for US military personnel and veterans.

ICD-11 Post-Coordination ICF Functional Assessment

We are grateful for the generous support of Ms. Marilyn Allen and the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM). The ICF-related work was supported by US DoDAward W81XWH-13-2-0010.

Future Work

In the coming year, the Stanford CC plans to develop and release iCAT-ICHI for the creation of a new version of ICHI and to generalize the software components developed for maintaining WHO classifications into toolkits for managing other ontologies and terminologies.

ICF Functional Assessment

WHO Collaborating Centre

The Institute for Public Health (IPH) at the Cumming School of Medicine, the University of Calgary has been designated by the WHO and WHO FIC as the host for WHO Collaborating Center in Calgary (WHO CC) for Research and Development in Classification, Terminology and Standards.

Mission of the IPH: To catalyze excellence in population health and health services research to the benefit of local, national, and global communities.

The WHO CC in Calgary focuses on the development and maintenance, continuous quality improvement, and research and networking on WHO classification, terminology, and standards products.

WHO Collaborating Centre in Calgary, Canada

Abstract The World Health Organization Collaborating Center (WHO CC) in Calgary will focus on Research and Development in Classification, Terminology and Standards located at the Institute for Public Health, within the Cumming School of Medicine, the University of Calgary in Canada.


C218


Hude Quan and William GhaliThe University of Calgary

Developing ICD-11 Field Trials

Participated in Quality and Safety TAG activities.

• Main Condition (led by Hude Quan): Of 30 countries surveyed, 17 employ a “reason for admission” coding rule as the basis for the main condition, while 13 countries employ a “resource use” coding rule. A few countries have recently transitioned from one of these general approaches to the other. Harmonizing the international definition will enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Ideally, all countries would code both the “reason for admission” and “resource use” as key conditions in their ICD-coded health data.

• Secondary Diagnosis Fields (led by Saskia Drösler): Patient safety indicators (PSI) rely on relevant events coded in the secondary diagnosis field. There is a positive association between PSI rates and the mean number of secondary diagnoses. We investigated the possible association by testing whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared to six countries that did not. Our analysis showed that 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. We concluded that at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes.

• Diagnosis Timing Indicator (led by Vijaya Sundararajan): A diagnosis timing indicator, also known as “present on admission (POA),” improves the ability of ICD coded hospital discharge data to support outcomes research and the development of quality and safety indicators. The importance of POA reporting is that enhancing risk-adjustment with POA-corrected covariates may have a substantial impact on estimates of hospital performance, especially for conditions and procedures that often involve acutely ill patients. An advantage of POA reporting is its ability to exclude relevant events (e.g. deep vein thrombosis) more likely of being present on admission and focus on complications only that occurred during hospitalization.

Quality and Safety TAG

• Revise ICD-11 field trial for grant application

Objectives: - Testing reliability of ICD-11 coding among coders.- Testing comparability between ICD 10 and ICD-11 in defining morbidities- Assessing data quality improvement generated from ICD-11 compared with data coded with ICD-10- Evaluating impacts of coding rules on condition identification and grouping- Documenting utility of ICD-11: experience of ICD-11 use for coding morbidity.

• Prepare and implement reliability and feasibility study on Quality and Safety related ICD-11 codes

• Prepare and implement ICD-10 -ICD-11 bridge coding study

Publication

Coding of obesity in administrative hospital discharge abstract data: Accuracy and impact for future research studies. Martin et al. BMC Health Services Research 2014 Feb 13;14(1):70

Assessing the validity of using administrative data to identify patients with epilepsy. Tu et al. Epilepsia 2014 Feb;55(2)335-342.

ICD-11 for quality and safety: overview of the WHO Quality and Safety Topic Advisory Group. Ghali et al. Int J Qual Health Care. 2013 Dec; 25(6):621-5.

Surveillance of ischemic heart disease should include physician billing claims: Population-based evidence from administrative health data across seven Canadian provinces. Robitaille et al. BMC Cardiovascular Disorders 2013 Oct 20;13(1):88

Validity of AHRQ patient safety indicators derived from ICD-10 hospital discharge abstract data (chart review study). Quan et al. BMJ Open 2013; Oct 3:e003716

Case definitions for acute myocardial infarction in administrative databases and their impact on in-hospital mortality rates. Metcalfe et al. Health Services Research 2013 Feb;48(1):290-318.

Defining quality indicators for best-practice management of inflammatory bowel disease in Canada. Ngyteb et al. Can J Gastroenterol Hepatol. 2014 May;28(5):275-85.

Using linked administrative data to study periprocedural mortality in obesity and chronic kidney disease (CKD). Bello et al. Nephrol Dial Transplant. 2013 Nov;28

Introduction

Title

Abstract The Venezuelan Center for Classification of Diseases is the oldest globally active collaborating center for thatreason we are proud to see in many of today's collaborating centers for people trained in our center. In our sixty years ourcommitment is to remain trainers and multipliers of the importance of families in international rankings in the world.


C219

CEVECE - CENTRO VENEZOLANO PARA LA FAMILIA DE CLASIFICACIONES INTERNACIONALES.

NETWORK ANNUAL MEETING 2014

Record

Conclusions


Present

.

Prospective

•It has not been easy the path, but fullof great satisfaction, so today wecelebrate each year more of lifealongside our children scattered acrossAmerica, together we can strengthenthe knowledge of families worldwiderankings.

Chart 3: Encoders CEVECE.

Chart 1: CEVECE Directors.

•Our vision is to remain a multipliertraining agency in the use ofinternational classifications familieswhile we perform demographic researchin the field, in search of tools tooptimize the naturalness of vitalstatistics.•Consider priority provide ongoingtraining to medical staff in filling thedeath certificate as being producer ofbasic data for the encoder.•Strategic alliances were made withuniversities in the country to implementthe death certificate filled correctteaching•Revision and creation of new trainingprograms according to our present wasconducted.

Chart 4: Distance learning and classroom

•Given the constant technologicaladvances that are currently CEVECEshows the need for its use as a toolthat allows the projection of the centerbeyond our borders as a country, interms of we have created platforms fordistance education together withtraining classroom

•The center was founded with theneed to have a body that will assumethe role of training in family rankingsin the countries of Spanish language.•Along with your human resourcesforming activity in coding, starts workas a translator of manuals of coding:ICD-10 and ICD-0, which are stillused today.

Chart 5: Mexico 2014 meeting with CC.

Chart 2: Manuals translated in CEVECE

•Our direction is to reinforce theproper use of classifications familiesalso strengthen vital statistics usingdemographic instruments that allowthe use of consistent data for theimplementation of public policies forthe development of our people.•Optimize encodings that usetechnological tools, proven by otherCC to accelerate our process ofconsolidating information.•Cooperate with other CC in theimplementation of new classificationsof textbooks family and our desire tocontinue translating and disseminatingmaterials in spanish-speakingcountries•The integration of knowledgepossessed by all collaborating centersas a way of establishing a universallanguage for classifications considernecessary

The CEVECE was founded with awritten agreement between theRepublic of Venezuela and PAHO-WHOFramework Agreement on August 19,1954.•It became officially active on June 6,1955, by convention between MSAS -PAHO - WHO, published in OfficialGazette No. 26,354, initially "LatinAmerican Center for Classification ofDiseases" (CLACE) with category"Reference Centre for the language iscall Spanish "in relation to the CIE.•In 1979 it changed its name to"Venezuelan Center for Classification ofDiseases" (CEVECE) category withPAHO-WHO Collaborating Centre.•Currently, it is the oldest contributorCenter (59 years), re last designationfor 2012-2016.

Author responsible for correspondence about the original Dra. Cordero, C., Masters in Epidemiology (UDO) and Demographer. (UCAB).

Dra. Cordero, C. Lcda.. Villegas, L. TSU. Ortega, N. TSU. Regalado, O. TSU. Moreno, S. TSU. Vasquez, J. TSU. González, A. and TSU. Morales, Y. Director and encoders of Center of DiseaseVenezuelan CEVECE Clasification, Statistics and

Health Information, Ministry of Popular Power for Health; Caracas, Venezuela .

CEVECE: TOWARDS THEIR SIXTY YEARS

ICD-10

Activity Report fromWHO-FIC CC in Japan


C220


Author: ICD Office, Ministry of Health, Labour and Welfare, Japan

Title

ICD-O

2013 became a milestone year in the Japanese cancer registry history. The Cancer Registry Act was enacted in December 2013, and is to be implemented within two years. Data registry, which formerly was made based on voluntary efforts of hospitals and clinics, became obliged for all hospitals with voluntary registries from clinics. In addition, the information gathered

through the surveillance system will bematched with the death information received via the Ministry of Health, Labour and Welfare to complement the database and for further analyses.

Continuing Collaboration

APN

ICD-11

The current designation period will end next year. We hope our effort to gather every members’ experience and knowledge, and to contribute to the improvement and dissemination of the international classifications will be passed over to the next period’s organization that is to be reviewed again taking into account the handling of the whole family of classifications.

The Japan CC supports the work of Internal Medicine Topic Advisory Group (IM-TAG) which covers a wide range of the ICD codes. Dr. Kentaro Sugano , after his long

contribution to the ICD development, left the Chair of IM-TAG in the end of March 2013. Dr. Naoko Tajima (please refer to the photo below) has succeeded his post and is working actively through participation to the monthly RSG meeting and separate teleconferences with WHO officers to coordinate the remaining issues toward the adoption of ICD-11. Centre members also participate in

the work of mTAG and contribute to the revision activity also from the mortality coding perspective.

Abstract The Japanese Collaborating Centre bases on close collaboration of five organizations: the International Classification and Information Management Office of the Ministry of Health, Labour and Welfare (Japan ICD Office); the National Institute of Public Health; the National Cancer Center; the Japan Hospital Association/Japan Society of Health Information Management, and the Japan Society for Oriental Medicine (The Japan Liaison of Oriental Medicine). This poster summarizes their activity taken since the 2013 WHO-FIC meeting in Beijing.

ICD development

Japan introduction

1899 ICD‐1

ICD‐1 1900

ICD‐2 1909 1909 ICD‐2

ICD‐3 1920 1923 ICD‐3

ICD‐4 1929

1933 ICD‐4

ICD‐5 1938

1946 ICD‐5

ICD‐6 1948

1950 ICD‐6

ICD‐7 1955

1958 ICD‐7

ICD‐8 1965

1968 ICD‐8

ICD‐9 1975

1976 ICD‐9

ICD‐10(update)

1989

1995 ICD‐10

2003

2006

2006 ‐

2010 ‐

2013 coming soon!

ICD transition in Japan

ICD-11-TM

was introduced in 2006. The representatives of medical societies and related areas had a lively discussion about the issue, and finally in September 2014 the ICD Board has recommended to apply the 2013 ver. to Japan. The discussion was then forwarded to the Statistical Committee and after the decision of the Committee,

In November 2013, Japan has started the discussion for adoption of the recent version of ICD-10. The current ver. is the 2003 ver., which

The WHO-FIC Asia-Pacific Network (APN) was established in 2006 to promote ICD implementation throughout the region.

Welcoming the new co-chair Dr.Hiroyoshi Endo, APN held their sixth meeting in June 2013 in Bangkok with the representatives from nine countries: China (Hong Kong), India, Indonesia, Japan, Korea, Laos Malaysia, Myanmar and Thailand.

For details please refer to the 2014 WHO-FIC poster “Activities of the WHO-FIC Asia-Pacific Network”, Hiroyoshi E. et al.

Ahead of other areas, the Traditional Medicine group has conducted a small Field Trial on 30 cases from China, Korea, and Japan. Having a variety in the matching rate of the results, it suggests the necessity of clear coding guide etc.

For details please refer to the 2014 WHO-FIC poster “The experience of Field Trial of Traditional Medicine in Japan”, Watanabe K et al.

The 2016 WHO-FIC Network Meeting will be held in Tokyo, Japan.Please plan your visit from now!

WHO-FIC CC Members & Supporters

Along with this movement the third edition of the International Classification of Diseases for Oncology (ICD-O-3) was revised incorporating the latest updates and also by refreshing its size and cover. It became a more handy portable size so that coders can carry around easily.

Renewed ICD-O3

New IM-TAG ChairDr. Naoko Tajima (back row, second from the left) with MHLW Vice-Minister Atsuko Muraki (front row)

The 6th Asia-Pacific Network meeting, Bangkok, Thailand

Commercial

the new ICD-10 2013 ver. will beannounced publically and implemented in each official statistics etc.


C301 Project Plan V3.0 for the ICD Revision Preisler; Robinson Nicol

C302 Proposal System for ICD‐11 Revision Celik; Üstün

C303 Review Process for ICD Revision Robinson Nicol; Celik

C304 ICD‐Transition Study Kostanjsek; Homb

C305 ICDfit: a web‐based system for ICD‐11 field trials

Della Mea; Donada; Celik; Kostanjsek

C306 ICD‐11 Field Trials: Basic Questions (Study 1)

Kostanjsek

C307 ICD‐11 Field Trials: Bridge Coding (Study 2)

Kostanjsek

C308 ICD‐11 Field Trials: Reliability (Study 3) Kostanjsek

C309 The experience of Field Trial of Traditional Medicine in Japan

Watanabe; Yakubo; Ito; Ueda; Sumino; Namiki; Ogata

C310 Standardizing short definitions for the new ICD

Huang; Manos; Shah; Wu; Robinson Nicol

C311 Multiple Parenting ‐ how it works Jakob; Obaro

C312 Postcoordination Coding with ICD‐11 Jakob; Obaro

C313 Implementing Post‐Coordination Support for ICD‐11

Nyulas; Tu; Tudorache; Musen

C314 ICD‐11 Reference Guide Jakob; Kim; Wee

C315 Developing coding guidelines for the ICD‐11 Traditional Medicine Chapter

Roberts; Kostanjsek; Lianghua; Ming; Watanabe; Ito; Kim; Yin

C316 ICD‐11 Traditional Medicine Chapter in Europe

Kostanjsek; Dean; Espinosa

C317 The telescope Jakob; Üstün

C318 Architecture for ICD 11 and SNOMED CT Harmonization

Brand‐Persson; Campbell; Chute; Harry; Kim; et al.

C319 Clinical Omics sub information model for ICD11 (iCOs)

Nakaya; Imai; Kamata; Hiroi; Tanaka

C320 How can ICD‐11 be more useful for quality and safety applications? An international survey

Southern; Ghali; Hall; White

C321 Clinical Dictionary for iSalut: An integrative ontological tool

Rius; Graupera; Nozal; Rovira; Gallego; Canela

C301-321 ICD-11

Introduction

Title

Considering the amount of work and the number of stakeholders involved in ICD Revision, it is essential to have a clear, current Project Plan. In addition to this, the ongoing work results in new decisions and flexible timelines, therefore WHO agreed that it was time to update the Project Plan. The current Project Plan is based on several key documents including ”ICD Revision Process: Beta Phase and Finalization”, ”ICD-11 BETA 2013 Annotation Document” and previous Project Plan Drafts from 2007, 2010 and 2012.One of the main purposes of this update was to design document from which visual outputs could be presented in a variety of formats, fit for different purposes and audiences.

Project Plan V3.0 for the ICD Revision

Abstract ICD Revision is planned to continue for at least three more years with World Health Assembly approval plannedfor 2017. Given this, WHO has updated the ICD Revision Project Plan to accommodate for the new timelines and additionalinformation, including feedback from the December 2013 meeting on the Joint Linearization for Mortality and MorbidityStatistics. Key goals for this update are to give detailed information on new and modified work streams, activities and tasks, to update start and finish dates for each item and intermediate milestone, to explicitly specify interdependenciesbetween tasks, to formally recognize the responsible persons for each task and to identify required resources. The visualoutputs are provided in a variety of formats, including a one slide overview, a so-called “task-only version”, and a “master version” which includes the full range of details available in the plan. The Project Plan is a living document and update must be an on going process with input from different stakeholders of the ICD revision.


C301


Authors: Dr Anni Preisler, Dr Molly Meri Robinson NicolClassifications, Terminologies and Standards (CTS), World Health Organization (Switzerland)

TitleMethods

Results

During the process of updating the Project Plan, several steps were undertaken. The first step was to decide which software program would be best suited for the task. After reviewing several options, Microsoft Project was selected, as it was reasonably priced, offered a free viewer for others to also review the plan, and was fairly easy to learn once a basic knowledge of other Microsoft Office programs was obtained.

Conclusions

We would like to specifically acknowledge and thank Dr Christopher G. Chute and the RSG-SEG for their input and guidance, among many others.

Timeline

Acknowledgments

Given the inflexible deadline of submitting the revised ICD to the World Health Assembly in May 2017, it was necessary to design the plan backwards from this point. This requirement does include its own set of potential issues, not least of which is the fact that tasks often take longer than originally projected. To accommodate for this, it may be necessary to maintain an ongoingoverview of the priority tasks, identifying those that are most essential to completing the core requirements of the project on time.The 13 major tasks and all their subtasks were based on the former task list from the "ICD Revision Process: Beta Phase and Finalization" document. A single, joint Project Plan was seen as preferred in order to maintain a common, high-level overview, to allow for the identification of the interdependencies, and to limit the need to review multiple documents in order to review and update such a complex project plan or for certain work items to be overlooked or forgotten, being separate. This was decided even though there are some tasks so complex and detailed that they might easily constitute a project plan in and of themselves, such as the review process or field trials. To ensurethat all involved parties in the ICD Revision Process had the opportunity to give feedback on the Project Plan, the document was reviewed in severalphases, including being on the agendafor both the RCG and RSG-SEGmeetings among other things.

In the current Project Plan version, the vision to create a document that suitsmultiple use cases has succeeded. The visual outputs are provided in a varietyof formats, including a one slide overview, a so-called “task-onlyversion”, and a “master version” fullfull detail at all levels. In addition, it is now possible to customize a visual output thataccommodates for a specific point in time, a specific workflow, or a specificresponsible officer, among otheroptions.

To maintain Project Plan currency, it will be necessary to revisit and updatethe document with set intervals, suchas quarterly or biennially, at minimum. In addition all the involved partners in the ICD Revison Process and users of the Project Plan need to continuegiving feedback to further improve the Project Plan.

Browsing and Creating Proposals

The proposals are organized according to the ICD structure and therefore each proposal have to be attached to one location in the classification. Because of this the main user interface of the proposal system works similar to the main ICD‐11 Browser.

The user could browse the classification using the hierarchy on the left or use the search tools.

When an ICD entity is selected the system shows the proposals attached to it. It could show all of the proposals attached its decedents as well. Clicking on a proposal shows the details on the proposal.

On the same screen one could create new proposals by using the “Create New Proposal” buttons. Below you see a screen shot taken from a “Content Enhancement Proposal” creation. As you see, the system automatically provides the existing content in an editable form so that the user can suggest changes by actually making the changes. Other proposal types have different screens.

Introduction

Title

The users can make different kinds of Proposals.

Proposal Types

Add Entity ProposalUsed when the user would like to suggest to add a new entity to the classification

Delete Entity ProposalUsed when the user would like to have an entity removed from the classification

Content Enhancement ProposalUsed when the user would like to propose changes in the existing entities. One could suggest the following kinds of changes:• Proposing changes in Title or

Definition • Propose deletion of any property

value in the content model such as synonym, body site, etc.

• Propose Adding any property valuesuch as synonym, body site, etc.

Complex Hierarchical ChangesUsed when proposing other hierarchical changes than simple addition or deletion of an entity

For example, this is the proposal type to use if the user is suggesting changes in the block structure of a chapter,

Rationale and References

Rationale and references for the proposed changes are very important for WHO. Therefore the tool provides mechanisms to enter rationale and references at very granular levels. For certain proposal types providing them is obligatory.

Commenting and User Opinions

Every user of the ICD-11 Browser can see other’s proposals, state opinion on them or comment on them. This creates an environment for discussions on the proposals.

Proposal System for ICD‐11 Revision

Abstract The Proposal System is an addition to the ICD-11 Browser software that allows experts to suggest changes in the classification or enhance the content in it. The commenting feature already provided unstructured discussions on the ICD-11 Entities. The Proposal System adds the capability of making suggestions in a much more structured fashion which is in line with the content model of ICD-11.


C302


Can Çelik, Bedirhan ÜstünWorld Health Organization, Geneva

The Software

Title

An essential component for the success of the revised ICD is the review of submitted content by independent experts, similar to what is done in scientific, peer-reviewed journals. As this has not been done in previous revisions, it has been necessary to design the process "from the ground up". Many parties are particularly interested in how the different types of reviews will be undertaken, as well as the environment in which these reviews will take place. This poster focuses specifically on the workflow of the review process, identifying who will be involved in the process and at what point.

Review Process for ICD Revision

Abstract This poster will answer questions about the review process; everything from how reviewers get involved to the workflow as an item moves from the proposal stage through review to publication. The information will be structured so it is useful for authors, experts, ICD reviewers, clinicians, and other stakeholders in the revision process.


C303


Authors: Dr Molly Meri Robinson Nicol, Can CelikClassifications, Terminologies and Standards (CTS), World Health Organization (Switzerland)

Title

Methodology

WHO put out notifications in many different forums calling for reviewers. Topic Advisory Group (TAG) members were invited to make nominations, as were WHO-FIC Collaborating Centres and professional networks. Member State representatives were informed and invited at the World Health Assembly, as were Non-Governmental Organizations (NGOs) in Official Relations with WHO. Through our ICD-related websites and applications, individuals were able to volunteer, and WHO underwent a lengthy search of available networks to identify experts in each topic area.

Each nomination is being contacted by WHO and asked to confirm their willingness to undertake this work, to verify their area (or areas) of expertise, and to complete a Declaration of Interest for WHO Experts form, ensuring that our process remains free from bias.

For the sake of tracking and transparency, all work done by reviewers is completed in the proposal and review mechanism platform and tracked by a review manager via a review process dashboard.

When content comes in, the proposal software triggers the review process dashboard. Each day, the review

We would like to specifically acknowledge and thank Dr T. Bedirhan Ustun, Dr Mark Musen, Mr Eric Miller, and the Zepheirateam for their work to date.

Workflow

Acknowledgments

manager can log into the dashboard and see the list of new proposals. The manager must evaluate each proposal and determine the necessary course of action. This human oversight will streamline the process by eliminating spam, erroneous or empty proposals. The system is also streamlined by allowing the review manager to clear very simple proposals, such as proposals to correct typos, which may be addressed directly without wasting the time of the expert reviewers.

When the manager sends a new issue, a "review unit", the dashboard will automatically generate an email to the assigned reviewers, informing them that they have a item to evaluate. The email includes five very important pieces of information to facilitate the work of the reviewers.

Figure 1. Review Process Workflow, developed with K. MacDougall, Zepheira

Figure 3. Proposal and Review Process Software Platform

Introduction

Figure 2. Sample message autogeneratedby the review dashboard

A reviewer may reject an incoming review unit for any reason, such as if they are just too busy at that time. Reviewers who do accept a review unit are asked to complete their short evaluation of the unit within three weeks. Reviewers are always encouraged to suggest colleagues who may be interested in a given review unit, or for general reviewer pool. The more experts we have, the better the revised ICD will be.

In the first round, reviewers are asked to consider each piece of content, such as the definition of the entity or list of signs and symptoms, saying whether they agree that each piece is accurate and complete, representing the most current scientific and clinical knowledge.

In subsequent rounds, reviewers will only evaluate newly proposed content, which will appear to them in a diff format, similar to “track changes” in word processing programmes.

Multiple reviewers are assigned to each review unit to ensure a well-rounded set of responses. Each reviewer is informed when others submit their remarks to better stimulate discussion and building of consensus. If a reviewer disagrees with the content, they are encouraged to propose what should be added, changed, or improved, pushing the unit into the second round of review.

In the second round of review when all the reviewers have completed their evaluation and discussion, the manager will re-direct the review unit to the relevant TAG. Once again, the Review Process Dashboard will send an automated email to the TAG members, similar to what the reviewers received, with a link to where they can see the unit, the results of the review, and any relevant discussion. The TAG will have the opportunity to add any additional comments, evaluation, or background in light of the responses provided by the independent reviewers.

When all work is completed and a change is agreed, the content will be manually changed in iCAT by either the review manager or another individual identified by WHO as a final quality check and to avoid any automation errors.

Background & Purpose

Title

Transition from an old to a new ICD version is a complex time and resource intensive exercise. In previous ICD revisions, it was up to individual Member States to handle the transitionand often they faced problems in terms of mobilising the acceptance for the new ICD version, arranging for training and implementation, and addressing IT system changes. Opportunities and synergies to manage the transition ahead of time, and where possible through international collaboration, were often missed or not fully realized.

In the ongoing ICD revision, WHO is undertaking for the first time ever a transition study which will run in parallel with the revision process. The main objectives of the study are: • to identify and analyse transition

requirements across WHO Member States in a systematic and structured manner;

• to inform the development of the ICD-11 Beta draft through the analysis of transition requirements;

• to make recommendation for development of a classification support infrastructure (incl. automated ICD-10 – ICD-11 crosswalks, tools for coding, training, translation, maintenance, and technical guidance.

The study results and follow-up activities will facilitate a more seamless and timely transition process.

ICD-Transition Study

Abstract As part of the overall ICD Revision process and in support of future ICD-11 implementation, WHO is preparing for the transition to ICD-11. The main work-streams will include studying transition requirements in WHO Member States as well as planning the development of application and training tools for easing the transition. The poster gives an overviewon the study objectives and its components. It also provides a more detailed outline on how the study’s 1st component “Eliciting ICD transition requirements” will be implemented.


C304


Authors: Kostanjsek N1 , Homb, N1

on behalf of WHO CTS, RSG and the WHO FIC Network1CTS, World Health Organization, Geneva, Switzerland

Implementing Step 1: Eliciting ICD transition requirements

b) Identify stakeholders including • Primary users (e.g. coders,

clinicians)• Secondary users (e.g.

statisticians) • Regulators• Coding software developers &

vendors• Political, financial, social or

functional beneficiaries

c) Questionnaire development

d) Development of a web-based data collection tool

In the main phase, (Jan.-Aug. 2015 onwards) the focus will be on actively seeking information through various means including:

a) Administer a web-based ICD stakeholder survey;

b) Organize focus group discussions with a cross-section of stakeholders;

c) Conduct interviews with stakeholders and domain experts

What are the needs or conditions that have to be taken into account for a smooth transition from ICD-10 to ICD-11? This question is at the heart of the transition requirement study.

The study will approach this question in a stepwise manner as follows:

What did we learn so far?

To ensure a comprehensive and effective information gathering on transition requirements, the following preparatory activities are being conducted between (Aug.-Dec. 2014)

a) “Framing” the transition requirement issues through

• conducting semi-structured interviews with WHO-FIC CCs and other resource persons

• Compilation and cursory review of published and “grey” literature

The framing exercise will specifically focus on identifying the different types of transition requirements such as:

How do we STUDY ICD transition requirements?

ICD-11

ICD-10

Step 1: Eliciting ICD transition requirements: gather information from ICD users and

Step 2: Analyzing ICD transition requirements: determine whether the stated requirements are incomplete,

Step 3: Specifying and recording ICD transition requirements: document the requirements in appropriate format such as use cases, prototyping, user stories, process specifications, etc.

beneficiaries regarding what their requirements are

ambiguous, or contradictory, and then resolve these issues

Transition Specification

What are YOUR requirements for ICD transition?

(Write them below) ••••••••••••••••••••••••••••••

• Operational requirements: Where, for what purpose, how, by whom, for how long, in which context will ICD-11 operate?

• Functional requirements: What specific functions and actions ICD-11 has to accomplish?

• Non-functional requirements: How is the ICD-11 supposed to be?

• Performance requirements: How well has ICD-11 carry out specify tasks or action?

a) Conduct interviews with stakeholders and domain experts

Introduction

Title

In order to support the implementationof of ICD-11 Field Trial core studyprotocols, a web-based system (ICDfit) has been designed and developed with a number of functionalities, including:- Computer Assisted Personal Interviews (CAPIs) for three field trial instruments;• support in creating other language

versions of the instruments and administering them in theselanguages;

• user access and policy mechanismsthat will be enforced in the userinterface, in particular the field trial organization is replicated: WHO coordination, Field Trial Center, Field Trial Site, raters and key informants.

- built-in extensibility to enablefurther studies.

The present poster illustrates the current prototype of the system.

ICDfit: a web-based system for ICD-11 field trials

Abstract In order to support the implementation of of ICD-11 Field Trial core study protocols, a web-based system(ICDfit) has been designed and developed with a number of functionalities to replicate the organizational structure of the ICD11 field trials, and help to collect data in a form ready to be analyzed.


C305


Authors: Vincenzo Della Mea1, Marc Donada1, Can Celik2, Nenad Kostanjsek21University of Udine, Italy, 2CTS, World Health Organization, Geneva, Switzerland

Title

Methods & Materials

Users are enabled to the systemthrough an invitation mechanism, afterwhich they register to the system by filling a Participant Information Form.They can then access the systemthrough a login page, that brings themto a web page personalised dependingon user category. In the next figure you can see a typical Rater page.

Key Informants will only see the Study 1 icon.The Study 1 (Basic questions) is not based on case rating, so there are only questions to be answered:

Study 2 and 3 consist in rating a number of cases, that are shown as a list when clicking on their icons, as shown in the next screenshot:

A case summary can be then viewed and the corresponding form filled:

Conclusions

Raters, key Informants, studies

The ICDfit system has been developedusing PHP5, MySQL, Apache, on a Linux server.The system implements the organization structure of field trials (FT), based on WHO coordination, FT centers (FTC) and FT sites (FTS). Users can belong to differentcategories: FTC Coordinator, FTS coordinator, Rater and Key Informant.The three main FT instruments havebeen developed in both Western and Traditional Medicine version.Collected data can be exported in CSV format for further processing by meansof statistical software.The system can be easily updated to include future studies. The web interface has been developed using a responsive template in order to be accessible from tablets and smartphones too, like in figure.

Coordinators

The prototype is up and running, and also a demo site for testing and training is available. A preliminary technical testing has been planned from August 2014 onwards to verify functionality and interface issues.

An FTS coordinator is able to invite and manage raters:

An FTC coordinator may assign new field trial sites in their country, and manages also key informants:

Sites can be defined by assigning a site name and inviting a coordinator:

Cases are assigned by selecting the raters and choosing the cases:

Finally, each coordinator has also a dashboard to check FT status:

Purpose

Title

The study is seeking to identify a spectrum of opinions as well as a consensus statement on the Basic Questions (BQs) related to both conceptual and operational ICD-11 issues.

The Basic Questions will address the following topics:• Use and issues with ICD-10 or

earlier versions• Uses and need for ICD-11 • Characteristics, structure and

content of ICD-11• Coding issues• Implementation issues

To ensure that the BQs are of relevance for the main ICD user groups and stakeholders the following BQ version have been created:• BQ version for coders• BQ version for analysers• BQ version for policy makers

ICD-11 Field Trials: Basic Questions (Study 1)

Abstract As part of the ICD-11 core studies, the Study 1 protocol is seeking to identify a spectrum of opinions as well as a consensus statement from ICD users worldwide on Basic Questions (BQs) related to both conceptual and operational ICD-11 issues. The poster provides a detailed overview of the Basic Question topics and the procedures and instruments for implementing the Study 1 protocol.


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Authors: Kostanjsek N1


Title

Procedure and instruments

Consensus conference approach:Each Field Trial Centre will conduct at least two consensus conferences to discuss and determine a consensus statement for each of the basic questions. The results of the consensus conference will be summarized in a report.

BQ examples:

There are two mandatory components of Study 1:

Key Informant Survey: Individual responses to the basic questions should be collected by each Field Trial Center(FTC) from at least 90 respondents (30 respondents per each of the above listed three categories). Each respondent should respond to the basic questions using the online questionnaire. The Field Trial Centre will collect these responses and provide a summary using the same format as for the Consensus Conference.

Implementation arrangements

Training & familiarization: Responding to the Basic Questions individually and as part of a consensus conference will require a certain level of familiarization with ICD. In light of this Field Trial Centers are encouraged to: • brief key informants and consensus

conference participants in advance with background material (a standard briefing kit will be prepared by WHO);

• consider having key informants also participate in the consensus conference;

• consider having some Study 2 and Study 3 participants (e.g. raters and field trial site coordinators) also serve as key informants and participate in the consensus conference.

Sample size WHO recommends that each FTC should: • collect responses to the Basic

Questions from at least 90 individuals;

• conduct at least two consensus conferences (at initial and final stage of the field trial) with participation of key stakeholders at the national level.

Data management and analysisThe key informant survey will be conducted using an online version of the BQ questionnaire. In coordination with WHO the FTC Coordinator will identify and invite key informants to complete the BQ questionnaire online using the ICD-FiT platform.

Analysis will focus on providing basic descriptive statistics including frequency distribution, measures of central tendency (mean and median) and disaggregation by specified covariates, such as age, sex, professional categories etc.

WHO will provide FTCs with online access to their data in order to facilitate analysis of data at national or local level. A separate document will specify the data sharing and publication arrangement.

Step 5: Bridge coding of the data set. Each rater will independently examine and code the pre-assigned case records in ICD-11 and ICD-10using the Study 2 instruments on the ICD-FiT platform.

Step 5a): Before commencing case assessment, all raters will be asked to complete the Participant Information Form (PI-Form).

Step 5b) Raters who have been assigned to recode case records in ICD-11 will complete Form BC11 for every case record. Raters who are tasked with coding the case records with ICD-10 will complete Form BC10for every case record. If the same record has been identified to be coded twice (i.e. once in ICD-11 and once in ICD-10) please make sure that two different raters are assigned (i.e. one coding the case with ICD-11 and the other coding the case with ICD-10).

Purpose

Title

The aim of the bridge coding study is to assess the level of agreement between coders when coding the same diagnosis using ICD-10 and ICD-11. This process will ascertain and enhance the comparability between ICD-10 and ICD-11.

The study will focus in particular on recoding existing ICD-10 coded data sets to estimate the level of • ICD-10 to ICD-10 concordance;• ICD-10 to ICD-11 concordance.

The study results will show whether and how the changes between ICD-10 and ICD-11 will affect the classification’s stability.

ICD-11 Field Trials: Bridge Coding (Study 2)

Abstract As part of the ICD-11 core studies the Bridge coding study is aiming to ascertain and enhance the comparability between ICD-10 and ICD-11 by measuring the level of agreement between coders when coding the same diagnosis using ICD-10 and ICD-11. The poster is giving an overview of the Study 2 components, procedures and instruments.


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Title


Study 2 will have two components, i.e. bridge coding of existing data sets (Component 1) and bridge coding of case summaries (Component 2).

The procedure for Study 2 Component 1: Bridge coding of existing data sets is outlined below.

Step 1: Identification of suitable data sets in close collaboration with WHO FIC Collaborating Centers and other stakeholders with access and authority to handle ICD coded data sets.

Step 2: Preparation of data sets. A random selection of case records will be selected based on the sampling plan. It is envisaged that within each data set, main sample of the randomly selected case records will be recoded in ICD-11 and a sub-sample will be recoded in ICD-10.

Step 3: Assignment of raters. For coding of each data set a minimum of two raters are assigned by the Field Trial Center (FTC ) or Field Trial Site (FTS) Coordinator.. Raters should have extensive coding experience and good understanding of ICD-10.

Step 4: Training of raters. Raters will undergo extensive training process which includes:• in depth familiarization with the Study

2 protocol and ICD-11 classification and

• guided coding of eight case records.


Sample size WHO will provide a sampling plan with detailed information about regarding the sample. For Study 2 Component 2, WHO is recommending that each FTC should conduct a minimum of 500 assessments (i.e. five raters coding 30 case summaries with ICD-10 and ICD-11).

Data management and analysisStudy 2 instruments will be provided in two formats, i.e. online and hardcopy versions.

FTCs and FTSs with computer and reliable internet access are encouraged to conduct the study using the web-based version of the instruments.

FTC and FTS with no or limited computer and internet access should use the hardcopy version of the instruments. Subsequently, they are required to enter the data in the web-based version of the instruments.

Advanced methods of multidimensional data analysis will be used to assess the comparability factors and concordance rates between multiple raters at different levels with appropriate covariates, such as rater experience, age, sex, frequency of the condition, number of raters etc.

WHO will provide FTCs online access to their data in order to facilitate analysis of data at the national or local level. A separate document will specify the data sharing and publication arrangements.

Step 6): Bridge coding evaluation. After raters have completed all assigned case records raters will provide their overall evaluation of the classification using FORM BCE: Bridge Coding Evaluation Form.

Purpose

Title

The study is seeking to identify a spectrum of opinions as well as a consensus statement on the Basic Questions (BQs) related to both conceptual and operational ICD-11 issues.

The Basic Questions will address the following topics:• Use and issues with ICD-10 or

earlier versions• Uses and need for ICD-11 • Characteristics, structure and

content of ICD-11• Coding issues• Implementation issues

To ensure that the BQs are of relevance for the main ICD user groups and stakeholders the following BQ version have been created:• BQ version for coders• BQ version for analysers• BQ version for policy makers

ICD-11 Field Trials: Basic Questions (Study 1)

Abstract As part of the ICD-11 core studies, the Study 1 protocol is seeking to identify a spectrum of opinions as well as a consensus statement from ICD users worldwide on Basic Questions (BQs) related to both conceptual and operational ICD-11 issues. The poster provides a detailed overview of the Basic Question topics and the procedures and instruments for implementing the Study 1 protocol.


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Title


Consensus conference approach:Each Field Trial Centre will conduct at least two consensus conferences to discuss and determine a consensus statement for each of the basic questions. The results of the consensus conference will be summarized in a report.

BQ examples:

There are two mandatory components of Study 1:

Key Informant Survey: Individual responses to the basic questions should be collected by each Field Trial Center(FTC) from at least 90 respondents (30 respondents per each of the above listed three categories). Each respondent should respond to the basic questions using the online questionnaire. The Field Trial Centre will collect these responses and provide a summary using the same format as for the Consensus Conference.


Training & familiarization: Responding to the Basic Questions individually and as part of a consensus conference will require a certain level of familiarization with ICD. In light of this Field Trial Centers are encouraged to: • brief key informants and consensus

conference participants in advance with background material (a standard briefing kit will be prepared by WHO);

• consider having key informants also participate in the consensus conference;

• consider having some Study 2 and Study 3 participants (e.g. raters and field trial site coordinators) also serve as key informants and participate in the consensus conference.

Sample size WHO recommends that each FTC should: • collect responses to the Basic

Questions from at least 90 individuals;

• conduct at least two consensus conferences (at initial and final stage of the field trial) with participation of key stakeholders at the national level.

Data management and analysisThe key informant survey will be conducted using an online version of the BQ questionnaire. In coordination with WHO the FTC Coordinator will identify and invite key informants to complete the BQ questionnaire online using the ICD-FiT platform.

Analysis will focus on providing basic descriptive statistics including frequency distribution, measures of central tendency (mean and median) and disaggregation by specified covariates, such as age, sex, professional categories etc.

WHO will provide FTCs with online access to their data in order to facilitate analysis of data at national or local level. A separate document will specify the data sharing and publication arrangement.

What are YOUR proposed questions for the

BQ-Questionnaire?(Write them below)

••••••••••••••••••••••••••••••

Introduction

Title

International Classification of Traditional Medicine (ICTM) is planned to be incorporated into ICD-11. Until now, the classification and content are almost completed and it is ready to move next step which are Review and Field Trial. We prepared 30 case series in English for the international Field Trial. Before that, we prepared cases in Japanese and did the pilot trial using Japanese Kampo patterns. Here we share our experience of the pilot Field Trial.Even though this is a very small test, this experience is thought to be useful not only for TM coding, but also the field trial for other field.

The experience of Field Trial of Traditional Medicine in Japan

Abstract This poster shares the experience of Field Trial of Traditional Medicine in Japan. Currently, WHO plans to run Field Trial in preparation for the revision to ICD-11. Topic advisory group for Traditional Medicine prepared 30 cases (10 cases from China, Korea Japan) for the international comparison of ICD-11 Traditional Medicine chapter. Before that, Japan had run the Field Trial using case series. The result shars some challenges of Field Trial with other chapters.


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Watanabe K1) Yakubo S1) Ito M1), Ueda Y1) Sumino M1) Namiki T1) Ogata H2)

1 Committee for Classification and Terminology, The Japan Society for Oriental Medicine2 National Institute of Public Health

Title

Methods & Materials

Among 20 directors, 16 participated the field test. The rate of matching of Kampo patterns was between 37.5 % and 100 %.Overall matching rate of the Kampo patterns was 77%.Most of the raters understood the rule of coding, on the other hand, some raters did not follow the coding rule even though we provided “Guide to Coding for Japanese Kampo with with FAQs” including two expample cases. Some raters claimed that some cases were not typical and difficult to choose the right codes.

(1) Case descriptionsThis small trial suggested that confusion arose out of complex case descriptions. They suggest there was difficulty in grasping the pathological condition in five cases, because of complex description of symptoms and findings. The committee has found there is a need for careful attention to avoid complexity in case descriptions.(2) Validity of case code selections The committee found some inappropriateness in case descriptions


Results

The aim of this study was to run the Field Trial of Japanese Kampo classifications as a preliminary step toward field testing traditional medicine classifications.The Committee for Classification of Diseases and Terminology, the Japan Society for Oriental Medicine (JSOM) worked on the Japanese Kampo patterns which harmonized the Traditional Medicine patterns made by Traditional Medicine topic advisory group (TAG) in the revision of ICD.JSOM is the biggest Kampo specialist group in the country with 8,640 members in which licensed physicians are 7,372. The committee made “Outline of Codes for Kampo Diagnosis Used in ICD-11” to assist the determination of TM pattern codes.For the field test, the committee prepared 2 typical case descriptions to assist Kampo medical diagnosis, and included Kampo medical findings, in addition to chief complaint, clinical history and physical findings. For the field trial, 10 additional cases were prepared.The committee also prepared “Guide to Coding for Japanese Kampo with with FAQs” including two expample cases.We have asked to participate 20 board members of JSOM who were all licensed physicians and among them, 16 experts participated in the Field Trial of Kampo patterns.

Conclusions

This study was supported by the Ministry of Health, Labour and Welfare, Japan.

There were some challenges to overcome in the future field test. First of all, clear coding guide is essential. Many participants did not understand the coding rule. Secondly, typical cases are needed. If the case is not clear enough, opinions of the experts were split. Lastly, case series should give enough information to judge. If the information is not enough, experts lost the code. From these experiences, we have prepared the case series in English and plan to have an international Field Trial.

Chart 1: Case descriptions

0102030405060708090

100

case Mailn complaint Kampo diagnosis

Example 1 38 y/o M chill & fever (flu) Early yang pattern

Example 2 71 y/o F dizziness Fluid disturbance pattern

Case 1 66 y/o F urticaria Fluid disturbance pattern

Case 2 79 y/o F sneeze Middle yin pattern

Case 3 64 y/o F dizziness Fluid disturbance pattern

Case 4 49 y/o F headache Deficiency and cold pattern

Case 5 18 y/o M abdominal pain Qi deficiency pattern

Case 6 48 y/o F appetite loss Late yang pattern

Case 7 53 y/o F knee joint pain Fluid disturbance pattern

Case 8 48 y/o F headache Blood stasis pattern

Case 9 56 y/o M diarrhea Qi stagnation pattern

Case 10 53 y/o M neuropathy Deficiency of lower abdominal region pattern

Chart 2: Matching rateCase 7 and 8 were 100 % matched with the result in preparation. On the other hand, case 9 was matched only in 37.5%.

Lessons from this study

and the pattern codes. In Case 9, the code selected by the majority of raters differed from the code that the committee initially deemed appropriate. After re-examining the case description, the committee confirmed that the target code was inappropriate. This suggested that the outcomes of previous deliberations of the committee were inappropriate in relation to descriptions of the clinical findings in this case. The committee found that prior deliberation of cases within the committee needed to be more detailed and thorough. (3) Coding rulesThe method stipulated by the committee for coding of additional pathological conditions does not provide for coding for both acute febrile disease and chronic disease at the same time.Nevertheless, the acute febrile disease code was selected in all eight chronic disease cases, and conversely, the chronic disease code was selected unnecessarily in two acute febrile disease cases.This suggests that raters did not fully comprehend the rules for coding in relation to acute febrile disease and chronic disease. The committee found that the coding method for acute febrile disease and chronic disease needs to be explained more thoroughly.

Introduction

Historically, definitions were only available for certain chapters of ICD. For the revised ICD, however, every entity will include a short definition. With definitions, coders across the world can be consistent with the common understanding of a concept, despite the use of different terminologies or languages, thus ensuring accuracy of coding. At present, the ICD Joint Linearization for Mortality and Morbidity Statistics consists of 25 chapters comprising over 16,000 unique entities.

Throughout the revision process, definitions have been written by numerous technical experts from diverse backgrounds. Each expert has naturally had their own preferences in terms of phrasing, terminology use, and writing style. This resulted in inconsistencies in the definitions and necessitated better guidance on standardizing short definitions. If the purpose of a definition is to ensure shared understanding of a concept, the same words must be employed to describe each of the concepts.

Standardizing short definitions for the new ICD

Abstract - To support users in accurate coding using the revised ICD, each entity in the classification will now include a definition. Input received from numerous experts with diverse backgrounds over the last several years has resulted in definitions that vary widely in style and content. Explicit guidelines on the formulation of definitions were clearly needed.The development of the guidelines for short definitions has been an iterative process; the guidelines need to accommodate for the spectrum of more than 40,000 foundation entities. To harmonize the myriad voices contributing to ICD revision into a single, unified voice is a critical requirement which will have far reaching effects for use and application, both now and into the future of ICD.


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Ms Jiayi HUANG†1, Ms Aspasia MANOS†2, Ms Anita SHAH†, Dr Jessica P. WU†3, Dr Molly Meri ROBINSON NICOL†

†Classifications, Terminologies, and Standards, World Health Organization (Switzerland) 1 Imperial College London (UK), 2 University of Toronto (Canada), 3 University of Calgary (Canada)

Methods

Acknowledgements

Results

The development of the short definitions and guidelines followed an iterative process (Figure 1). There were two simultaneous phases of development: (A) the process of definition development (blue boxes/black text);and (B) the process of guideline development (green boxes/white text).

Conclusions

Dr T. Bedirhan Ustun, Ms Anni Preisler, Dr Finnian Hanrahan, Ms Michelle Gomes, and Dr Nicole Homb

The guidelines for short definitions were created to standardize the rubrics for the representation of content, word and phrasing preferences, terminology, exceptions to the guideline rules, and definitions for common concepts (e.g. what qualifies as a “complication” and how is the concept defined?). Guideline specifics were developed for communicable diseases (e.g. Smallpox) and non-communicable disease (e.g. Classic lissencephaly), congenital and acquired, and other similar issues. Examples of such definitions are included below:

Smallpox - A disease caused by an infection with variola virus. This disease is characterized by a maculopapular rash that progresses to vesicles (commonly on the face, arms, and legs), and fever. Transmission is by direct contact. Confirmation is by identification of the variola virus in a skin sample of the rash.

Classic lissencephaly - A condition caused byfailure of the brain to correctly develop due to genetic mutation. This condition is characterized by defects in the normal circumvolutions of the cerebral cortex, high forehead, retrognathia, and developmental delays. This condition may also present with agyria, or pachygyria. Confirmation is by imaging.

By 31 July 2014, the guidelines were implemented across four chapters for some 2,000 entities, with work on an additional 5 chapters being completed in August and September by a different cohort of editors. The guidelines standardize the definitions while still allowing sufficient flexibility for the wide variety of concepts, and for updates and future developments. Standardization will ease comprehension of terms and limit disambiguation of terms for coders, translators, and users, leading to the potential for increased accuracy and reliability of coding.

Figure 1. Workflow for writing short definitions, with the iterative process of updating and implementing the guidelines included. (Diamonds= decisions; rectangles=processes)

Revise

No

No

Yes

Yes

Yes

No

Look at entity title.

Understand the concept.

Assess the entity concept by its place

in the ontology

Conceptualize/ research

the entity title

Is there an existing workable

definition?Discard existing definition.

Write definition.

Theorise about the necessary

rubrics/content needed for a short

definition in the experts’ chapter of

specialisation.

Brainstorm and write

preliminary definitions en

masse to explore these rubrics/

theory.

Update guidelines regularly, as

problems are detected and resolved.

Edit existing workable definition

Do definitions conform to the

guidelines & writing style in other

chapters?

Do definitions conform to the

ontology?

Internal approval

Short definition

inserted into iCAT

External approval by experts in

the field

Formulate, consolidate, and agree on guidelines as

common concepts (and their means of denotation)

emerge.

14 Diseases of digestive system Diseases and disorders of orofacial complex Diseases of oesophagus Acquired anatomical alterations of the

oesophagus EB30 Motility disorders of oesophagus

EB31 Gastro-oesophageal reflux disease Columnar metaplastic epithelium of the

oesophagus EB50 Oesophagitis EB51 Oesophageal ulcer Vascular disorders of the oesophagus Neoplasms of the oesophagus

2H82.1 Benign neoplasm of oesophagus

2C90 Malignant neoplasms of oesophagus2G50 Carcinoma in situ of oesophagus

EB8Y Other specified diseases of oesophagusEB8Z Diseases of oesophagus, unspecified

Fig 5: ICD-11 Beta Draft – Diseases of oesophagus - Malignant neoplasms of oesophagus

ICD-11 Beta browser (Joint Linearization for Mortality and Morbidity

Statistics) Chapter ‘Diseases of the digestive system’

Multiple Parenting – how it works

Abstract ICD-11 makes explicit what has been implicit in ICD-10: a category may be legitimately allocated in two or more chapters. For the matters of coding a category can bear the code of only one place. For ease of use, the same category is shown in other places, still having the same code. The code is determined by a primary parent for a linearization. The secondary parents are used to show the same category in other places.


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Authors: Robert Jakob, Ewoma ObaroWHO

Multiple parenting allows you to find entities in the place where you expect to see them. A gastroenterologist will see all conditions of the digestive system in one chapter, including neoplasms of the digestive system. An oncologist will be pleased to have all neoplasms in one chapter.

For formal comparison in statistics, the coding scheme that is based on the primary parent will be used. For other analytical purposes, e.g. ‘all diseases of the digestive system’ the multiple parenting can indicate the categories from other chapters that should be included.

Some conditions might correctly be classified in two different places, such as being organized by site or by etiology. In ICD-11 this is expressed by 2 or more parents, as shown in the example above for oesophageal cancer.

In a linearization (classification) an entity can have only one code, no matter in how many different places it is shown. The code is determined by the primary parent-child relationship for every individual linearization.

Fig 4: ICD-11 Beta Draft – Neoplasms –Malignant neoplasms of oesophagus

02 Neoplasms Neoplasms of brain and central nervous system Neoplasms of haematopoietic and lymphoid

tissues Malignant neoplasms Malignant neoplasms, stated or presumed to

be primary, of specified except of lymphoid, haematopoietic and related tissues Malignant mesenchymal neoplasms Malignant neoplasms of lip, oral cavity

and pharynx Malignant neoplasms of digestive organs 2C90 Malignant neoplasms of

oesophagus2C90.1 Squamous cell carcinoma of oesophagus

2C90.2 Adenocarcinoma of oesophagus2C90.Y Other specified malignant neoplasms of oesophagus2C90.Z Malignant neoplasms of oesophagus without mention of type

ICD-11 Beta browser (Joint Linearization for Mortality and Morbidity

Statistics) Chapter ‘Neoplasms’

Fig 1: Many conditions may be grouped in different ways in a classification. In this example, the Oesophageal cancer could be seen as a Neoplasm and also as a condition of the oesophagus.

OesophagealCancer

NeoplasmCondition of

the Oesophagus

Window to another part of the classification;this window does not have a code because it is not intended for coding.

Multiple parenting link that allows you to look at the neoplasms chapter- there are more such links between the neoplasms chapter and ‘neoplasms of the oesophagus’ that are not shown here, as for benign neoplasms.

In the browser or in print versions, special formatting indicates whether the entity is shown in its primary location (black) or in its secondary location (grey). In the secondary location the entity will have the same code as in the primary location –see the examples below.

Fig 3 (below): Multiple parenting at the level of the individual entities. In the foundation of ICD-11, multiple links indicate the possible multiple child-parent relationships – see here for the ‘malignant neoplasm of the oesophagus’. Lines in blue indicate ‘primary parents’ for that linearization (classification). Grey lines indicate secondary parents.

Window

Sign, Symptom, Finding

Injuries

Infection

Congenital

Neoplasms

Perinatal

Maternal

Blood

EndocrineNutrition

Mental h.

Nervous system

Sleep disorders

Sexuality related conditionsEye Ear

Circulatory

Respiratory

Digestive

Skin

Musculoskeletal

UrogenitalICD

Sexual conditions

Immune system

Most conditions may be shown from an etiological view (infections, neoplasms, injury, etc) or a functional anatomical perspective (respiratory system, digestive system etc.). Multiple parenting allows for these different views.

Fig 2 (left): Illustration of multiple parenting across chapters. Only a subset of the possible parenting is shown.

Content from the neoplasms chapter, shown in grey, with code from neoplasm chapter

Introduction

Title

In order to limit the number ofcategories in a specific linearization, the entities in the FoundationComponent are divided into twogroups. One group of entities is of high relevance for usecases that can handle only one code per case, or theyrepresent clinical entities that can orshould always be described as oneentity. These entities become a category in a linearization and are called 'Stem Codes'. All other entities are then expressed using two or more codes. This we call postcoordination.

Postcoordination Coding with ICD-11

Abstract One of the new features of ICD-11 is a mechanism to add more detail to the categories: postcoordination. A whole chapter, the X-chapter, has information that can be added to the categories of the classification to identify in more detail the condition that needs to be reported. In addition, also categories can be combined to express more detail. Conventions regulate how the codes are to be reported.


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Authors: Robert Jakob, Ewoma ObaroWHO

The X-chapter has been designed to standardize the way additional information is added to stem codes.

The entries of the X-chapter must never be used alone but need always to be combined with one or more stem codes. In chapter X, three types of extension codes exist.Type 1 allows the user to help refine the level of detail of a stem code, e.g. adding laterality or temporality, as ‘acute’ Type 2 extension codes are mainly used to mark different types of use of the same ICD stem code in health and other records or for administrative detail, or the certainty of diagnosis.Type 3 extension codes are used to indicate when the associated stem code is being used as a reference, such as in the documentation of a patient’s history. They are used as prefix.

Codes describing one condition are linked in two optional ways:

Fig 1: Multiple coding – Post-coordination of ‘Lipoma of the right medial eyelid with erythema’; note the secondary stem code ‘Erythema’.

Type 1 Type 2 Type 3Severity Main

Condition (types)

History of

Temporality(course of the condition)

Reason for encounter/admission

Family History of

Temporality(Time in Life)

Main Resource Condition

Screening/ Evaluation

Etiology Present on Admission

Anatomic detail

TopologySpecific Anatomic Location

Provisional diagnosis

Histopathology Diagnosis confirmed by

Biological Indicators

Rule out / Differential

ConsciousnessExternal Causes (detail)Injury Specific (detail)

Fig 4: X-Chapter: Extension Codes

Using the X-chapter

Users that want to report more detail about a particular condition or external cause than what is included in a stem code have different options, depending on what information they would like to add:1. A specific chapter, the X-chapter2. Combinations of stem codes

2.1. Chapter 21, “Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings”

2.2. Any other chapter of ICD-11

The X-chapter contains information that must be used in postcoordinationwith a stem code only. Stemcodes of chapter 21 do not code conditions, and thus should not be used alone where more information is available. When combining stem codes from other chapters. The first mentioned is the aetiologically leading one, and the second is the one adding detail.

Reporting more detail

Stem codeOther specified benign neoplasms2J7Y

AnatomyeyelidXA10.1

Histopathologylipoma XH80.35

Clinical forms

Topology

Laterality

medialXA91.2

ErythemaMF11

RightXL1

Stem codeOther specified benign neoplasms2J7Y

AnatomyeyelidXA10.1


Clinical forms

Topology

Laterality

medialXA91.2

ErythemaMF11

RightXL1

Diagnosis typeReason for admissionX2D1

Fig 2: Using type 2 extension – Post-coordination of ‘Reason for admission, Lipoma of the right medial eyelid with erythema’

AnatomyeyelidXA10.1


Clinical forms

Topology

Laterality

medialXA91.2

ErythemaMF11

RightXL1

Type 3 extension

History ofX31

Stem codeOther specified benign neoplasms

2J7Y

Notation

Clustering2J7Y1XA10.11XA91.21XH80.351MF111XL11

The last digit (1 in bold) is the cluster code.

String style lists the codes in one line and the codes are separated by a separator:

2J7Y/XA10.1/XA91.2/XH80.35/MF11/XL1 and ‘/’ is the separator.

Fig 3: Using type 3 extension – Post-coordination of ‘History of Lipomaof the right medial eyelid with erythema’

Post-coordination must never be used to replicate the meaning of an existing stem code.

Sanctioning mechanisms identify applicable combinations of codes.

Introduction

Title

Starting with the availability of the 11th revision of the International Classification of Diseases (ICD), users of the classification will be able to code diseases and other health-related conditions by using combinations of codes in accordance with a specific grammar, a practice commonly referred as post-coordination. Post-coordination is an effective way to avoid the combinatorial explosion that would result if ICD were to specify codes for all possible manifestations of health conditions (i.e., pre-coordination). To support post-coordination, we have extended the ICD Content Model and the ICD collaborative authoring tool (iCAT) with new features that allow subject-matter experts to edit post-coordination information. In particular, we have added two new tabs to iCAT, the “Post-Coordination” tab and the “Logical Definition” tab.

Implementing Post-Coordination Support for ICD-11


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Csongor I. Nyulas, Samson W. Tu, Tania Tudorache, Mark A. MusenStanford University WHO Collaborating Center

Stanford Center for Biomedical Informatics Research, Stanford, CA, U.S.A.

Title

Post-Coordination Axes

Acknowledgments

ICD-11 introduces a number of post-coordination axes (such as severity, onset, and anatomic location), and a dedicated chapter of ICD (Chapter X) will contain possible values for each of these post-coordination axes.

Conclusions

We are grateful for the generous support of Ms. Marilyn Allen and the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM).

The “Post-coordination” tab allows iCAT users to specify the valid post-coordination axes that can be used with a given entity in each linearization. In the same tab, the user is also able to specify the possible value scales or value hierarchies that can be used to post-coordinate the entity along a given axis

Screenshot from the Protégé ontology editor, showing the supported post-coordination axes that have been added to the ICD-11 Content Model

The “Logical Definition” Tab in iCAT

The “Post-Coordination” Tab in iCAT

Chapter X for Value Sets

The “Logical Definitions” tab allows ICD-11 authors to give an existing ICD entity a logically necessary and sufficient definition by selecting a superclass and specifying values for some allowed post-coordination axes of that superclass.

Abstract ICD-11 will allow coders to enter details such as severity and temporal course as modifiers to the main ICD code. To support this kind of post-coordination, we extended the ICD-11 Content Model and iCAT authoring tool so that ICD developers can specify which post-coordination axes are allowed for each ICD-11 entity, to specify valid values for each axis from Chapter X, where value sets are defined, and to give selected ICD-11 categories logical definitions so that equivalence of multiple codes and defined categories can be established automatically.

Screenshot from iCAT showing how the entity “Intermittent asthma” can be logically defined as equivalent to “Asthma,” where the “Temporal pattern” axis has the value “Intermittent”. The existence of logical definitions allows the system to detect that a disease coded with multiple codes in one linearization (e.g., “Asthma” with temporal pattern “intermittent” in the Pediatrics linearization) is the same as a disease coded with a single code in another linearization (e.g. “Intermittent Asthma” in the Morbidity linearization).

Partial screenshot of Chapter X in iCAT

iCAT Screenshot showing how one can specify that “Asthma” can be post-coordinated on “Severity” and “Temporal pattern” axes in a hypothetical “Pediatrics” linearization. Also shows that for the “Severity” axis different values of the “Mild–Moderate–Severe” scale can be used. Both severity values (“Mild”, “Moderate”, “Severe”) and temporal-pattern values (“Intermittent” and “Persistent”) can have “local” Asthma-specific definition.

EXTRACT of Table of Content

Title

ICD-11 Reference Guide

Abstract ICD-11 reference guide is designed as a knowledgebase allowing recombination of its elements. In such a way use specific guides can be produced as much as as individual questions be answered.


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Authors: Robert Jakob, Taeyong Kim, Seongbong WeeWHO

Title

One Source – Multiple Outputs

The ICD-11 Reference Guide is organized as a knowledgebase. It consists of some 260 individual documents that correspond to the entries listed in the table of contents that is shown on the left.This content is accessible as a text document in various formats (ebook, pdf, print) and as an online knowledgebase .

The online knowledgebase allows browsing along a tree structure and searching relevant sections, as show in the screenshots on the upper right. Commenting on that platform will contribute to continuous improvement of the content of the Reference Guide.

For user specific guides, only subsets of the individual documents are used. The individual documents may be arranged in a different sequence, as necessary.In such a way an overview like “ICD in a nutshell” can be produced, as much as a specialist guide for morbidity coders.

1 Purpose and multiple uses of ICD2…3 Structure and Content of the ICD Classification System3.1 The Foundation Component of ICD-11 3.1.1 Linearization 3.1.2 Stem codes and Extension codes3.1.3 Pre- and post-coordination3.1.4 Multiple parenting3.1.5 The Content Model3.1.6 ICD Concepts3.1.7 Definitions3.1.8 Diagnostic Criteria3.2 Organization of a Congruent System3.3 ICD-11 conventions 3.3.1 …3.3.2 …3.3.3 Use of operators3.3.4 Other conventions3.4 Key Organization Principles 3.4.1 Code Format3.4.2 Adding Detail – post-coordination with multiple stem codes and extension codes3.4.3 Specificity of the code: residual codes –“Other” and “Unspecified”4 Chapter Structure of the Joint Linearization4.1 Chapter 01 – Infectious Diseases4.1.1 Structure of Chapter 014.1.2 Differences between ICD-10 and ICD-11 in Chapter 014.1.3 Rationale for Chapter 014.2 Chapter 02 – Neoplasms4.7 X-chapter 32 5 Main Uses of the ICD: Mortality5.1 Mortality statistics 5.1.1 What is coded: Causes of Death5.1.2 Aim of the instructions: international comparability5.1.3 The International Death Certificate5.1.4 Coding and selecting the underlying cause of death5.1.5 The modification rules5.2 Routine use and special cases5.3 International mortality statistics5.4 Recommendations in relation to statistical tables for international comparison 6 Links with other WHO-FIC classifications7 Main Uses of the ICD: Morbidity7.1 Morbidity statistics 46 7.1.1 What is coded : Conditions of patient 477.1.2 Morbidity Rules7.1.3 Definitional framework for reporting7.2 Special cases 7.2.1 Morbidity for clinical care8 Main Uses of the ICD: Morbidity -Traditional Medicine9 Summary of the ICD Organization and Update Process10 History of the development of the ICD

Documents

Knowledge base

Knowledge base

The first example below shows first use of subsets of every section to create an overview of the kind “ICD in a Nutshell”. The second example shows use of parts of some sections and rearrangement of these parts to produce a use specific guide, e.g. for morbidity coders.

Morbidity coding Guide

ICD in a Nutshell

Introduction

Title

What are the basic principles and rules when coding a Traditional Medicine (TM) diagnosis using ICD-11 TM Chapter?

Can TM disorders and TM patterns stand alone as independent codes?

How to use the ICD-11 TM Chapter as a stand-alone chapter and in combination with other ICD-11 Chapters?

What TM diagnosis types (e.g. main diagnosis, secondary diagnosis, post –admitting diagnosis, external causes etc.) need to be identified and defined?

Developing coding guidelines for the ICD-11 Traditional Medicine Chapter

Abstract With the introduction of a Traditional Medicine (TM) Chapter in ICD-11, it is critical that coding guidelines be prepared to complement the of TM disorders and patterns with their titles and definitions. Not only is this the first appearance of Traditional Medicine in ICD, but it introduces new users to that special chapter as well as the Western Medicine (WM) chapters. The poster provides an overview of the TM Chapter coding guideline structure and content and it outlines the development process and the next steps for field testing and integration in the ICD-11 Reference Guide.


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Authors: Rosemary Roberts1, Nenad Kostanjsek2, Zu Lianghua3, Li Ming3, KenjWatanabe4, Michijo Ito5, Yong-Suk Kim6, Chang Shik Yin7

1Sydney, Australia, 2CTS, WHO Geneva, 3 SATCM, China, 4Keio University, Japan, 5Kyoto University Japan 6Gangban Hospital Korea; 7Kyung Hee University, Korea

Title

Guidelines for whom?

These are some of the question which the coding guidelines for the ICD-11 TM Chapter have to address. The coding guidelines for the TM Chapter will be an integral part of the ICD-11 Reference Guide (former Volume 2).

Development process

Coders: Clinical coders and health information managers in clinical settings integrated within hospitals; Clinicians documenting and coding in diverse settings ranging from hospitals to ambulatory public and private health care facilities.Analysers: Clinical researchers internationally; Specialists reimbursing hospitals, practices, practitioners based on morbidity data (casemix, insurance – private and national); Other users of coded morbidity data (allocation of resources, quality and safety, education of TM practitioners, etc.).Developers: Developers of ICD-11 TM Chapter; Field trial participants testing ICD-11 TM Chapter; Peer reviewers of ICD-11 TM Chapter; Experts involved in update and maintenance of ICD-11 TM Chapter.

Structure and content

The current draft TM Chapter coding guidelines are organized in the followings sections and sub-sections:

1. General Principles

a) The rationale for a Traditional Medicine Chapter of ICD-11 is provided with a summary of the scope of the Chapter and the definitions of high level concepts classified (i.e. TM Disorder and TM Pattern).

b) The main use cases for the Traditional Medicine Chapter are outlined including:• Reporting• Research• Casemix reimbursement and

insurance• Quality and Safety of care • Education• Standardising terminology for

use in electronic health records

c. The update and maintenance arrangements for the TM Chapter are described.

2. How to code for Traditional Medicine: Coding conventions

a) The introduction describes the main data sources, data quality issues and generic rules for coding TM diagnosis.

b) How to use the TM Chapter as a stand-alone• Coding rules• Sequencing• National and international coding • Examples

c) How to use TM Chapter with other ICD Chapters• Coding rules• Sequencing• National and international coding • Examples

Appendix 1 is listing a series of Frequently Asked Questions (FAQs) which will form the basis for the development of knowledge base.

Appendix 2 includes the Definition of Main Condition.

The ICD-11 TM Chapter represent a unified set of harmonized traditional medicine disorders and patterns from national classifications from China, Japan and Korea.

The development of the coding guideline document was conducted in the following manner:

1. National coding guidance information from China, Japan and Korea was compiled and reviewed.

2. A 1st draft was produced. The draft identified a wide range of questions which the coding guidelines needs to address.

3. In bilateral discussion with TM experts form China, Japan and Korea the questions were answered.

4. Based on the country responses a 2nd draft of the TM Chapter coding guidelines was produced.

5. In a second round of consultations the draft was discussed with TM experts form China, Japan and Korea. Subsequently, the 3rd draft was generated.

Next steps

• Discussion and input for TM coding guidelines will be solicited from TM experts from other countries in regions including Australia, Europe, USA and Canada.

• The draft will be incorporated in the ICD-11 Reference guide and undergo field testing.

Introduction

Title

In Europe, the biggest meeting of TM-trained practitioners and physicians isthe Traditional Chinese Medicine (TCM)Congress in Rothenburg o.d.T.Germany. For the 2014 edition of thecongress, over 1300 participantsgathered from 20 countries.

The Congress organizers (i.e. TCMKongress Rothenburg, the EuropeanTraditional Chinese MedicineAssociation (ETCMA) and the GermanAssociation of TCM (AGTCM) co-hostedan ICTM Forum.

The forum objectives included :

1. Familiarize TM Community inEurope with the ICD-11 TM Chapterdevelopment and the underlyingreasons and mechanisms forintegrating Traditional Medicine(TM) related health concepts intoICD.

2. Understanding national and regionalTM practices and information needs(i.e. use cases) to which the futureICD-11 TM Chapter should respond.

3. Discuss and promote participationin the international Peer Reviewprocess and Field Testing of the TMChapter (including the piloting ofBasic Questions (BQ) on the ICD-11TM Chapter).

ICD-11 Traditional Medicine Chapter in Europe

Abstract ICD-11 being an international public good, the Traditional Medicine (TM) Chapter has to respond to user needs of the TM and the Western Medicine community across the world. Global and regional meetings of TM-trained practitioners and physicians provide good opportunities to introduce the International Classification of Traditional Medicine (ICTM) project and foster participation in the field testing of the ICD-11 TM Chapter. One of the major gatherings of the TM community in Europe is the annual Traditional Chinese Medicine (TCM) Congress in Rothenburg o.d.T. Germany. This poster presents how awareness and feedback on the ICD-11 TM Chapter were raised and elicited during an ICTM Forum at the congress.


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Authors: Kostanjsek N1 , Dean L1, Espinosa S1

1CTS, World Health Organization, Geneva, Switzerland

Title

Piloting Basic Questions

Examples of BQs for ICD-11 TM Chapter:

BQ feedback & Way forward

Following a familiarization session onthe ICD revision process, ICD-11 TMChapter, and its linkages with the WHOTM Strategy, focus group discussionswere held on the draft Basic Questionsfor the ICD-11 TM Chapter.1. Current situation: How are

practitioners currently documentingand coding TM diagnosis in Europe?Do practitioners report theirdiagnosis?

2. Needs and usage of ICD-11 TMChapter: What are the perceivedneeds for a diagnostic TMclassification? What functionalityand usage are envisaged?

3. Characteristics, structure and content of the TM Chapter: How adequate are the characteristics, level of detail, coverage of specialty areas, applicability, structural principles and linkages?

4. Coding: Providing an opportunityto analyze coding or documen-tation practices in terms of primaryand secondary recording, usage ofdisorder and pattern, and otherpractices.

5. Implementation issues:Understanding the perceivedbenefits and challenges ofimplementing the TM chapterclassifications.

Following the focus group discussions,participants were invited to respond tothe draft BQ-Questionnaire individually.

Conclusion and Next Steps

BQ feedback

• TM diagnosis documentation &coding in Europe: Practitioners inEurope commonly record the TMdiagnoses in accordance with goodpractice guidelines, however, theyrarely code or report thesediagnoses.

• Perceived need for ICD-11 TMChapter: The TM community inEurope on the whole supportsenhanced coding and reporting of TMdiagnosis with the aim of facilitatingbetter patient access to TMtreatment.

Participants welcomed the ICTMdevelopment, stressing in particularthe benefit of having TM conditionsclassified in a Chapter of ICD-11.

• ICD-11 TM Chapter use cases:Having a WHO approved commonlanguage to classify TM diagnosiswas regarded as very important forimproving clinical communication,reimbursement, comparability of TMrelated clinical research data, forprofessional recognition and TMintegration in health systems.

• Field Trial participation: TheEuropean Traditional ChineseMedicine Association (ETCMA) andvarious national TM practitionerorganizations indicated their interestand willingness to participate inpreparation and conduct of fieldtrials and peer review process ofICD-11 TM Chapter.

Way forward

• Preparations are under way to pilot the core study protocols in various European countries.

• A 2nd ICTM Forum will be organized during the 2015 TCM Kongress Rothenburg. The forum will focus on • presenting feedback from the

pilot testing;• launch the main phase of field

testing the ICD-11 TM Chapter in Europe.

Title

The telescope

Abstract ICD-11 is designed to be useful in different settings. The level and kind of granularity in the settings differs. Nevertheless, it is possible to build the hierarchies in ICD-11 for a set of linearizations in a way that data can be aggregated to a common denominator from the set of congruent linearizations.


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Authors: Robert Jakob, Bedirhan ÜstünWHO

Title

The foundation of ICD-11 has information that allows the production of multiple linearizations. The WHO set of linearizations for international use and derived specialty adaptations share one hierarchical structure.

ConclusionsThe chart illustrates the “telescope” for “cataract” and the way levels of detail fit together. Please be aware that in some uses of ICD, postcoordination can be used to add information to the shown precoordinated entities (code more detail using multiple codes for one condition) (The level for intermediate resource primary care has been omitted to simplify the view.)

Specialty linearization high detail; in the sample set of cases, each one is coded differently. Here we see no group – all cases are separated by colourand pose.

Joint linearization for mortality and morbidity statistics; intermediate level of detail; in the sample set of cases several get different coding. Here we see 3 groups. They are identified by different colours.

The foundation component of ICD-11 consists of entities with multiple parents and different levels of detail. Some entities are very broad, for example “cataract”, while others are more detailed, for example “capsular and subcapsularage related cataract”.

To categorize cases in a classification, entities needs to form one line and these entities are mutually exclusive and jointly exhaustive. This is called a “linearization”. The hierarchical structure of such a linearization, with a detailed level for coding at the “bottom”, and a hierarchy with groups and chapters is very much what a classification would looked like in the past. In this context, classification and linearization can be used synonymously, though the term linearization is preferred, becauseit indicates that it is derived from a multidimensional foundation.

The level of detail that is included in one category is different in this set of international linearizations. A low resource version does e.g. include Cataract, and age related cataract, a specialty linerarization would allow to address more detail with one code – and more detail could be added using postcoordination(multiple codes).

Such a set of ‘telescopic’ linearizations draws on the same hierarchy, the data collected with any linearization of such a set can be aggregated to the smallest common denominator for tabulation and comparison, as for the Millennium Development Goals (MDG), Global Burden of Diseases (GBD), Hospital data list, or International health regulations.

Low resources version; low level of detail; in the sample set of cases most cases get the same code. Here we show the 2 groups: “age related cataract”, and any other cataract

Cataract

Age)related,cataract

Cor$cal(age+related(cataract

Nuclear(age+related(cataract

Cataracta(brunescens

Nuclear(sclerosis(cataract

Capsular(and(Subcapsular(age+related(cataract

Capsular(age+related(cataract

Anterior(subcapsular(polar(age+related(cataract

Posterior(subcapsular(polar(age+related(cataract

Incipient(age+related(cataract

Coronary,age)related,cataract

Punctate,age)related,cataract

Water(cle: s

Advanced(or(mature(age+related(cataract

Mature,age)related,cataract

((((Subtotal(advanced(or(mature(age+related(cataract

Advanced(or(mature(age+related(cataract,(total(cataract

Morgagnian(age+related(cataract

Calcified(age+related(cataract

Combined(forms(of(age+related(cataract

Cataract


Coronary,age)related,cataract

Punctate,age)related,cataract

Mature,age)related,cataract

Cataract


SNOMED CT is a standardized terminology forhealth records, based on principles of formalontology using description logics.Here, a subset is extracted, the CommonOntology, mostly consisting of concepts andaxioms from the highly polyhierarchical“Finding / Disorder” branch. They denote“situations”, i.e. life periods of a patient havinga given clinical condition. This commonontology will provide most of the entities ofmeaning thatare necessary to represent the content of ICD-11.

INTRODUCTION Title

Conclusions

Architecture for ICD 11 and SNOMED CT Harmonization

Based on agreed principles for a Common Ontology for ICD 11 and SNOMED CT, an architecture has beenelaborated. It is being used to help characterize what is ICD-11 and owned by WHO, what is SNOMED CT andowned by IHTSDO, and what are the Collaborative Work Products, which are jointly owned. The architecturedistinguishes the components available for the end user (linearizations) from their background repository(foundation). It furthermore distinguishes the representational status of different artefacts: from context-free, pure ontological content of a SNOMED CT subset to purpose-specific monohierarchical arrangements ofcodes. It is finally supplemented by medical knowledge provided by the content model and by a rich collectionof multilingual names, definitions and interface terms.

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Title

Title

Results

METHODS


The ICD Foundation Ontologycontains the ontological content,mostly SNOMED CT, apart from theexternal sources. It is a multi-hierarchical taxonomy and takesadditional description logics axiomsfrom SNOMED CT. Its entities ofmeaning describe what isuniversally true for the conceptscovered.

The ICD Content model providesmultilingual names, sets ofinterface terms (value sets) anddefinitions, together withsupportive knowledge about theICD classes to be represented inthe linearizations, e.g. diagnosticcriteria, body sites, causalmechanisms, all of them linked tothe common ontology. Furthermore

the contentmodel providesrules that guidethe building oflinearizationclasses, suchas exclusions,which ensurethe disjointnessof linerarizationclasses.

Externalsources covercontent that isoutside thescope ofSNOMED CTbut considerednecessary forthe commonontology, e.g.gene names ornew contentneeded forICD-11 but stillin thesubmissionprocess forSNOMED CT.

A collection ofNon-Descrip-tion LogicsEntities con-stitutes therepository forall lineariza-tions. They arelinked viaqueries to the

concepts in the commonontology. These queriesrepresent the numerousexclusion rules in linearizationsand define non-ontologicalgroupers (headings).

Linearizations are those releases of ICD-11 which address specific use cases like mortality, morbidity, primary care,reimbursement or classifications for medical specialties. They are familiar to the user, as they incorporate the classicalclassification principles (single hierarchy, non-overlapping classes, exhaustive partitions). They are expressed as queries onthe common ontology, and incorporate additional knowledge from the ICD-11 content model. Residuals (NEC – notelsewhere classified, NOS – not otherwise specified) are automatically generated at all hierarchical levels. Thatlinearizations are expressed by queries highlights their status as a special kind of terminological artefacts, which are notontologies but whose content can be traced back to a principled ontology, viz. the Foundation Ontology. The hierarchicalmakeup may differ between linearizations, as they reflect pragmatic preferences in the arrangement of classification codes.Linearizations can also be nested.

Kristina Brand-Persson, James R Campbell, Christopher G Chute, Monica Harry, Sukil Kim, Vincenzo Della Mea, Alan Rector, Molly Meri Robinson Nicol, Jean Marie Rodrigues,

Stefan Schulz, Harold Solbrig, Kent Spackman, Jane Millar, Bedirhan Üstün

Common Ontology Working Group of the IHTSDO – WHO Joint Advisory Group (JAG)

Introduction

Title

In the Background of escalation of huge amount of Omics information, utilizing Omics information has got to be esential. installing omics sub information model in ICD 11 is essential task for next decades medicine. We developed ICD11 OmicsSub information model (iCOs) based on GSVML(Genomic Sequence Variation Markup Language) which is a recognized standard as IS25720 at ISO (International Organization for Standardization), then we validated it through using on real data.

TITLE : Clinical Omics sub information model for ICD11 (iCOs)

Abstract This study aims at developing clinical omics information sub model which can build in to the content model of ICD11 as a part of clinical information model. Installing omics information into clinical information is essential issue to establish future medicine and medical researches. In this study, we developed omics information sub model corresponding to current ICD11 contents model mainly based on ISO 25720 GSVML (Genomic Sequence Variation Markup Language) which is formal international standard (IS) in ISO (International Organization for Standardization). Additionally, we reffered the previous work such as GO (Gene Ontology)[3], NCK (Normalized Clinical Knowledge) [4], SNOMED-CT [5] through matching analysis. Our sub model can be called as reverse transcription information model which can connect parameters of ICD11 contents model with parameters of omicsmolecular information model through transcription module of sub information model. This reflects a kind of causal association among parameters. We also verified interoperabilities with other standardized structure such as SS-MIX2 which is a kind of Japanese MHLW standard based on HL7 CDA R2.


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Jun Nakaya¹, Takeshi Imai², Michiyo Kamata¹, Kaei Hiroi¹, Hiroshi Tanaka 3１Department of Medical Informatics, Tohoku University Graduate Graduate School of Medicine, Sendai, Miyagi, Japan, 2 Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan3 Department of BioMedical Informatics, Tokyo Medical and Dental University, Tokyo, Japan

Title

Methods & Materials


Results

We validated whether iCOS is on the right track or whether iCOS has enough ability to be built in the content model of ICD11 with using real clinical omics data stored in Tokyo Medical and Dental University.

Conclusions

Chart 2: Model Validation on Real Data

Abstract

Chart 8: Refined methodology for iCOS

Chart 1: ICD 11 Omics Sub Information Model (iCOS α and iCOSβ)

Results are as follows:

Chart 3: Finalized iCOS

Chart 4: Transcription Module

Chart 5: XML Schema of iCOS

Chart 6: Mapping Target of iCOS

Chart 7: Mapping Results

This research is funded by MHLW and MECSST of Japanese government.

iCOS has ability to represent whole Omics information with combining clinical information for both research purpose and clinical purpose. It has easy interoperability with ICD11.

Introduction

Title

• The primary goal of this survey was to solicit stakeholder perspectives on enhancements that could make ICD-11 more useful for quality and safety applications worldwide.

• The results are a necessary and valuable complement to the Q&S TAG’s a priori work plan, guiding strategic directions for an enhanced ICD-11.

Abstract


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Authors: Danielle Southern, William Ghali, Marc Hall, Deborah White

University of Calgary, Calgary, Alberta

Title

Methods & Materials

• 258 unique individuals accessed the online survey, among which 246 provided complete responses.

• 161 (67%) were from stakeholders located in North America, 61 (25%) in Europe, 18 (7%) in Australia and 3 (1%) from Singapore.

Figure 1Panel A. Type of organization

Panel B. Role in organization

Figure 2. Respondents’ use of information on health system quality/safety derived from ICD-coded data, by purpose

Figure 3. Familiarity with ICD coding and usefulness of the ICD-9 and/or ICD-10 classification systems as tools for quality and safety measurement

Discussion

Results

• Health stakeholders defined as: coders, ontologists/classification experts, researchers utilizing secondary data sets for quality and safety-related research, clinicians with responsibility for administering quality measurement &improvement programs, etc.

• Survey conducted using snowball sampling method & invitation emails from Q&S TAG members asked stakeholders to send it along to 5 additional people.

• An 8-item survey was created and posted online (stored and managed with Fluid Surveys).

• Demographic questions as well as a question regarding the respondents’ self-rated familiarity with ICD coding.

• Respondents asked how often they “currently use information on health system quality or safety derived from ICD-coded data” for a variety of purposes, and how useful the current ICD classification systems have “been as tools for quality and safety measurement in your experience or the experience of your organization.”

• Open-ended questions included to identify 1) specific “key limitations/ challenges associated with the use of ICD-9 and/or ICD-10 in the measurement of quality and safety”; and 2) “key elements and/or functionality that you would like to see in an enhanced ICD-11 system that would permit better coding of quality and safety concepts.”

Conclusions

• Big issues identified: financial drivers, clustering, technical, updates consistent with current medical knowledge, missing codes/information/concepts and standardization and rules.

• Our open ended survey validates Q&S TAG work.

Table 1. Common themes identified and selected quotes in the qualitative analysis of the open-ended responses.

How can ICD-11 be more useful for quality and safety applications? An international survey

0.0%

10.0

%

20.0

%

30.0

%

40.0

%

Government

Regional health authority/local health integration network

Health quality council/patient safety institute

Health care delivery organization

Professional association

Accrediting or Certifying organization

University, academic health science centre or research institute

Insurance company, program or fund

health information technology organization or vendor

self-employed

Other

Percent

0.0%

10.0

%

20.0

%

30.0

%

40.0

%

Senior Management (e.g. CEO, VP, Director)

Program Lead (e.g. Manager)

Analyst/Statistician

Project Coordinator/Manager

Health Care Provider/Clinician

Health Records Coder

Researcher

Student

Other

Percent

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Cli

nic

al d

ecis

ion

-mak

ing

Qu

alit

y im

prov

emen

t

Pol

icy-

rela

ted

dec

isio

n m

akin

g

Res

earc

h

Qu

alit

y re

por

tin

g (c

onfi

den

tial

or

pu

blic

)

Oth

er

Never

Rarely

Occasionally

Often

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1 2 3 4 5 6 7 8 9 10

Per

cent

10=extremely familiar1=not at all familiar

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

1 2 3 4 5 6 7 8 9 10

Per

cent

1=not at all useful 10=extremely useful

Themes/Sub-Themes Definition Limitations/Challenges (Question 7) Recommendations (Question 8)

Technical Issues

Clustering The inability to link

concepts/codes.

“Problem with lack of ability to cluster.”

“Not being able to link/cluster codes.”

“In Canada, we were previously allowed to use

clustering for any type of codes and we used them

to link trauma codes with their respective external

cause code. This was very helpful, but clustering

is now restricted to use with Y40 to Y84 and U82

and U83.”

“Clustering of concepts would be very helpful to

perform thorough search. The way it is scattered

now makes it harder to be exhaustive, and to be

sure to be using the most specific code.”

“Use clustering to enable the capture of the

complete 'clinical picture", i.e. link all diagnosis

associated with the medical/procedural

complication.”

“Particular attention should be paid to

“Combination codes” that can span more than one

chronic disease category.”

Different Versions of ICD Changes in the ICD make it

difficult to have standard

rules.

“Coding rules that keep changing, new

procedures, approaches, etc. that are not included

in the look ups.”

“How to ensure when changes to coding and the

standards were implemented to ensure trending.”

“Crosswalk between ICD-9, ICD-10 and ICD-11.”

“It should be possible how ICD-10 and ICD-11 are

linked. This is crucial when we want to understand

how prevalence of a determinate disease has

changed in time.”

Linkages with SNOMED The need to link ICD to the

global reporting system of

SNOMED.

“Terminology not consistent with SNOMED CT

terminology.”

“Inconsistency in terminology with terminology

SNOMED CT; lack of sufficient mapping from

SNOMED CT to ICD-10.”

“Should be based entirely on SNOMED CT.”

“Consistency in terminology with terminology

SNOMED CT; sufficient mapping from SNOMED

CT to ICD-10-CM.”

Specific Technical Technical details about ICD

coding that create challenges

(i.e., character position, etc.)

“Sometimes having the decimal point makes it

challenging to have clean data entry…It becomes

a nightmare trying to fix all of the data errors

where people put in the decimal, or do not put it

in or use other characters.”

“Each code should have the character initial or

secondary to better explain the taking charges.”

“Keep the 7th character info for Injury codes (ex A,

D and S).”

“Do not assign the same U code for so many

different locations.”

“It would be necessary to have a letter (for example

"S") added to the code to allow coders to input that

diagnoses as a safety problem.”

“All procedure codes should have status attribute

A-Abandoned. This would result in more precise

reporting of started then abandoned procedures and

fewer errors in applying the cancelled/change of

plan/failed intervention coding standards.”

“Some code groups, such as N00-N08 (glomerular

disease) are particularly challenging for coders.

The terminology and Alpha Index lookups do not

lead to matching terms in the Tabular Index (e.g.

IgA nephropathy).”

Content Problems

Missing Codes, Info, or

Concepts

The ICD is missing codes,

information, and/or concepts

to identify certain clinical

situations, diagnoses, etc.

“Missing codes and/or inclusion in a code.”

“Missing codes, especially for new

technologies/procedures.”

“Missing concepts.”

“Identifying missing codes.”

“Updated and better drug table listing many more

drugs.”

“More postoperative codes.”

Clarification of

Terms and/or

More Details Needed

Codes and descriptions are

not clear enough to properly

and accurately code.

“Vagueness of descriptions leaves classifications

open to interpretation. This results in inconsistent

coding of same condition.”

“Would be helpful if there were coding

examples.”

“Clarification of terms and examples would be

beneficial.”

“More detail in the diagnosis codes (especially the

mental health codes).”

“Better clarification of terms, they aren't intuitive at

all.”

“More precise description of diabetes.”

“Definition of the main manifestations included in

diseases for non-medical coders.”

Specificity Overall, codes are very broad. “Overall lack of detailed codes that uniquely

identify patient safety and quality issues. A lot of

the patient quality and safety issues get lost in

generic codes.”

“Key limitation of ICD-9 has been the lack of

nuance of the codes; codes are too broad.”

“Granularity of information - Too general for

clinical use in most contexts.”

“More specificity in codes - especially those that

relate to quality indicators.”

“Lack of specificity of body parts (e.g. for wounds

and ulcers).”

“Less redundancy so that providers would be

"forced" to choose from a limited number of codes

for the same diagnosis. Even something as simple

as cataracts grows into senile cataract, cataract

bilateral, cataract, etc.”

“Improve indicating the includes/excludes/ code

also/code separately for diabetic coding.”

Complications/ Adverse

Events

Lack of coding to identify

complications/adverse events.

“Consistent and promoted codes for

complications, errors, iatrogenic harm etc.”

“Specific codes for patient safety and quality items

- not to be thrown together with a bunch of other

conditions.”

“Codes that reflect medical errors and/or system

related errors (e.g, EHR caused errors).”

“Better guidance to distinguish between pre-

existing medical conditions and new complications

or acute acerbations of prior conditions.”

Severity No codes that identify the

severity of illnesses.

“Missing information on severity of condition.”

“Inability to identify the level of severity of the

disease like hypertension, heart failure, etc...”

“Challenging to code COPD severity and

difficulty with coding type of COPD.”

“Lack of consistent approaches to describing

acuity.”

“For specific assessment of severity of cases and

complications.”

“Mild, moderate or severe, a graded code of the

level of comorbidities.”

“More flexibility in the codes to capture severity of

quality/safety.”

“Able to express concepts as chronic/acute,

complications.”

Training Needs

Standardization Rules and

Documentation

Standardization rules and

appropriate documentation

and reporting to support

consistent coding.

“More visible rules to limit their interpretations.”

“Need for more precise coding rules.”

“Vagueness of descriptions leaves classifications

open to interpretation. This results in inconsistent

coding of same condition.”

“Inadequate documentation to support

appropriate/specific code selection.”

“Conflict in documentation on causal relationship

of care to complication. E.g. Hypotension

occurring after surgery. Documentation is often

vague regarding causal link.”

“Coding standards are not always clear: need for

clarification of terms.”

“Conditions arising as a result of healthcare,

complications of medical and surgical care need

additional coding rules to guide coders.”

“Stakeholders often do not understand the coding

rules and concept.”

“Physicians and coders do not agree on how to

use the codes, the more codes we have the less

they agree, but with fewer codes there is less

precision.”

“Providers (physicians) not choosing the correct

codes.”

“Coding rules that would create better

standardization.”

“Need for [clearer and specific] coding rules that

constrain performance.”

“Rules that are clearer, more standardized.”

“Documentation may not be clear to allow accurate

coding and/or codes may be limited in being able to

capture the specifics of the case.”

“Rules to assure standardization across all health

care entity reporting.”

“Standardization of terminology and rules, so that

clinicians/coders and ICD-11 all speak the same

language.”

“Would like to see increased standardization and a

better link with providers. I believe there is often a

disconnect between what is documented and

coding.”

To better understand the strengths and limitations of currently used ICD versions (e.g., ICD-9-CM in the United States, Spain, Italy, and Israel; ICD-10 or its various Clinical Modifications in most other countries) for the quality and safety use case, and to inform the ICD revision process, we undertook an international stakeholder survey.


C400-439 ICD-10

C401 Impact of change from ICD-9-CM into ICD-10-CM/PCS in Catalonia

Hernandez-Cortes; Gelabert; Montoliu; Raurich; et al.

C402 The shift from ICD-9CM to ICD-10 in coding health conditions in Italy: preliminary data on morbidity statistics effects

Frattura; Della Mea; Vuattolo; Munari; et al.

C403 A summary of ICD-10 implementation on mortality statistics in Spain

Cirera; Salmeron; Navarro; Compara Group

C404 Improving casemix systems by integrating functioning information: A systematic literature review and call for expert input

Hopfe; Stucki; Brach; Prodinger

C405 Principles for an international casemix classification system


C406 The implementation of Electronic Death Certificate in China

Puwa; Zhou; Li; Zhou; Liu

C407 AUTOMATION OF VITAL STATISTICS IN COLOMBIA 2008-2014

Alvarez Castaño

C408 Biases in Measurement of Healthcare Outcomes Attributable to Changes in the ICD-10 Version that is used for Coding Diagnoses

Januel; Burnand

C409 Improving the analysis of health problems in primary care: from ICD-10 to ICPC-2

Ramos; Medina; de la Torre; Camús; Coma; Caro

C410 Is ICPC-2 an appropriate tool to code ideas, concerns and expectations (ICE) to better describe the reason for encounter in general practice?

Schrans; Avonts; Boeckxstaens; et al.

C411 Recommendations for the use of the International Classification of Primary Care (ICPC-2) in the problem-list and the episode of care

Kuehlein; Mennerat; Kamenski; Pinto; et al.

C412 Improving IDC-10 codification in primary care: the QDS feedback

Medina; Coma; Fina; Méndez; Caro

C413 A DESCRIPTIVE CLASSIFICATION OF DIVING DISORDERS AND INJURIES

Desola; Canela-Soler

C414 Verbal Autopsy - Next Generation Leitao; Jakob

C415 Assessment of the quality of Indigenous identification in mortality and morbidity data sets using data linkage and audits

Dugbaza; Pham; Zhang; Al-Yaman


C416 Development and use of French hospital-level mortality indicators based on coded administrative data: lessons from the literature

Le Pogam; Grenier; Calmus; Devaud

C417 Innovative approaches to strengthening mortality statistics from routine CRVS systems in the South East Asia Region

Chikersal; Paliwal

C418 National cause-of-death data in the English- and Dutch-speaking Caribbean, 2000-2010: A quality assessment

Crooks; Hinds; Bissessarsingh; Elias

C419 The experience of Catalonia in coding mortality data with Iris

Puigdefàbregas; Freitas; Gispert; Molina; et al.

C420 Vital statistics - capacity building in Pacific Island Countries and Territories

Walker; Lanyon; Eynstone-Hinkins; Hodge

C421 Beneficial Effects of Intentional Search and Reclassification of Maternal Deaths

Torres; Jimenez; Rhenals; Piña; Uriostegui; Yañez

C422 Quality of discharge summaries of Japanese hospitals

Takahashi; Kawai; Otsuka; Miyauchi; Matsumoto; et al.

C423 EQA: A CLINICAL DECISION SUPPORT SYSTEM DERIVED FROM THE ELECTRONIC MEDICAL RECORDS

Medina; Coma; Fina

C424 Importance of the training corpus in an automatic diagnoses coding system

Conesa; Lozano Rubí; Farreres; Castellon; Pastor Duran

C425 Medical self-training in Death Certification – The Certifica website

Cirera; Aguinaga; Navarro; Certifica group

C426 Mortality Medical Data System (MMDS) implementation process in Chile

Carrasco; Piedra; Guerra; Velozo

C427 Virtual Course on Medical Coding Information based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

Orellano; Navarro Robles

C428 The collaborative effort to implement updated classifications: the lesson learned in developing and using web tools and services to translate, update, browse, and publish ICD-10.

Frattura; Grippo; Frova; Alicandro; Tonel; et al.

C429 A review of CARPHA initiatives to support FIC Implementation in the English- and Dutch- speaking Caribbean over the ten year period 2004-2013

Crooks; Ivey; Hinds


C430 Consideration of Small Area Health Disparities Using ICD-10 Coded Data: Association of Avoidable Hospital Admission Rates and Prevalence Estimations

Drösler; Knorr; Czihal; von Stillfried; Weyermann

C431 DBS: Basic health dataset available for every primary care professional

Fàbregas; Ramos; Medina; Camús; Mercadé

C432 Opinions and attitudes among health professionals towards the coding of clinical information: lessons learnt from the epSOS project.

Moharra; De Cool; Vallvé; Almazán

C433 A tool to predict post-operative mortality in the first year following total hip replacement surgery: results from the PRESS-UP cohort study.

Roso; Tebé; Espallargues; Pons; Prieto-Alhambra

C434 An International comparison of venous thromboembolism events occurring in hospitalized patients undergoing hip arthroplasty: Potential confounders may impact results

Januel; Burnand; Ghali

C435 Diabetes as an underlying disease: what we can learn from diabetes hidden in the death certificate

Nakayama; Oikawa; Yatagai; et al.

C436 Recognising undiagnosed diabetes in the US using primary care data

Holt; Gunnarsson; Cload; Ross

C437 The Catalan arthroplasty register (RACat): summary results for the period 2005-2013.

Marinelli; Tebé; Martinez; Nardi; Giros; Espallargues

C438 What influences our decisions in family practice? - A qualitative study in search for person related information (PERI)

Schrans; Avonts; Christiaens; et al.

Introduction

Title

Currently, we have over 20 yearsexperience in the use and analysis of the information coded with ICD-9-CM. Gradually, these data have improvedto reach a quality that allows to get a valid and reliable information to carryout morbidity statistics, useful for theevaluation of the healthcare quality, research, management, planning, andeven for billing aims. Theclassification change will impact on all issues connected to these encodeddata, directly or indirectly, andthrough information products basedon those (indicators, reports, epidemiological alerts).

Impact of change from ICD-9-CM into ICD-10-CM/PCS in Catalonia

Abstract


C401


Authors: A. Hernàndez-Cortès; G. Gelabert; R. M. Montoliu; M. Raurich; T. Ros; S. Gelabert; A. Conesa; E. Sarsanedas; S. Marín; M.del M. Salazar; T. Soler; M.C. Díaz; M. A. VárezGroup of Experts in Medical Coding, Catalan Health Information Association, Barcelona

Title

Methods & Materials

It will require greater time investmentto work with ICD-10-MC/PCS, whichmeans more human resources to keepthe current terms delivery, and thesame quality and reliability of MinimumData Set (MDS) • Provide ongoing training for professionals in medical coding beforeand after implantation.•Guidelines should be established to ensure a homogeneous coding, especially in procedures.• Additional funds will be needed in thecenters and Public Administration to adapt information systems.• Center leaders will have to be involved so that they can lead thetransition.

Results

1- Analyze the impact of the change of the classification in the coding servicesand all information products based or linked to these codes.2- Identify the key issues that weshould know to minimize this impact.

Conclusions

It will be needed to increase theprofessionals training before and afterimplantation.• Trainers and professionals will haveto get time to make complete codingguidelines and final translations.• Tools to assist the coding should be developed to shorten the coding timeof professionals.• A pilot process, prior to implementation, must be conducted. To analyze the results and compare them with those obtained using ICD-9-CM should be possible to determineadjustments in the implementationcalendar.

Impact of the change

Source: AAPC (American Academy of Professional Coders)

Source: PASBA (Patient AdministrationSystems and Biostatisctics Activity)

Before the implementation of the new classification ICD-10-CM/PCS as a new coding system, scheduled for January 2016 in Spain, many questions are raised about the real impact of this change in healthcare framework. This paper wants to contribute to identify these effects, from the technical point of view.

Introduction

Title

In Italy, ICD9-CM is currently used for coding health conditions at hospital discharge. In order to introduce ICD-10 in morbidity coding and revise the overall case mix classification system, since 2010 a national project has been founded led by the Italian Ministry of Health and Emilia Romagna Region (“IT-DRG Project”). It involves the Friuli Venezia Giulia Region (as Italian WHO-FIC CC) to update ICD-10 and the Lombardia Region to update the interventions and procedures classification. In order to evaluate the impact of ICD-10 introduction in Italy, the Italian WHO-FIC CC has been active on the translation of ICD updates, the update of ClaML files [1] and development of web tools and services. The ICD-10 2013 Italian version was used as the reference version to transcode administrative hospital discharge data by a specifically developed web tool named TransIT. This was developed to make the transition easier for coders that already know ICD9-CM.

The shift from ICD9-CM to ICD-10 in coding health conditions in Italy: preliminary data on morbidity

statistics effects


C402


Frattura L.1, Della Mea V.2, Vuattolo O.2, Munari F.1, Verdini E.3 , Zanier L.4, Arcangeli L.5, Carle F.51Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC; 2University of Udine; 3Health Information System Service, Emilia Romagna Region; 4Central Health Directorate, Health Information System Service, Friuli Venezia Giulia Region; 5Ministry of Health, VI Office, Rome

Methods & Materials

Acknowledgements

A subset of the Hospital Discharge Form (SDO) database was provided by the Italian Ministry of Health, including data from 3 Regions (Emilia Romagna, Veneto, Friuli Venezia Giulia) for 2011 and 2012. TransIT was used to transcode SDO ICD9-CM codes from the available database.TransIT transcoding rules were obtained initially by processing the original American ICD9-CM to ICD10-CM transcoding rules (http://www.cdc.gov/nchs/data/icd/DiagnosisGEMs_2007.zip), complemented by rules identified by classification experts to take into account the differences between ICD9-CM and ICD-10 (in particular, the dagger/asterisk convention). The outputs of TransIT can be a single exact ICD-10 code, a single approximate code, a set of codes

Conclusions

The transition from ICD9-CM to ICD-10, based on these preliminary data analysis, could be less difficult than supposed, because a large number of ICD9-CM codes can be easily transcoded to one single ICD-10 code, leaving a manageable 10% of codes to be chosen by coders among a small set of options. However, training is needed for coders to understand the differences between the two ICD versions, in particular when involving the dagger/asterisk mechanism, which is not present in ICD9-CM. The lack of the E codes in current SDO coding rules is another issue to address in ICD-10 V-W-X-Y codes implementation in Italy.



Region Year

Totalrecords

(N)

Mainconditions

(N)

Otherconditions

(N)

Friuli Venezia Giulia

2011 197,664 197,663 235,566

2012 198,225 198,224 240,074

Veneto2011 729,748 728,210 596,233

2012 697,020 696,991 587,969

Emilia-Romagna

2011 787,152 787,142 1,023,630

2012 764,514 764,511 1,006,775

Total 3,374,323 3,372,741 3,690,247

ICD9-CM

Mappingtype ICD-10 Count

(N)Frequency

(%)Cumulative

(%)

427.31 exact I48.0 160,051 2 2

401.1 approximate I10 154,454 2 4

V30.00 approximate Z38.0 119,093 2 6

250.00 approximate E11 99,086 1 8

401.9 exact I10 72,246 1 9

V58.11 approximate Z51.1 67,694 1 10

1. Dept of Mathematics, University of Udine was founded by theRegion Friuli Venezia Giulia, to support the research activities onWHO classifications use, 2014-2016

2. Agreement between Italian Ministry of Health and Friuli Venezia Giulia Region, 2010-2012; 2013-2015 to support National HealthService in implementing WHO classifications

3. "Progetto It.DRG", founded by National Health Service 2004 to realize strategical objectives under the National Health Plan, according to art. 1, comma 34, Law n. 662/1996 (CIPE Decision 23 March 2012 for assigning to the Emilia Romagna region the amount allocated for the realization of the "It.Drg Project")

Region Year

Single exactICD-10 code

(N)

Single ApproximateICD-10 code

(N)

Composite ICD-10 codes

(N)

Multiple ICD-10 codes

choice(N)

Not trans-coded

(N)

Friuli Venezia Giulia

2011 161,524 212,018 1,951 54,308 0

2012 163,131 215,795 1,971 53,911 0

Veneto2011 473,204 659,351 4,613 177,388 199

2012 457,646 642,714 4,977 170,545 201

Emilia-Romagna

2011 644,378 919,009 4,468 228,357 1

2012 632,884 895,487 4,812 223,810 0Total (N) 2,532,767 3,544,374 22,792 908,319 401

% 35,86% 50,18% 0,32% 12,86% 0,006%Table 1 – Sample of the Italian Hospital Disharge Forms considered for transcoding

Table 2 – Transcoding ICD9-CM to ICD-10 by TransIT in a sample of the Italian Hospital Disharge Forms by Region and Year

Table 3 – The most used ICD9-CM/ICD-10 categories in the SDO sample

("composite"), or even a number of codes or composites among which to choose. The developed software can be used either online, through a web browser, or embedded in SDO compilation software as a transcoding table or as a web service.

Database source: Ministry of Health 2014

Database source: Ministry of Health 2014

I48.0 Paroxysmal atrial fibrillationI10 Essential (primary) hypertensionZ38.0 Singleton, born in hospitalE11 Non-insulin-dependent diabetes mellitusZ51.1 Chemotherapy session for neoplasm

A total of 3,374,323 SDOs were analysed, of which 3,372,741 contained a main condition, with a total of 3,690,247 secondary conditions. The number of different ICD9-CM codes used was 10987 (88.4% on a total of 12,435). Looking at both main and secondary conditions, a large number of SDOs ICD9-CM codes (86.36%) was transcoded automatically, that is, transcoding provided just one option, either exact (35.86%), approximate (50.18%) or composite (0.32%).

Results

The remaining 12.86% of SDO ICD9-CM codes needed manual intervention, since transcoding provided more than one option. 401 codes could not be transcoded (0.006%). When examining the 100 most used ICD9-CM codes, which covered 42% of SDOs, 44 were coded exactly, 46 approximately, and 10 with multiple choices. When analyzing details of codes that could not be transcoded, a number of coding mistakes were found (mostly: intermediate level categories and groups that cannot be used for SDOs coding conditions according to coding rules).

Abstract Data are presented in order to evaluate the impact of the introduction in Italy of ICD-10 on morbidity statistics, by transcoding ICD9-CM codes in administrative Hospital Discharged Form database to ICD-10 2013 Italian version codes, by a specifically developed web tool named TransIT, under the “IT-DRG Project”.

References 1. Frattura L., Grippo F., Frova L. The collaborative effort to implement

updated classifications: the lesson learned in developing and using web tools and services to translate, update, browse, and publish ICD-10. WHO-FIC Network Annual Meeting, Barcelona 2014, submitted

Figure 2 –TransIT userinterface

A summary of ICD-10 implementationon mortality statistics in Spain

Abstract. In Spain, ICD-10 was implemented in mortality statistics in 1999. Coding of underlying cause (UC) of death is decentralized in the Autonomous Communities (AC) and led by the National Institute of Statistics. All the coding staff was trained at the same course in 1998. A sample of 88,048 UCs from different regions, was manually coded in ICD-9/10 to obtain kappa index and comparability ratios (CR). In one region, inflections in trends were calculated along ICD-9/10 periods. Kappa index was 95.4% and CR showed no-major differences. In the one-region study, the main causes tendency was largely unaffected by ICD revisions, except in infrequent or less specific death causes.


C403


Authors: Cirera L, Salmerón D, Navarro C, and Compara Group*.Regional Health Council of Murcia, Spain

Specific causes list reached Kappa indexes of 96%. A decrease in infectious diseases (-2%) and viral hepatitis (-12%) was described, while AIDS increased (6%). Neoplasms increased 0.3% due to the incorporation of myelodysplastic syndrome (55%). Diabetes increased (2%). Mental disorders declined, as dementias were coded as Alzheimer's disease (29%). Cardiovascular diseases declined (-1%) with no impact on Stroke, although acute Myocardial Infarction decreased (-1%). Pneumonia declined (-13%) and Liver Cirrhosis increased (4%). Ill-defined conditions broadened by the assignment of cardio-respiratory insufficiencies. External causes did not change, without registering ICD-9 accuracy (Table 1). Comparability ratios by gender were not significantly different of total, except for breast cancer in man and very few causes of scarce numbers.

Acknowledgements

An ecological bridge-coding study (alias COMPARA) was designed with 88,048 underlying causes of death from several ACs and a big city (Andalucia, Barcelona, Basque Country, Cantabria, Murcia, and Navarra), and coded in ICD-9 and ICD-10 during 1999. Lists of correspondences were drawn up by grouping major causes of death. The Kappa index and its comparability ratios (CR) were calculated.

The existence of inflection periods in selected causes of death with significant CRs and relevant absolute differences were assessed by Joinpoint regression in a AC (Murcia region). Corrected and uncorrected yearly rates to the ICD-9 were compared in Murcia for the 1980-2004 period.

(*) M Méndez, C Murillo, I Rojas, M Ruiz-Ramos (Consejería de Salud, Andalucía); C Borrell, D Martos, G Pérez (Agència de Salut Pública, Barcelona); L Gómez, I Torcida, LJ Viloria (Consejería de Sanidad de Cantabria); C Martínez (Consejería de Sanidad, Murcia); C Moreno-Iribas, Y Floristán (Instituto de Salud Pública, Navarra); and C Audicana, T Lizárraga, J Rodríguez (Dpto. de Sanidad, País Vasco).

Trends of annual rates, corrected and uncorrected to ICD-10, illustrated only inflection figures in blood and hypertensive diseases, cancer of ill-defined sites, respiratory insufficiency, and myelodysplastic syndrome (Figure 1).

Table 1. ICD-10 and 9th correspondences of Major Groups of Death Causes. TheCOMPARA project - Spain 1999

Introduction

ICD-10 was introduced in Spain in 1996 by Pan American Health Organization / WHO.

In Spain, coding of causes of death was transferred to the regional statistical/health (administrations Autonomous Communities [AC]). All the mortality coding staff was trained at the same face-to-face course in 1998.

The National Institute of Statistics implemented ICD-10 in mortality statistics in 1999.

Objectives. 1) To establish and quantify ICD-10/9 changes in tabular list of death causes in Spain; 2) To evaluate tendencies of annual mortality rates, corrected and uncorrected to the ICD-9 in a Spanish regional area.

Materials & Methods

Results

Conclusions

Grouping of major death-causes up to 4 characters coding, changed 3.6% between ICDs with a Kappa index of 97%, and of 96% for a list of 102-items.

• ICD-10 introduction effect was minor in major and specific tabular lists of death causes.

• Mortality trends of main causes remained unaffected by ICD-10 implementation (in a region of Spain).

I II III IV V VI-VIII IX X XI XII XIII XIV XV XVI XVII XVIII XX

I Certain infectious and parasitic 1,601 2 2 1 2 2 6 13 12 1 1 5 1,648II Neoplasms 19 21,956 75 2 5 1 19 7 5 3 1 3 2 22,098III Blood and blood-forming organs and

certain disorders involving the immune mechanism 6 6 275 1 2 1 291

IV Endocrine, nutritional and metabolic 1 2,721 3 3 12 49 2 6 2 1 2,800V Mental and behavioural disorders 1 2 2,403 74 48 1 2 2,531

VI-VIII Nervous / eye / ear systems 1 1 1 278 2,109 14 24 1 2 1 2 4 6 2,444IX Circulatory system 1 29 2 2 28 6 31,473 136 17 2 12 3 96 3 31,810X Respiratory system 11 3 2 17 14 14 206 10,543 7 1 4 20 28 4 10,874XI Digestive system 20 3 1 1 1 10 20 4,684 1 5 4 4,750XII Skin and subcutaneous tissue 5 4 1 1 180 1 8 1 201XIII Musculoskeletal syst. & connective tissue 1 2 1 1 6 8 1 653 1 6 2 682XIV Genitourinary system 1 1 1 1 25 19 1,668 2 3 1,721XV Pregnancy, childbirth and the puerperium 8 8XVI Certain conditions originating in the

perinatal period 3 1 1 169 5 3 182XVII Congenital malformations, deformations

and chromosomal abnormalities 4 1 4 1 1 1 1 319 1 333XVIII Ill-defined 1 2 390 5 2 1 1,572 6 1,979

XX External causes 6 1 1 11 1 1 3,675 3,696

Total 1,677 22,010 358 2,749 2,733 2,141 32,255 10,877 4,734 185 665 1,715 8 171 334 1,734 3,702 88,048

(*) in 4 characters coding

Total

ICD

-10

co

rres

po

nd

ence

s* o

f M

ajo

r G

rou

ps

of

C

ICD-9 Major Groups of Causes

Objective

This systematic literature review provides evidence on the integration of functioning information into casemixsystems throughout various settings. The preliminary findings reveal great heterogeneity with regard to theassessment of functioning, which in turn challenges the synthesis of the existing evidence, and points to the need forstandards in collecting and reporting functioning information. As casemix grouping is a major use case forinternational classifications, this review will provide a relevant and valuable foundation to foster the discussion aboutadapting current reimbursement systems.

In total 86 studies from various countrieswere found to be eligible for full-textscreening (Figure 2). Empirical studies toexamine the added value of integratingfunctioning into casemix were conducted incountries from 4 WHO Regions (Table 1 &Figure 3) based on the studies included inthis review.

Functioning OR “Functional status” OR Function* OR ICF

OR “International Classification of Functioning,

Disability and Health” OR “Activities of Daily Living”

OR ADL

Casemix OR “case mix” OR “Diagnosis Related Groups”

OR “Function Related Groups” OR “Resource Utilization Groups” OR

“AN-SNAP”

Maren Hopfe1,2, Gerold Stucki1,2,3, Mirjam Brach1,2, Birgit Prodinger1,2

1Swiss Paraplegic Research, Nottwil, Switzerland2Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland

3ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI), Nottwil, Switzerland

Though disease-specific and functioning information are conce-ptually complimentary, on an operational level current reimburse-ment systems, especially casemix systems, still rely predominantlyon disease-specific information. A first screening of the literature hasindicated some evidence that functioning information can add value toexisting casemix systems, such as Diagnosis-Related Groups (DRGs),with respect to e.g. prediction of length of stay and service costs.1Evidence on the added value of functioning information in casemixsystems is needed to inform the decision on whether to adapt currentcasemix systems.

Improving casemix systems by integrating functioning information: A systematic literature

review and call for expert input

Abstract Health information constitutes the foundation for any decision-making related to finances, service delivery, policy andgovernance in health systems. From a comprehensive perspective, it includes bio-medical information (morbidity and mortality) andinformation on how health plays out in daily life (functioning). Next to the International Classification of Diseases (ICD), World HealthOrganization (WHO) has released the International Classification of Functioning, Disability and Health (ICF) which serve – when jointlyused – as standards for describing morbidity, mortality, and functioning. Current reimbursement systems, such as casemix, however, relyprimarily on ICD-coded information. This paper provides preliminary findings on a systematic literature review on the evidence forintegrating functioning information into casemix systems to optimize financing in current health systems.


C404


The objective of this research is to identify the value of integratingfunctioning information into casemix systems to improve financing incurrent health systems.More specifically, the aims are toi) determine indicators of added value of casemix systems based on

the existing literature, andii) examine potential areas of use for integrating functioning

information into casemix systems

A systematic literature review using standard literature databases(PubMed, EMBASE, CINAHL, Sociological Abstracts, JSTOR and EconLit)and hand-search of reference lists was conducted with the search termsillustrated in Figure 1.

Introduction Methods & Materials

Maren Hopfe, M.Sc.(PhD Student)

Swiss Paraplegic ResearchCH-6207 Nottwil – Switzerland

Phone: +41 (0) 41 939 65 [email protected]

1 Hopfe M, Marshall R, Riewpaiboon W, Tummers J, Kostanjsek N, Ustun B. Improving casemix systems by adding functioning information [Internet]. WHO-FIC Network meeting; 2011 Oct 29-Nov5; Cape Town, South Africa. Geneva: World Health Organization; 2011. Available from: http://apps.who.int/classifications/network/meeting2011/en/. Accessed on Dec 2011.

Figure 1: Search Terms

Preliminary Results

Conclusion

Iden

tifi

cati

on

Figure 2: PRISMA Flow Chart

Scr

een

ing

Elig

ibil

ity

Incl

ud

ed

Table 1: Countries of data collection by WHO regions

WHO Region CountriesAmericas United States of

America, CanadaSouth East Asia

Thailand

Europe Denmark, Finland, Germany, Greece, Italy, Netherlands, Poland, Spain, Sweden,Switzerland, UK

Western Pacific Australia, Hong Kong, New Zealand, Singapore

Figure 3: Number of studies over time by WHO regions

Figure 4: Assessment of functioning*

* Not all studies provided information on their assessment of functioning. The preliminary results displayed are based on available information

15

6

3 3 32 2

1 1 1 1 1 1 1 1 1 1 1 1 1

0

2

4

6

8

10

12

14

16

0

2

4

6

8

10

12

14

16

1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009

Americas South East Asia Europe Western Pacific

Records identified through database searching

(n= 3374)

Records after duplicates removed

(n= 2224)

Records screened(n= 2224)

Records excluded(n= 2129)

Full-text articles assessed for eligibility

(n= 95)

Articles excluded(n= 9)

Studies included for full-text screening

(n= 86)

Additional records identified from

reference lists of screened studies

(n= 0)

The added value of integrating functioninginformation has been examined acrossdisciplines and settings. The most commonsettings in which the studies wereconducted include:• Acute care hospitals• Inpatient rehabilitation facilities• Long-term care facilities• Nursing homes• Psychiatry

Functioning information was collected withvarious modes and methods (Figure 4). Themost common outcome parametersdeployed in the studies were• Costs• Length of Stay (LOS)• Mortality• Discharge destination• Functional gain

Inclusion criteria for studies: empirical, with a comparative component account for functioning information in casemix systems published in peer-reviewed international journals (English or

German language)

AND

The authors acknowledgethe support of ConalTwomey.

Acknowledgments

Introduction

The Family Development Committee has been considering principles for an international casemix classification system, as an example of a potential use of the WHO-FIC classifications together, in an integrated manner.

Possible purposes of an international grouper would include • international comparisons (for

example to support the work of the OECD), noting that the current casemix groupers and DRGs are not internationally comparable

• A ‘best practice’ basis for international groupers that would add detail to the ‘core’ international specifications

• Informing grouper development internationally.

The long term goal is endorsement by the WHO-FIC Network of a grouper specification that uses the WHO-FIC classifications as the core.

At the 2014 mid-year meeting of the FDC, members worked to develop the objectives for principles for an international casemix classification system, and to develop the principles themselves. This poster reports the outcomes of that work.

Principles for an international casemix classification system

Abstract

The WHO-FIC Family Development Committee has developed principles for an international casemix classificationsystem based on the use of the Family of International Classifications. The overall long-term objective of thedevelopment of the principles would be a set of casemix groupers for multiple care types or settings that could be usedfor international comparisons, or by nations who wish to use them. The principles anticipate that the WHO-FICproducts, particularly following the finalisation of ICD-11 and ICHI, and further work on use of ICF in casemix, willprovide more comprehensive information than currently available products, and groupers based on them will haveenhanced capability to predict resource use.


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Jenny Hargreaves (FDC co-chair, Australian Collaborating Centre), Huib Ten Napel (FDC co-chair, Netherlands Collaborating Centre), Brooke Macpherson (FDC secretariat, Australian Collaborating Centre)

Objectives

1. Be based on routinely collected information2. Patient characteristics (demographic and clinical) should be used as the

basis of any grouping 3. Clinical information should be collected using ICD, ICF, and ICHI.4. Ensure clinical meaningfulness

a) the casemix groups should contain patients who are similar from a clinical perspective

b) information on diagnosis, intervention and functioning should be used as appropriate to the type of care and to predicting resource use

5. Contain a limited number of casemix classes a) casemix groups should encompass all patients seen within a particular type of care (e.g. admitted acute)b) casemix groups that reflect similar resource use.

6. Ability to implement at differing levels of detail dependant on the purposes it is being used for (e.g. international comparison or local use in a casemix system)

7. Ability to aggregate groups8. Routinely updated

a) to reflect changes made to supporting classifications to follow updates on the classifications based on evidence of changed use of the classifications

b) to provide information (such as concordances) that can illustrate how the same cases can be grouped in a new grouper compared with an old grouper

9. Avoids use of information on administrative/organisational aspects of the care (e.g. same-day)

10. A known process for updating and how stakeholders can provide input (known, publicised and able to be accessed)

11. Incorporating consideration of stability over time versus responsiveness to change

12. Available in the public domain.

Acknowledgements

The FDC co-chairs would like to thank the FDC members for their valuable contributions in progressing this FDC work-plan activity

Draft principles for a WHO set of casemix groupers

Next steps

Further issues to be considered include

• identification of sources of information to generate the grouper

• whether the work would lead to a grouper specification or an actual software implementation

• The importance of testing the hypothesis that casemix classifications will be better with use of ICD-11 and ICF.

Comments from Network members are welcome.

For the WHO to have a set of grouper products based on the WHO-FIC.

Short termDevelop guiding principles for a set of casemix classification groupers for multiple care types or settings (that can be used for international comparisons or by nations who wish to use it) which may:• identify how the WHO-FIC would be used to support an international

casemix system.• guide best-practice for an international casemix classification

systemgroupers• aide in informing international grouper software development

Long termThis anticipates that the WHO-FIC products, particularly following the finalisation of ICD-11 and ICHI and further work on the use of ICF in casemix, will be more comprehensive than currently available products. With better input information from the WHO-FIC, groupers would be likely to have enhanced capability to predict resource use.

Introduction

In China, traditionally death certificates are paper-based and filled out by doctors, mostly depending on manual work. Thus there are several problems under this scheme. Firstly, it takes a lot of time of doctors because doctors have to copy patient’s personal information multiple times. (The death certificate in China has 4 pages. The 1st page, which should be preserved together with medical record, includes death cause linkage and underlying cause of death; the 2nd and 3rd pages are used for cancelling residence and funeral; the 4th one is preserved by the death’s relatives.) There will be some unavoidable mistakes under high pressure working condition, like leaving blanks, inconsistent or wrong information and inappropriate cause linkage. Secondly, because the death’s relatives have to go to fetch the 2nd~4th pages of death certificate to ask for seals, it will cause them lots of troubles, turning back and forth many times. Thirdly, the 1st page, which should be preserved in medical record, easily gets lost. Fourthly, as long as death cause coder did not report the death case to the National Network of death cause surveillance accidently, it will be very difficult to detect the missed case later. Last but not the least, the quality of death certificates filled out by doctors cannot be measured. Administrators cannot tell an exact number about how good or how bad of the quality.

The implementation of Electronic Death Certificate in China

Abstract An electronic death certificate system was implemented in six hospitals in Beijing. As one of the pilot institutes, rates of missing report was reduced and the quality of death certificate improved significantly. Besides, the new electronic system save much time and energy both to doctors and death’s relatives.


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Authors: Puwa Ci1, Jiong Zhou1, Chunhou Li1, Yanli Zhou2, Aimin Liu 1,*

1 Peking Union Medical College Hospital, Beijing 2 Center of Disease and Control, Dongcheng District, Beijing Corresponding to: Aimin LIU, Email: [email protected]

A well-established electronic death certificate system put into use. Clinical doctors fill the certificate on HIS system. Most of the personal information was abstracted from HIS system whereas doctors are allowed to give some change according to the current condition of the patients. Personal information will be print on 1st

-4th pages. In this way, doctors could save some time and energy, avoiding multiple times of copying. The patient’s relatives could get the 2nd

-4th pages of death certificate as soon as the doctor submits it. (To be cont.)


Results

Conclusions

Medical Records Department, Peking Union Medical College HospitalMedical Affair Office, Peking Union Medical College HospitalInformation Center, Peking Union Medical College HospitalCenter of Disease and Control, Beijing

Electronic death certificate is more efficient than traditional paper-based certificate for doctors filling. Through the implementation of the electronic death certificate managing system, rate of missing report is dramatically reduced. In the future, interface between a hospital and the Network/Platform will be developed and the information could be collected automatically after coding. When the pilot study becomes mature, the electronic system will be used across China.

Chart 2: the 1st and 2nd~4th pages of death certificate, required by National Health and Family Planning Commission, generated by the electronic system..

Chart 3a(left) and 3b(below): The reporting interface of electronic death certificate toward doctors.

Death case

Personal information is abstracted from HIS system into Death Certificate Managing System.

Page 1~4 are generated automatically

The 1st page is modified and coded by well-trained coders

The 2nd~4th pages are printed and sealed by Admission Office

Reporting to Death Cause Surveillance Network of China CDC

Methods & Materials

To solve the problems mentioned above, and to promote the implementation of electronic information collecting system, in September 2013, Beijing Health Bureau issued a document supporting electronic death certificate in some pilot hospitals. Since February 2014, 5 hospitals in Beijing began to use electronic death certificate. Besides, a system of performance appraisal for the quality of death certificate is carried out. Some functions were added into the system to help modify the quality of work. For example, the function of logical check was added into the filling interface toward doctors; required fields are set through computer technology method.

Handed to patient’s relatives

Chart 1: The flowchart of electronic death certificate fill, generating, coding and reporting. It has become a new model of certificating and reporting death causes.

Doctor inputs some current info(such as current living address and relatives’ contact), death cause linkage and underlying cause of death.

(Cont.) The data will be transferred to mortality reporting department and linkage of causes of death is coded by professional coders. Then the first page will be printed after coding and the information will be reported to China Death Cause Surveillance Network/Platform by coders.Every death case will be recorded. So rate of missing report is reduced, closing to zero. E.g. Rate of missing report in the past six months from March 1st to August 31th is 0.6%. Besides, after implementing the performance appraisal system, the quality of death certificate could be measured quantitatively, benefiting quality control in the future.

Introduction

Title

In Colombia, the Civil Registration System andVital Statistics (SRCEV) consists of twosubsystems: the Civil Registration that is incharge of the National Registry of the Civil State(RNEC), and the Vital Statistics in charge of theMinistry of Health and Social Protection (MSPS);the National Institute of Legal Medicine (INML)and the National Administrative Department ofStatistics (DANE).

From 1998, because of laws, the network of publicand private health service providers under thedirection of the Ministry of Health and SocialProtection, are in charge of the medicalcertification of births and deaths. Doctors certifyover 95% of the births and deaths that happen inthe country, they use standardised formats as arequirement for the Civil Registration of vitalevents; while less than 2% are registered under atoken base.

In 2008, a technological modernization processwas initiated in order to find a way to improveopportunity, quality and coverage of vital statisticswith the automated online registration and theacceleration of reviews and feedback processes.Nowadays, the system consolidates the transitionof medical certification in physical forms toelectronic forms in the RUAF-ND web-basedapplication and it makes progress in systeminteroperability processes with related records inorder to simplify procedures for the citizens andoptimise the exchange of information processesamong government agencies involved in themanagement of Vital Statistics

Abstract The modernization of the Colombian System of Vital Statistics through the implantation of the electronic information platformas part of the Unique Registry of Affiliates (RUAF-ND), allows registering the Births and Deaths in a synchronous way by capturing theinformation of the vital events certificates online since 2009. Nowadays, the system has electronic certification coverage of 91% of birthsand 72% of deaths; while the certification on real time among the 30 days following the occurrence of the vital event, reaches anopportunity of 86% in births and 98% in deaths.


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Author: Victor Hugo Alvarez Castaño, MD, Mag. EPI, METiPEpidemiology and Demography Management Consultant Ministry of Health and Social Protection of Colombia

Title

Methods & Materials

Today, the medical certification of births anddeaths in Colombia has reported significantprogress in its modernization process:

1. Proportional increase of vital events capturedby the health system and registered in theRUAF-ND module, when compared with thedata of concluding Vital Statistics published byDANE, show a higher level of coverage in 2013to 90% in most departments, except those thattechnology and data transfer difficulties do notexceed 60%. Among the enabled HealthInstitutions in the country, all IPS providingmidwifery services, hospitalization andemergency room, estimated at more than1,900 institutions throughout the country,produce records of births and deaths which arerecorded in real time (86%) or on a deferredbasis.

2. Stabilization and consolidation of the onlineregistration and real time top 90% vital eventsof births and 70% of deaths. Approximately25% of deaths related to external cause,haven’t been directly recorded in the RUAF-NDyet because the procedure sets the currenttraffic death certificates from the offices ofLegal Medicine to the Territorial Health Entitiesfollowing DANE where they are entered into thedatabase.


Results

The modernization process of the technologicalplatform for data capture and management ofvital events started with the development andimplementation of the ND module into the UniqueRegistry of Affiliates (RUAF-ND). During the years2008, 2009 and 2010, it was carried outtechnological developments, testing and gradualimplementation of the RUAF-ND application andthe induction, training and technical assistance tomost departmental and district territorial entities.The implementation of electronic platform webenvironment managed by the Ministry of Health,allows registering the births and deaths in asynchronous way by capturing the information ofthe vital events certificates online since 2009.

Conclusions

Thanks to the entities responsible for SRCEV andthe certifiers that enable continuous improvementof vital statistics. Acronym in Spanish.

The results demonstrate the benefit derived fromthe online registration, especially because of thetimeliness in the count of vital events and thepossibility of improving the statistical quality ofthe recorded data by verifying and correctingthem much more closely to the occurrence ofevents. The real-time information not only allowsmore frequent use and dissemination of vitalstatistics but also stimulates quality improvementand registration coverage by suppliers. Thisimplies a permanent management to implementbest practices and standards in healthcareinformation systems and certification of vitalevents.

Figure 1. Migration from paper forms to record web application

AUTOMATION OF VITAL STATISTICSIN COLOMBIA 2008-2014

The data capture in real time or deferred to ashort-term is executed by doctors and otherauthorised personnel; while the vital statisticiansand epidemiologists of Health Services performprocesses of pre-review and statisticalamendment, when appropriate to correctinformation. People that are involved in theadministration of this kind of data have theprimary function of quality control of the recordeddata, where the Ministry of Health is in charge ofthe definition of its standards and the NationalAdministrative Department of Statistics (DANE) isin charge of the data integrity evaluation for thefinal production and public diffusion of StrategicStatistics.

During the years 2011, 2012, 2013 and 2014elapsed; it has been performed computermaintenance and routine review of the NDdatabase in order to verify completeness,consistency and timeliness of data based on pre-established criteria for quality control. Likewise,developments in the data exploration and miningof vital statistics cube-based information, designand development of virtual courses for doctors onthe certification of vital events are advancedapplications.

Methods & Materials (cont….) Results (cont….)

Currently, the monthly average of births anddeaths that are registered online behavesaccording to the expected incidence of eachevent; there are 16,500 deaths and 50,000births per month.

3. Certification of stillbirth not only showsimprovement in their record in terms ofnumbers but in the quality of data that allowanalysis of cause. Since 1998, when theregistration of foetal deaths under thedefinition of WHO was established, certificationof foetal deaths has increased from 16,004foetal deaths in the year 1998 to 33,388 in2010, 37,294 in 2011, 43,016 in 2012 and44,042 in 2013. Moreover, in 2013 nearly 40%are early foetal deaths of less than 22 weeks ofgestation, which can be characterised bycauses of death and other relevantepidemiological variables of interest.

4. Interoperability with the Network InformationSystem for Missing and Dead Bodies (SIRDEC)of the Institute of Legal Medicine, allowsintegrating into the RUAF-ND the certificationof violent deaths in real time, optimizing thecoverage and quality of the record of totaldeaths. In December 2014, deaths records inSIRDEC, automatically migrate to RUAF-ND.

Figure 2. RUAF-ND Registration in real time 2009-2013

Figure 3. Institutional Interaction for certification of death from external causes

Registro Único de Afiliados: RUAF - Módulo ND

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

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2009 2010 2011 2012 2013

Deaths

MONTH / YEAR

Number of DEATHS registered in real time

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20,000

30,000

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2009 2010 2011 2012 2013

Births

MONTH / YEAR

Number of BIRTHS registered in real time

Introduction

Title

Changes in the International Classification of Diseases(ICD-10) occurred concerning the version that is usedin Switzerland: Since 2009 the German Modifiedversion (ICD-10-GM) has replaced the WHO’s originalversion (ICD-10-WHO). These changes could bias themeasurement of healthcare indicators using ICD-10data.

Objectives was:

To evaluate differences between ICD-10-GM andICD-10-WHO in measuring the Charlson index(CI)

and to assess effects of changes on hospitalmortality.

Biases in Measurement of Healthcare Outcomes Attributable to Changes in the ICD-10 Version that is used for Coding Diagnoses

Abstract This study was to evaluate potential difference in health outcomes using hospital routine data associated with changes in the international Classification of Diseases

(ICD-10) version used in hospitals. Because theses changes potentially provide biases in measurement it is important to assess how differences were using a commonlyuse health outcome indicator.

Although this study reported significant differences in concordance between two ICD-10 versions for some Charlson comorbidity conditions, changes in ICD-10 versiondid not provided significant difference in mortality estimates at macro-levels. However model performance could be different between the two ICD-10 version wereevaluated.


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Methods & Materials


Results

The Swiss part of this study was supported by a Sinergiagrant (CRSII3_132786) from the Swiss National ScienceFoundation (SNSF), Bern, Switzerland.

This study has highlighted that changes in ICD-10 version that occurred in Switzerland have generated differencesconcerning the measurement of CCI conditions based on principal diagnosis and secondary diagnoses coding fields.However, only modest impacts were found for risk-adjustment models of in-hospital mortality.Because the use of ICD data increase for health performance comparisons between countries and over time, this studyprovided an alarm that should catch the attention of researchers and managers to take into account these results forinterpretation of comparisons when ICD data are used.

Conclusions

CONTACT: [email protected]

Population:Hospitalized adult patients (medical and surgical acutecare) in Swiss public hospitals were selected from DRGdatabases in 2009 and 2010.

Main outcome measurement:

The CI was developed under two forms: Charlson comorbidity index (CCI) and Charlson score index (CSI).

In addition, we used alternatively the CSI with 17conditions (i.e., the Deyo’s adaptation with ICD-10 byQuan et al. [Med Care 2005]) and the CSI with 12conditions by Quan et al. [Am J Epidemiol 2011].

TABLE 1. Characteristics of hospitalized patients in 2009 and in2010

Jean-Marie Januel1,2, Bernard Burnand2

1University Institute of Graduate Studies and Research in Health Care, University Hospital of Lausanne, Lausanne, Switzerland2Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland

Charlson comorbidity

2009 2010

Concordant pairs

Discordant pairs

Kappa McNemar Concordant pairs

Discordant pairs

Kappa McNemar

GM+ /

WHO+

GM- /

WHO-

GM+ /

WHO-

GM- /

WHO+

k (95% CI) P-value GM+ /

WHO+

GM- /

WHO-

GM+ /

WHO-

GM- /

WHO+

k (95% CI) P-value

MI PDX 13 444 832 666 17 0 0.99 (0.99 – 1.00) <.001 14 309 842 628 0 0 1.00 (1.00 – 1.00) 1.000

SDX 12 799 831 463 1 865 0 0.93 (0.93 – 0.93) <.001 16 416 840 436 85 0 0.99 (0.99 – 0.99) <.001

CHF PDX 11 238 831 693 3 196 0 0.87 (0.87 – 0.88) <.001 14 944 841 845 148 0 0.99 (0.99 – 0.99) <.001

SDX 27 206 813 979 4 942 0 0.91 (0.91 – 0.92) <.001 34 774 821 919 244 0 0.99 (0.99 – 0.99) <.001

PVD PDX 9 614 835 697 816 0 0.96 (0.96 – 0.96) <.001 10 435 846 348 154 0 0.99 (0.99 – 0.99) <.001

SDX 24 388 819 581 2 158 0 0.96 (0.95 – 0.96) <.001 26 752 830 080 105 0 0.99 (0.99 – 0.99) <.001

CVD PDX 17 007 828 026 1 094 0 0.97 (0.97 – 0.97) <.001 18 992 837 917 28 0 0.99 (0.99 – 1.00) <.001

SDX 16 228 829 190 709 0 0.98 (0.98 – 0.98) <.001 15 376 841 554 7 0 1.00 (1.00 – 1.00) 0.008

Dementia PDX 1 855 844 268 4 0 1.00 (1.00 – 1.00) 0.046 1 923 855 012 2 0 1.00 (1.00 – 1.00) 0.157

SDX 19 338 826 739 50 0 1.00 (1.00 – 1.00) <.001 19 459 837 467 11 0 1.00 (1.00 – 1.00) 0.001

CPD PDX 6 360 837 566 2 094 107 0.85 (0.85 – 0.86) <.001 7 849 848 626 308 154 0.97 (0.97 – 0.97) <.001

SDX 33 717 804 259 5 861 2 290 0.89 (0.89 – 0.89) <.001 36 407 816 902 130 3 498 0.95 (0.95 – 0.95) <.001

RD PDX 1 378 844 716 33 0 0.99 (0.98 – 0.99) <.001 1 417 855 513 7 0 0.99 (0.99 – 1.00) <.001

SDX 6 973 838 867 287 0 0.98 (0.98 – 0.98) <.001 7 340 849 564 33 0 0.99 (0.99 – 0.99) 0.008

PUD PDX 2 490 843 637 0 0 1.00 (1.00 – 1.00) 1.000 2 630 854 307 0 0 1.00 (1.00 – 1.00) 1.000

SDX 2 787 843 340 0 0 1.00 (1.00 – 1.00) 1.000 2 675 854 261 1 0 1.00 (0.99 – 1.00) 0.317

Mild-LD PDX 2 128 843 998 1 0 1.00 (0.99 – 1.00) 0.317 2 246 854 691 0 0 1.00 (1.00 – 1.00) 1.000

SDX 14 860 831 266 1 0 1.00 (1.00 – 1.00) 0.317 12 885 844 051 1 0 1.00 (1.00 – 1.00) 0.317

Diab-woCC PDX 1 954 843 473 700 0 0.85 (0.84 – 0.86) <.001 2 811 854 089 37 0 0.99 (0.99 – 0.99) <.001

SDX 47 157 783 988 14 982 0 0.85 (0.85 – 0.86) <.001 63 860 792 684 393 0 0.99 (0.99 – 0.99) <.001

Diab-wCC PDX 1 360 844 424 343 0 0.89 (0.88 – 0.90) <.001 805 855 045 1 087 0 0.60 (0.57 – 0.62) <.001

SDX 10 098 832 637 3 392 0 0.85 (0.85 – 0.86) <.001 7 673 844 048 5 216 0 0.74 (0.74 – 0.74) <.001

Hemi-Para PDX 444 845 641 42 0 0.96 (0.94 – 0.97) <.001 512 856 422 3 0 0.99 (0.99 – 1.00) 0.083

SDX 12 820 832 827 480 0 0.98 (0.98 – 0.98) <.001 14 204 842 665 68 0 0.99 (0.99 – 0.99) <.001

RF PDX 2 376 843 631 120 0 0.98 (0.97 – 0.98) <.001 549 854 627 1 761 0 0.38 (0.36 – 0.41) <.001

SDX 55 247 788 119 2 761 0 0.97 (0.97 – 0.98) <.001 27 647 799 687 29 603 0 0.64 (0.63 – 0.64) <.001

TUMOR PDX 62 657 783 015 455 0 0.99 (0.99 – 0.99) <.001 64 560 792 283 94 0 0.99 (0.99 – 0.99) <.001

SDX 23 486 821 834 745 62 0.98 (0.98 – 0.98) <.001 24 599 832 232 25 81 0.99 (0.99 – 0.99) <.001

MS-LD PDX 752 845 277 0 98 0.94 (0.93 – 0.95) <.001 635 856 222 0 80 0.94 (0.93 – 0.95) <.001

SDX 3 539 842 076 314 198 0.93 (0.93 – 0.94) <.001 2 592 852 907 1 026 412 0.78 (0.77 – 0.79) <.001

META-TUMOR PDX 8 215 837 868 44 0 0.99 (0.99 – 0.99) <.001 8 343 848 204 390 0 0.98 (0.98 – 0.98) <.001

SDX 30 108 815 876 143 0 0.99 (0.99 – 0.99) <.001 31 975 824 306 656 0 0.99 (0.99 – 0.99) <.001

AIDS/HIV PDX 82 845 963 82 0 0.67 (0.60 – 0.74) <.001 78 856 814 45 0 0.78 (0.71 – 0.84) <.001

SDX 852 845 139 136 0 0.93 (0.91 – 0.94) <.001 671 856 186 80 0 0.94 (0.93 – 0.96) <.001

Statistical analysis:

1.- After having translated diagnosis codes from ICD-10-GM into ICD-10-WHO, we evaluated theconcordance between those two ICD-10 versions foreach CCI conditions using Kappa tests.

We performed analysis using respectively principaldiagnosis (PDX) and secondary diagnoses (SDX)coding fields.

2.-We then performed Poisson regression models of in-hospital mortality using CCIand CSI as risk-adjustment variables based on ICD-10-GM and ICD-10-WHO independently.

Characteristics 2009 2010 P-value

At hospital-level

No. of Hospitals in each category (admission per year), N (%)

<.001

>30 000 143,826 (17.00) 145,411 (16.97)

9 000 to 30 000 341,156 (40.32) 368,767 (43.03)

6 000 to 9 000 147,537 (17.44) 137,438 (16.04)

3 000 to 6 000 160,793 (19.00) 157,261 (18.35)

<3 000 52,815 (6.24) 48,060 (5.61)

Average number of inpatient cases per hospital in each hospital category, Mean (SD)

>30 000 29,156 (8.95) 29,404 (8.11)

9 000 to 30 000 16,752 (12.05) 18,467 (12.50)

6 000 to 9 000 6,967 (3.21) 7,405 (2.89) <.001

3 000 to 6 000 4,919 (6.35) 5,057 (6.50)

<3 000 2,090 (3.82) 2,130 (3.76)

At inpatient-level

No. of Cases 846,127 856,937

Sex (Male), N (%) 421,137 (49.77) 428,269 (49.98) 0.008

Age, Median [IQR, 25th – 75th pct.] 63 [47 – 76] 63 [47 – 76] <.001

≤49 yrs 242,994 (28.72) 241,266 (28.15)

<.001 50 to 64 210,835 (24.92) 213,860 (24.96)

65 to 79 245,744 (29.04) 250,532 (29.24)

≥85 yrs 146,554 (17.32) 151,279 (17.65)

LOS, Median [IQR, 25th – 75th pct.] 5 [3 – 9] 5 [3 – 9] <.001

Quartile 1, N (%) 306,236 (36.19) 312,006 (36.41)

<.001 Quartile 2, N (%) 159,911 (18.90) 162,816 (19.00)

Quartile 3, N (%) 178,538 (21.10) 183,676 (21.43)

Quartile 4, N (%) 201,442 (23.81) 198,439 (23.16)

SDX, Median [IQR, 25th – 75th pct.] 2 [1 – 4] 2 [1 – 4] <.001

Quartile 1, N (%) 362,818 (42.88) 353,862 (41.29)

<.001 Quartile 2, N (%) 123,365 (14.58) 128,960 (15.05)

Quartile 3, N (%) 162,127 (19.16) 166,902 (19.48)

Quartile 4, N (%) 197,817 (23.38) 207,213 (24.18)

Admission in emergency, N (%) 402,535 (47.57) 421,186 (49.15) <.001

Surgical inpatient, N (%) 426,891 (50.45) 437,999 (51.11) <.001

ICU stay, N (%) 57.843 (6.84) 60,271 (7.03) <.001

Before discharge mortality, N (%) 20,817 (2.46) 20,761 (2.42) 0.112

TABLE 2. Comparison of ICD-10-GM and ICD-10-WHO versions for coding Charlson comorbiditydiagnosis conditions in 2009 and 2010, respectively.

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0

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Charlson score with 17 comorbidity conditions Charlson score with 12 comorbidity conditions

1 3+

IRR

with

95%

Con

fiden

ce li

mits

Charlsonscore (ref.=0) 1 2 3+ 2

846 127 hospitalization stays wereincluded for 2009 and 856 937 for2010. Patients who died beforedischarge were 2.46% and 2.42%(P=0.112), respectively (Table 1).

Comparisons of CCI conditions usingICD-10-GM and ICD-10-WHOprovided Kappa ranging from 0.67(0.60 – 0.74) to 1.00 (1.00 – 1.00) in2009 and from 0.57 (0.57 – 0.62) to1.00 (1.00 – 1.00) in 2010 concerningPDX, and ranged from 0.85 (0.85 –0.86) to 1.00 (1.00 – 1.00) in 2009and from 0.74 (0.74 – 0.74) to 1.00(1.00 – 1.00) in 2010 concerning SDX(Table 2).

FIGURE 1. Incidence Rate Ratio as Relative Risk to Compare Charlsoncomorbidity index (CCI) using ICD-10-GM and using ICD-10-WHO forDiagnoses Coding To Perform In Hospital Mortality Outcome Measurement in2009 and 2010 Respectively using Poisson Regression Models.Variables for risk-adjustment: Sex; Age; Hospital admission in emergency,Stay in intensive care unit (ICU), medical vs. surgical DRG; No of secondarydiagnoses coding fields; and type of hospitals.

Risk-adjustment models of in-hospital mortality were notsignificantly different between ICD-10-GM and ICD-10-WHOusing CCI and CSI as main independent variables. Differencesin model deviances between ICD-10-GM and ICD-10-WHOwere slightly higher in 2010 (-57.49 to -436.77) than in 2009(-52.84 to -309.57) according to models using CCI and CSI(Figures 1 and 2).

FIGURE 2. Incidence Rate Ratio as Relative Risk to Compare Charlsonscore index (CSI) using ICD-10-GM and using ICD-10-WHO for DiagnosesCoding To Perform In Hospital Mortality Outcome Measurement in 2009 and2010 Respectively using Poisson Regression Models.Variables for risk-adjustment: Sex; Age; Hospital admission in emergency,Stay in intensive care unit (ICU), medical vs. surgical DRG; No of secondarydiagnoses coding fields; and type of hospitals.

Introduction

Title

The electronic health record of the primary care teams (ECAP) of the Institut Català de la Salut (ICS) uses the tenth version of the International Classification of Diseases (ICD-10) to codify the health problems of the patients. This classification includes more than ten thousand codes for different health problems, which it makes the analysis of information difficult. In order to be able to represent results related to the health problems of the population assigned to the primary care teams at the ICS, it was necessary to map across the ICD-10 codes to the codes used in the International Classification of Primary Care, version 2 (ICPC-2). The ICPC-2 was chosen because it is the classification designed for primary care. The correspondence method performed between both classifications is presented here, as well as the visualisation of the health problems included.

Abstract The electronic health record of the primary care teams of the ICS uses the ICD-10 to codify the health problems of the patients. In order to be able to represent results related to the health problems of the population assigned to the primary care teams, it was necessary to map across the ICD-10 codes to the codes used in the ICPC-2. The correspondence method performed between both classifications is presented here, as well as the visualisation of the health problems included.


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F. Ramos, M. Medina, E. de la Torre, J. Camús, E. Coma, J. CaroInformation system for primary care services. Information System Department.

Institut Català de la Salut, Catalonia

Title

Methods & Materials

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Conclusions

To perform a mapping of codes of health problems codified in ICD-10 to ICPC-2, we used a catalogue of 8,742 correspondences from a previous study (REGIPREV) that expands WONCA 's official mapping. This new approval was necessary because others regions, different of Catalonia, taking part in the study used the ICPC-2 as classification for the EHR. As it was not an exhaustive mapping, it was necessary to expand the conversions of the ICD-10 codes not included in the catalogue at the same time they were being registered the reasons for referrals on the EHR. The criteria used for these new correspondences are the same as those used in the study (Table 1)

Results

792 correspondences have been added to the initial catalogue. This catalogue has enabled the grouping of 12,770 codes on ICD-10 for different health problems into 597 codes on ICPC-2. These groups are those used to show the prevalence, incidences and main health problems of the population assigned to the ICS via the web based application epiDADES, accessible to the ICS management bodies. The results can be disaggregated by classification of disease, 17 ICPC-2 chapters and ICPC code, as well as by age groups and monthly evolution.

Situation Solution

An ICD‐10 code (3‐4 digits)

corresponds to more than

one ICPC‐2 code

The ICPC‐2 code used in most

referrals is selected.

An ICD‐10 code (4 digits) for

which not directly

correspondence with ICPC‐2.

The ICD‐10 code is reduced to 3

digits, if:

There is a single

correspondence: then it is

chosen

>1 correspondence: the most

frequent in referrals is chosen

Situation Solution

An ICD‐10 code (three digits)

doesn’t correspond with any

code on ICPC‐2.

Selection of the 4‐digit code

with a single correspondence in

ICPC‐2. The code with a more

similar description or that is

more non‐specific will be

chosen.

The same ICD‐10 code has

correspondence with two

ICPC‐2 codes and they are

different depending on the

patient's gender.

The correspondence will be

made, setting the variable sex.

An ICD‐10 code with

correspondence with more

than two ICPC‐2 codes that

are not related because they

make reference to a different

anatomical location

The most non‐specific code will

be assigned

An ICD‐10 code with two

ICPC‐2 codes with different

definitions

The code with more prevalence

in referrals will be assigned

An ICD‐10 code doesn't have

direct correspondence with

ICPC‐2, not even when

applying the previously

described criteria

It is directly searched for on the

ICPC‐2 classification, in

accordance to the ICD‐10

description

Physical assaults Z25

Traffic accidents A80

Pregnancy and childbirth W92

Y83‐Y84 (other surgical and

medical procedures)A87

X51 (travel and motion) It is not standardized in ICPC‐2

Y98 (disease related to

lifestyle)

It is not standardized in CIAP‐2

because it is just a one record.

Medical treatments and

secondary complications

The ICD‐10 code is reduced to

3 digits and if it is:

A single correspondence: it is

chosen

Without correspondence: the

description is chosen by

comparing the detailed

description

CIM10 codes created

specifically for ECAP to cover

diverse requirements (I50.90,

I50.91, Z86.70, Z13.60 i

N90.81, Z91.81)

The CIE‐10 code is reduced to 3

digits a check is done to see if

there is a single correspondence

in the ICPC‐2. If there is a single

correspondence, then a further

check is carried out to ensure

the description of the ICPC‐2 is

appropriate for the description

of the invented IDC‐10 code:

If it is appropriate, it is

chosen and

If it is not appropriate, then

the CIAP‐2 code that is more

appropriate for the case is

searched for using the

description

Table 1: Criteria used for the new correspondences between ICD-10 to ICPD-2

The grouping of the ICD-10 codes into ICPC-2 enables the analysis, interpretation and presentation of the information. This mapping allows for the interchange of information with electronic records that use the ICPC-2.

Figure 1. Type 2 diabetes prevalence by gender and age (epiDADES)

Figure 2. Chickenpox monthly incidence by gender and age (epiDADES)

IMPROVING THE ANALYSIS OF HEALTH PROBLEMS IN PRIMARY CARE: FROM ICD-10 TO ICPC-2

Methods & Materials I

C E

Introduction

A major advantage of ICPC-2 over other classifications is its suitability to not only allow for coding of health problems, but also for care processes and reasons for encounter (RFE). Patient’s can describe their RFE as symptoms or complaints, as requests for services or as health problems. A major part of RFEs is coded as symptoms. A symptom is a body sensation interpreted as caused by a disease. However, many people with the same body sensations will not consult a physician. This suggests that frequently the driving force behind illness behavior might not be the symptom as a body-sensation itself, but it’s interpretation by the patient. ICE is a helpful acronym frequently used in the teaching of consultation skills. ICE should be elicited in good consultations to better understand the patients agenda. ICE has been defined differently. We supposed it might be used to create data about the interpretation of body sensations by patients. Therefore we wanted to know, whether ICPC-2 might be suitable to code ICE and which codes might be missing in order to do so.

Abstract Right or wrong - patients often interpret body-sensations as a symptom of an underlying disease. Therefore the reason for encounter might not be sufficiently described by the symptom alone. Ideas, concerns and expectations (ICE) of the patient concerning the symptom might be among the major driving forces of illness behavior in family practice (FP). To capture data on ICE, a classification is needed. Therefore the objective of this study was to test whether the International Classification of Primary Care (ICPC-2) is suitable to code ICE appropriately and what codes might be missing for this use case.


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Title

ICE could be coded in 78% of the cases with ICPC-2 either as component 1-7 codes or as process codes (Fig.1)

Acknowledgements

Results

Conclusions

The acronym ICE has mainly been proposed and described by Pendleton D, Schofield T, Tate P and Havelock P in their seminal book “The New Consultation – Developing Doctor-Patient Communication” Oxford Medical Press, Oxford 2003. The data we used for our study stem from the work of Matthys J, Elwyn G, NulandMv, Maele Gv, Sutter, Ad Meyere Mdand Deveugele M. Patients’ ideas, concerns, and expectations (ICE) in general practice: impact on prescribing. Br J Gen Pract 2009; 58: 29–36.

Most of the content of ICE can be coded with current ICPC-2. The reason that 22% of the data could not be coded initially, turned out to be that the definition of ICE as used in the original study - that had revealed the narrative ICE data - was different than the one used in this study. Thus only a few new codes will need to be added to ICPC-2 to conduct research on ICE. The process to define these codes will still have to be completed following the methodology described above. The intention of this study was not to add new codes to ICPC-2 and distress FPs

with even more coding work. Insteadthe idea was to conduct research to give FPs a notion of what spectrum of ICE might be behind the symptoms presented to them in their practices, and that it might be fruitful to elicit ICE in the consultation.

Is ICPC-2 an appropriate tool to code ideas, concerns and expectations (ICE) to better describe

the reason for encounter in family practice?Diego Schrans1,3, Dirk Avonts1; Pauline Boeckxstaens1,3; Jan Matthys1; Thierry Christiaens1, Thomas Kuehlein2,3,1 Department of Family Medicine and Primary Health Care, Ghent University, Belgium.2 Allgemeinmedizinisches Institut des Universitätsklinikums Erlangen, Germany.3 Member of the WONCA International Classification Committee (WICC

To elicit ICE is a major elementin the teaching curriculum for FP in Belgium. The data used in this study had been collected for a different study on the impact of eliciting ICE on prescribing in 36 FP teaching practices of the University of Ghent,in Belgium. FP trainees narratively recorded ICE in 613 live consultations which they could observe during their training on one day (30 May 2005). Two researchers independently coded the narrative data. Differences were solved by discussion and agreement. Data not codeable with ICPC-2 will be analyzed according to the methodology of qualitative text analysis. Again two researchers inductively will create codes independently of each other (triangulation). In a process of discussion and agreement the categories found will be united to a common code set of new codes.

In many cases of entriesrecorded as ideas (I)

that could not be codedwith ICPC-2, the

narrative text was toovague to be coded

(27%). For the rest ofnon-codeable entries these

had been applied to thewrong category as for

example a process registeredas an idea. In cases of entriesrecorded as concerns (C) that

could not be coded, the entriesconcerned either duration orseverity of the symptoms as

the underlying concern. In fewcases the patients did not havea concern themselves, but their

relatives did. Some had concernsnot being able to participate in social events. Other concerns were that the patients worried

about infecting others. Most of thenarrative data entries coded asexpectations (E) were process

codes that could easily be coded.

For the purpose of a future study on ICE, it should be defined in a clear and mutually exclusive way. We defined ICE asI = what the patient thinks the

diagnosis will beC = what the patient is afraid of the

diagnosis might beE = what the patient expects the

doctor to do The Belgium data had been collected with different definitions.

Fig.1

Introduction

Title

Episodes of care are distinguished from episodes of disease and episodes of illness. The distinction between these three forms of episodes is important for the recommendations given here. The three different forms of episodes are:1. Episode of illness: Illness is what

the patient feels - the suffering. An episode of illness experienced by the patient is defined by the Wonca Dictionary as extending from the onset of symptoms to their complete resolution.

2. Episode of disease: Not every health problem brought to the attention of primary care can be attributed to a defined disease concept, nor should it be. The episode of disease starts at the moment a defined diagnosis can be made and lasts to its resolution or until the patient's death.

3. Episode of care: The episode of care is defined as a health problem or disease from its first presentation to a health care provider until the completion of the last encounter for that same health problem or disease so far.

Recommendations for coding can hardly be given without reference to some important elements in (electronic) health records. Elements a good record should contain are the:- problem list- episode-of-care list- list with Person Related

Information (PERI list)

Abstract Standardization and coding of documentation is useful for information retrieval and analysis when caring for the single patient during the consultation, and essential for communication between health care providers and for assessment of the content or quality of care. The International Classification of Primary Care (ICPC-2) is used in different health-care settings worldwide. Our aim as the Wonca Classification Committee was to provide general advice regarding coding in order to minimize variation in the use of ICPC-2 codes. Our intention was to enable reliable calculation of incidences and prevalences of health problems from electronic health records (EHR) in order to compare data in networks for scientific and clinical purposes, both nationally and internationally.


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Thomas Kuehlein (Germany), Francois Mennerat (France), Gustav Kamenski (Austria), Daniel Pinto (Portugal), Marija Vrca Botica (Croatia), Kees van Boven (The Netherlands) as

the WICC working group “coding recommendations”

TitleConclusions

the electronic spreadsheet:- P = usually recorded in the

problem-list- PN = usually not recorded in

problem-list, dependent on severity and importance

Table 1 gives a snippet of the electronic spreadsheet.

Table 1

Caption: A signifies the class should usually be recorded only once in the episode of care list. Bsignifies it could be used more than once.P signifies the class should usually also be recorded in the problem list. PN signifies it should usually not be recorded in the problem list.

Recommendations for the use of the International Classification of Primary Care (ICPC-2) in the

problem-list and the episode of care

Methods

The recommendations given are the result of a long discussion process in a working group of the WICC. The method agreed upon was to fix some principles based on which the recommendations would follow a certain logic and traceability. In some cases a certain degree of arbitrariness could not be avoided. In these cases the recommendation given was based on discussion and agreement in the group. One part of the recommendations focusses on he question, which codes should be

Results

As the process is still under way we only want to present the example of recommendations for the problem list here, to give an impression of how they might look like:

1. The problem-list1.2 Rules for the problem list1.2.1 Every health problem that has been given a defined diagnostic label and that is important for the patient’s further life and health care should be recorded in the problem list, together with the date of the first time this disease was diagnosed. The problem list should contain only component 7 codes of the ICPC-2. 1.2.2 Every entry in the problem list should be listed only once. 1.2.3 The problem list may contain health-problems that are currently not cared for if they are important to know for the patient’s current or future care. 1.3 Application of the rules for the

problem list: For every code of the ICPC-2 that usually should be stored in the problem-list an identifier was added in

The problem of this process is the dependence of the recommendations with the availability of certain elements in health records. These elements are not regularly part of the very different health records world-wide. To harmonize the recommendations with the elements of health records the WICC will seek closer collaboration with the Wonca informatics working group. Principally we want to emphasize that as the health record mainly serves to organize individual patient care the recommendations given can never be rules that have to be strictly applied. The recommendation should serve those who seek advice.

recorded were (i.e. in which list) in the record. The other part focusses on how often a certain code should be registered in the record. The rules were then applied to each code of the ICPC-2 independently by three researchers by adding a coded identifier referring to the appropriate list where the code should normally be recorded and how often. Disagreements were solved by discussion in the whole group. If necessary the recommendations were refined in this process. The intention was to create an electronic spreadsheet with the ICPC-2 codes and the corresponding identifier that might be integrated in electronic health records in order to support homogenous documentation and coding for example by giving prompts if a code is entered a second time that should usually be recorded only once (e.g. R96 Asthma).

Introduction

Title

On the electronic health record (EHR)of 5.4 million patients in Cataloniaattended by the Institut Català de laSalut (ICS) there are 78 millions IDC-10 diagnoses registered by primarycare healthcare professionals. Toassess the quality of these records andto promote their improvement wedeveloped the Quality DiagnosisStandard (QDS) feedback, whichprovides information to professionalsabout the follow-up of diagnosticcriteria for a series of health problems.Eighteen months after itsimplementation we assess anyimprovements produced.

Improving ICD-10 codification in primary care: the QDS feedback

Abstract IDC codification in electronic health record of primary care is made by healthcare professionals. The quality of diagnostic codification may improve with feedback of information. The QDS feedback provides information to professionals showing results and list of patients with diagnostics to improve quality. After 18 months, the feedback produces a mild-moderate improvement to the quality of diagnostic codification.


C412


Authors: M. Medina, E. Coma, F. Fina, L. Méndez, Caro J.Information system for primary care services. Information System Department.


Title

Methods & Materials

At the beginning of the study 81% ofthe selected treatments had aconcordant diagnosis, 51.19 % of thenew diagnoses had records of variablesor criteria that justified them, 60.88%of the patients with diagnostic criteriahad the corresponding code and13.33% of patients with asthma, COPDor heart failure had a specific recordfor severity or stage. Theimprovements after the feedback were2.38%, 3.18%, 4.50% and 35.14% foreach of the four dimensions. Theimprovements to new diagnoses ofheart failure with echocardiogram wentfrom a percentage of 19.82% to24.29%, and must be highlighted.

Results

We designed the QDS as a syntheticindicator that shows 4 dimensions: theconcordance between diagnoses andtreatments, the existence of electronicrecords for necessary criteria for newdiagnoses (e.g. glycaemia in diabetesmellitus), the existence of diagnosticcriteria without the requiredcodification, and the specificity of somediagnoses. Diagnoses included in QDSwere: high blood pressure, diabetesmellitus, chronic obstructive pulmonarydisease (COPD), heart failure, asthma,obesity, dementia, anaemia,hypothyroidism, osteoporosis,hypercholesterolemia, urinaryincontinence and chronic kidneydisease. In the creation of thisinformation only EHR structured data isused- the written notes that are notcodified are not used. From January2013 all primary care professionals(7,500) can examine the monthlyfeedback results using EHR and accessthe lists of patients with diagnosticcodes that do not meet quality criteria.The QDS results are included in thecontracts of the primary care teams asan objective, and frequently appear aspart of the pay per performancesystem for professionals. Eighteenmonths after the feedbackimplementation we evaluatedimprovements.

Conclusions

The feedback apparently produces amild-moderate improvement to thequality of diagnostic codification. It isprobable that the quality of thecodification was greater if we includedan analysis of the medical noteswritten by the professionals.

Figure 1. The QDS feedback. EHR view by healthcare professionals.

Dimension Outcome examples

Concordance between diagnoses and treatments

Diabetes drugswith/without diabetesmellitus diagnostic

Existence of electronic records for necessary criteria for new diagnoses

3 measures of bloodpressure and high blood pressure

Low TSH and hypothyroidism

Low haemoglobin and anaemia

Heart failure with echocardiogram

Existence of diagnostic criteria with the required codification

High glycaemia levels with /without diabetes diagnostic

Spirometry criteria with/without COPD diagnostic

Specificity of diagnoses

Asthma with specified severityCOPD with specified severityHeart failure with specified types

Table 1. Dimensions of QDS outcomes

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

%

Evolution of the results of QDS dimensions

concordance between diagnoses and treatments

existence of electronic records for necessary criteria for new diagnoses

diagnostic criteria with the required codification

specificity of diagnoses

Chart 1. QDS Dimensions: Results by month. A higher % means higher quality.

Introduction

Title

The wide concept of Diving orUnderwater activities does not apply toSport or Recreational diving, the mostcommonly known, but to underwaterrescue and savage, safety proceduresin harbours, submarine surveillance,engineering, archaeology, biology,underwater subsistence hunting inundeveloped countries, oil and gasextraction in oceanic platforms,maintenance of ships and aquaticfacilities, and military submarineprotection, among other fields. Regularunderwater activities are present inalmost the whole world. Diving iscurrently a very safe activity providingthat safety proved procedures arefollowed, but unfortunately theseguidances are not always applied, anda significant number of diving disordersand injuries (DDI) happen every yearproducing high morbidity and mortality.Being DDI widely polimorphicdisorders, their symptoms and signsare varied adopting atypical andspecific clinical forms that are not seenin any other kind of human pathology.Common DDI’s signs and symptomsinclude very serious spinal cord and/orbrain injuries, bone aseptic necrosis,pulmonary disorders, and extremelyserious haematological and rheologicalalterations. These disorders are notincluded in the syllabus of MedicalSchools thus many medical doctors arenot aware of the existence of DDIs.

A DESCRIPTIVE CLASSIFICATION OF DIVING DISORDERS AND INJURIES

Abstract A descriptive classification of Diving Disorders and Injuries is presented following chronological, ethiopatogenic,clinical, and morphological basic concepts. An alpha-numeric code, similar to the WHO’s diseases classification, can beapplied to any disorder making possible a quick, descriptive, and specific identification of any case. These classification hasproved to be useful in order to establish unified criteria for therapeutical, safety, reimbursement and still other purposes.


C413


Jordi Desola1, Jaume Canela-Soler2

(1) CRIS-UTH, the Hyperbaric Therapy Unit of Barcelona, Moisès Broggi Hospital, 08970 Sant Joan Despí, BARCELONA. (2) Preventive Medicine and Public Health Department, University of Barcelona.

Title

Methods & Materials


Results

A rational descriptive classification ofDDI is actually needed in order toprovide better communication, and toameliorate international procedures onresearch, assistance, prevention, andsurveillance.

This Classification, and over all thedescriptive codes provided, can behighly useful when an exact criterion isneeded, for instance in order toestablish therapeutical protocols, to joingroups of patients, or to definereimbursement polices for insurancecompanies. However it is not adequatedto be used for short clinical reports inoperational diving centres, or inemergency services. Several divingcentres are applying it satisfactorilyconfirming its utility in the dailypractice. The recognition and approvalof the WHO International ClassificationFamily would be very important in theworld’s domain of Diving and HyperbaricMedicine.

Chart 3: Etiopatogenic classification.

Chart 5: Morphologic Classiffication

Chart 2: Chronologic Classification

Basic English words but internationalconcepts have been used, in the goal ofproducing a classification that can beused, with minor changes, in a bigmajority of languages, and makingpossible an easy translation using everthan possible the same initial or similarpronunciation in the most commonlanguages.

Alpha-numeric codes, similar to theWHO’s diseases classification, aresuggested for each condition thus to beused as a reference in reports andcommunications.

Chart 1: More common signs, symptoms, and clinical forms of DDI. Source: CRIS-UTH.

Different linked classifications aresuggested based on the chronologic,etiopatogenic, morphologic, or clinical,approach to a DDI.

Chart 4: Clinic classification.

This Descriptive Classification of DivingDisorders and Injuries is completelyoriginal and based on the author’s ownexperience during more than 30 yearsin CRIS-UTH the oldest and mostactive Centre of Hyperbaric Medicine oftheir country. A preliminary draft waspresented in the 2nd ConsensusCongress of the European Committeefor Hyperbaric Medicine (ECHM), inMarseille, France, in 1996.

Conclusions

Introduction

Title

Verbal autopsy (VA) ascertains probable causes-of-death (CoD) through interviews carried out with caretakers of the deceased or witnesses of deaths. The method uses questionnaires to elicit information on signs, symptoms and circumstances leading to death, generically described as indicators, which are subsequently interpreted into CoD. The questionnaire data can be interpreted by either physicians (physician certified VA-PCVA) or by software (computerized coding of VA).

The method is most useful for application in surveillance sites and household surveys, and as a routine part of civil registration and vital statistics (CRVS) systems. The proliferation of different VA instruments has limited the comparability and consistency of CoD information across populations and over time. Due to these challenges and needs, WHO has produced the 2014 WHO VA instrument, that now includes indicators from the automated methods currently in use, such as the Tariff, InterVA and Random Forest methods.

Verbal Autopsy – Next Generation2014 WHO Verbal Autopsy Instrument

Abstract. Verbal autopsy (VA) is an approach used to ascertain probable CoD via interviews with the relatives or caretakers of the deceased. The 2012 WHO VA instrument was revised to enable the collection of information needed for multiple automated diagnosing software in a single platform that is still feasible for application in civil registration and vital statistics (CRVS) systems. To enable countries to adopt, integrate and implement VA into their civil registration, detailed guidance on the best ways to implement VA in routine systems, such as in Sample vital registration.


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Authors: Jordana Leitao, Robert Jakob

Title

Methods & Materials

Acknowledgements

Results- The 2014 WHO VA instrument

Figure 1- Process development of the 2014 WHO VA instrument

Application in Vital Registration

The 2012 WHO VA instrument was developed from experience with the use with existing VA instruments, include those from WHO, INDEPTH Network, InterVA and the Population Health Metrics Research Consortium (PHMRC). Feedback from the field-testing of the 2012 WHO VA instrument in Kenya and the need to have an international VA instrument that collects the information needed for multiple methods in a single platform, guided the development of the 2014 WHO VA instrument.

To make the necessary amendments to the instrument, an international working group was created with experts and users of VA from WHO, INDEPTH Network, InterVA, PHMRC, and various countries that have interest in the application of VA in their CRVS systems.

The resulting instrument comprises a total of 350 CoD-related indicators to certify 63 CoD mapped onto ICD-10. The instrument was specifically developed for automated ascertainment of CoD, and has a skip pattern embedded that embraces all age groups. Note that only a small subset of questions is usually asked.

The resulting instrument has 6 sections:1. Personal information 2. Information on the respondent3. Cause of death related indicators

• Medical history • General signs and symptoms• Signs and symptoms associated

with pregnancy • Neonatal and child history, signs

and symptoms • History of injuries and accidents • Risk factors• Health service utilization

4. Background and context 5. Optional open narrative text field6. Death certification and health

record (optional for use outside routine VA, e.g. for research environments)

Table 1- Number of entry-level questions by age group:(in brackets maximum number of questions)

Verbal autopsy can be used to complement routine cause of death registration. In view of the resources needed, Verbal Autopsy may be applied to samples, only.

Censuses can be used as sampling. Another option is to select people using multi-stage cluster sampling after stratification. Currently, best sampling practice is being discussed. For matters of sustainability, and for comparability of the results is seems that a Verbal Autopsy system should have a permanent structure, with dedicated human and technical resources.

The work would not have been possible without the contributions of the WHO Working Group for Verbal Autopsy: Shams El Arifeen, International Centre for Diarrhoeal Disease Research (ICDDR); DrPeter Byass, Umea Centre for Global Health; Dr Daniel Chandramohan, London School of Hygiene & Tropical Medicine; Dr Samuel Clark, University of Washington; Dr Edward Fottrell, University College London; DrBernardo Hernandez Prado, Institute for Health Metrics and Evaluation/UW; DrAbraham Flaxman; Institute for Health Metrics and Evaluation/UW; Dr Henry Kalter,Johns Hopkins Bloomberg School of PublicHealth; Dr Soewarta Kosen, NationalInstitute of Health Research and Development Indonesia; Dr Erin Nichols, National Center for Health Statistics, USA; Dr Arvind Pandey, National Institute of Medical Statistics of India; Dr Chalapati Rao, The University of Queensland; Dr Ian Riley,The University of Queensland; Dr Osman Sankoh, INDEPTH Network

Field testing Cognitive testing Suitability for Tariff

• Indicators essential for the functioning of the shortened Tariff method that were not included in the 2012 WHO VA instrument were added;

• Differently phrased questions were aligned and combined to become more comprehensive and clear;

• Added questions to certain age groups that are not separate in the Tariff;

• Adjustments were made to the level and sequence of questions to accommodate suggestions for improvement of the logical flow of the interview;

• Split complex questions into two or more to make the questions more understandable;

• Changed questions with a negative phrasing into positive ones to make them more understandable

• Format and wording of indicators were edited to improve understanding, retrieval, judgment and response of the question;

=132 more questions overall

module Perinatal Child AdultMedical history associated with final illness 19 19

General signs and symptoms associated with final illness 11 (26) 35 (113) 34 (102)

Signs and symptoms associated with pregnancy and women section

4 (42)

Neonatal and child history, signs and symptoms 43 (68) 16 (24) 1

History of injuries/accidents 1 (19) 1 (19) 1 (19)Risk factors 2 (4)Sum 55 (113) 71 (176) 61 (189)Increase compared to 2012 (maximum) +9 +75 +59

The questionnaire is available in different formats.1. Excel: readable and easily

understandable2. Formated for paper based input3. Open Data Kit (ODK) compatible to

facilitate and standardize implementation in electronic environments

Data linkage: the Enhanced Mortality Database projectThis project aims to improve information on Indigenous status on the registered deaths data set bylinking it to several additional data sources that contain information on deaths and Indigenous status:• Hospital Morbidity Data Set• Residential Aged Care Data Set• National Perinatal Data CollectionIt involves creation of an enhanced mortality database (EMD) containing enhanced Indigenous status information. The ‘ever-identified’ method was initially used in deriving enhanced Indigenous status. Alternative algorithms will be used in subsequent phases of the projectThe project is in four phases:1. Feasibility study and initial linkage

to create EMD2. Test feasibility of linking EMD with

‘gold standard’ database to assess validity of derived Indigenous status

3. Undertake complete linkage of EMD and ‘gold standard’ database to validate derived status

4. Ongoing linkage to create time series EMD for use in future research, and construction of life tables.

Data audit project The Indigenous under-identification in hospitals data quality study sought to identify correction factors for Indigenous identification, based on an estimate of current under-identification in hospital separation data at four levels:• national• national by remoteness• state and territory• remoteness within jurisdictions.For all states and territories, the level of under-identification was assessed through a data quality study in public hospitals that compared the results of face-to-face interviews with patients where Indigenous status was ascertained with the information recorded in the patients’ administrative records. Two such audits have been undertaken by the AIHW, in 2007-08 and 2011-12, based on a sample of separations in public hospitals throughout Australia.

Linkage projectThe linkage of the National Death Index to the additional data sets identified 10 per cent more deaths that were registered but were not identified as Indigenous. The proportion of additional Indigenous deaths identified tended to be higher in the youngest and oldest age groups.

Introduction

Significant disparities exist between Indigenous and non-Indigenous Australians leading to a significant gap in outcomes across a range of health and welfare measures. To combat this the Council of Australian Governments (COAG) announced 6 targets in 2007 focusing on early childhood (1), education (2), employment (1) and health (2). In 2013, an additional target on school attendance was also included. The health targets were: Close the gap in life expectancy between Indigenous and non Indigenous Australians by 2031; and halve the gap in mortality rates for Indigenous children under five by 2018. However, the extent of the gap and monitoring progress toward the closing of the gap is challenging due to the under identification of Indigenous people in many data collections. To address these issues the AIHW has embarked on a number of strategies. This presentation focuses on the use of data linkage and audits to assess and adjust for under identification in key data sets and improve the accuracy of mortality and life expectancy measures. It describes challenges in undertaking the work and results to date.

Assessment of the quality of Indigenous identification in

mortality and morbidity data sets using data linkage and audits

Abstract Since 2008, a number of targets were announced by the Australian Government in order to close the gap in Indigenous disadvantage. However, accurate estimation of the gap is affected by the level of under-identification of Indigenous people in many data sets. This poster provides an overview of the AIHW’s work to quantify and adjust for under identification in key data sets.


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Authors: Tetteh Dugbaza, Le Anh Pham, Jessica Zhang, Fadwa Al-Yaman

Australian Institute of Health and Welfare, Australia

Methods

Current estimates of Indigenous mortality suffer from:• imperfect identification of

Indigenous deaths in the death notification collection

• changes in coverage of the Indigenous population in successive censuses which affect estimates of the Indigenous Estimated Resident Population.

International collaboration

Results

Challenges

All of the issues mentioned above are common to some extent for other countries' Indigenous populations and hence the need for International collaboration to exchange information and expertise. The work described in this poster will be part of a discussion at the meeting of the International Group for Indigenous Health Measurements to be held in Vancouver, Canada, in October 2014.

Key challenges for this type of linkage work involving multiple data sets is the considerable length of time needed to access the relevant data for linkage from the data custodians and the multiple number of separate ethics committees required to approve the linkage work.

Chart 1: Per cent of additional deaths identified through the EMD, by age group, 2001-2006

Problems with Indigenous data quality and capture

Two approaches were taken:• The use of data linkage to enhance

Indigenous status information across mortality data sets

• The use of hospital audits to develop adjustment factors that can be used to enhance Indigenous identification on hospital morbidity data sets

0

5

10

15

20

25

0-4 5-19 20-44 24-64 65+ All ages

Data audit projectCorrection factors were calculated for each level, with an overall Australian adjustment factor of 1.14 in 2011-12. The results varied by jurisdiction and remoteness, with generally better identification in remote areas and in jurisdictions where a larger proportion of the population is Indigenous.

Introduction

Title

Since 2006, the French National Authority for Health (HAS) along with the French Ministry for Health has been committed to the development and implementation of hospital-wide quality and safety indicators to be used for internal quality improvement, public and patients’ information, and health services regulation (through both external evaluation and financial incentives). Accordingly, a core set of hospital-level process indicators based on retrospective reviews of randomly selected patients’ records have become mandatory for public reporting and hospital accreditation. They will soon be used in the national pay-for-quality program. The HAS focuses now on outcome indicators as they remain “the ultimate validators of the effectiveness and quality of medical care”. In order to minimize the time-consuming and costly task of collecting data from medical records, the development of patient safety and mortality indicators based on coded administrative data have been favored. A narrative review focusing on methodological issues and current use of hospital-level mortality indicators based on coded administrative data have been conducted by the HAS in order to establish some guidelines for the development of French national hospital mortality indicators.

Development and use of French hospital-level mortality indicators based on coded administrative data:

lessons from the literature

Abstract A narrative review focusing on methodological issues and current use of hospital-level mortality indicators based on ICD-10 coded administrative data have been conducted by the French National Authority for Health (HAS) in order to establish some guidelines for the development of French national hospital mortality indicators.


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Authors: M.A. Le Pogam1,2, C. Grenier1, S. Calmus1, C. Devaud1

1Haute Autorité de Santé, Saint-Denis La Plaine, France2 Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland

Title

Methods & Materials

Guidelines for development Risk-standardized mortality ratios should be favored because of their relative ease of interpretation and their international use.Definition: ratio of observed to expected number of deaths for one hospital X 100.Outcome: all-cause mortality following hospital admission for any conditions or for specific conditions/procedures that are highly prevalent, reliably coded in hospital administrative data and related to the quality of care processes and structures.Time-Frames: in-hospital all-cause mortality (HSMR), appropriate fixed-timeframe (30-day, 60-day or 90-day) all-cause post–index-admission mortality following admission for any condition (FT-RSMS any condition) or following specific condition (FT-RSMS specific condition), appropriate fixed-timeframe post-index-procedure (FT-RSMS specific procedure). Risk-modelling dataset: A 3-year national dataset of acute hospitals’ administrative data (PMSI-MCO) linked to the vital status information available in the National health insurance information system (SNIIRAM) and to the national cause of death register.Exclusion criteria from the dataset: day care admissions, stays of infants under one, records with palliative care (Z51.5), inconsistent or unknown vital status or unreliable demographic data, deaths before admission including brain death and organ donation.Numerator: observed number of deaths for one hospital occurring during the year of interest.Denominator: expected number of death for that hospital and for the same year estimated from a risk-adjusted model based on the 3-year national dataset.Risk-modelling on a development sample randomly selected from the 3-year national dataset: logistic regression model on each main diagnosis category or hierarchical logistic regression model adjusted on main diagnosis category.Main diagnosis clustering: the CCS for ICD-10 (Clinical Classification Software developed by AHRQ) should be used to assign each stay to a category of chief cause of admissionPotential risk-adjustment variables: socio-demographic factors (age, sex, deprivation index), comorbidities present on admission (recalibrated Charlson index based on secondary diagnoses or selected comorbidiesbased on clusters of ICD10 codes present in the secondary diagnoses of PMSI-MCO or identified from SNIIRAM in the 12 months prior to index-admission), severity of disease on admission: main diagnosis category , admission method (in emergency, transfert-in from an acute care…), SAPS II, period of admission,interactions between age and comorbidities or severity of disease, year of admission.Adjustment for hospital characteristics are not recommended.:FT-RSMS specific condition/procedure must be adjusted on specific comorbidities.

Results

HAS reference librarian performed comprehensive searches including several relevant electronic databases (MEDLINE, The Cochrane Library and CINAHL), key authors’ reference lists and, article or report reference lists. Electronic grey literature, key books, institutional websites and personal communication with experts in the field completed the search strategy.We included all references (in English or in French) between January 1997 and December 2013 focusing on conceptual and methodological considerations for 1) developing and validating mortality indicators based on ICD-9 or ICD-10 administrative data to compare hospitals 2) relating mortality measurements to the underlying quality of hospital care 3) using these indicators to concurrently drive internal quality improvement (QI), public accountability (PR) and regulation (R).

Conclusions

Two national projects currently aim to develop and validate French hospital mortality ratios (HSMR, FT-RSMS) based on ICD-10 hospital administrative data linked to the national insurance database and to the national cause of death register, to be used for internal quality improvement, public reporting, and health services regulation. Using hospital mortality ratios in pay-for-quality programs requires verifying the causal relationship between mortality and quality. Fixed-timeframe risk-standardized mortality ratio following specific condition/procedure should be considered.

Conclusion & Perspectives

Guidelines for validationValidation process should include testing for validity of the risk-adjusted models: Tests for calibration (Hosmer-Lemeshow chi-square test for goodness of fit), discrimination (area under the ROC curve) and explanatory power (pseudo-R2, AIC and BIC); cross validation on a validation sample randomly selected from the 3-year national dataset. Validity of coded data: Review of ICD-10 codes, CCs categories and risk-adjustment variables by an expert panel including clinicians and professional coders; external coding audit in a representative sample of hospitals; comparison between administrative data-based mortality ratios and medical-records based mortality ratios.Validity of the causal relationship between hospital-level mortality ratios and quality: Test for correlation between mortality ratios and other measures of quality (other hospital-level outcome, process or structure indicators, and accreditation decisions); external quality audit.

Guidelines for useValidated FT-RSMS should be favored for public reporting or regulation. HSMR may be more appropriate for internal quality improvement and peer-group benchmarking. Public reporting: Hospital mortality ratios should be compared to 2 or 3 standard deviation limits from a Poisson distribution accounting for overdispersion. Each hospital will then be assigned to 3 classes of mortality: higher than expected, inside the expected limits lower than expected. Regulation: hospital mortality ratios should be provided with their corresponding class of mortality and complementary information: time-trend analysis, peer-group analysis, regional analysis, structure and organisation of health services or hospital care that can affect patients’ outcomes. External audits should be conducted by health authorities or accrediting bodies for hospitals with higher than expected mortality ratios.

After removing duplicates, 1086 titles and abstracts were screened by two reviewers and 146 references appearing to meet inclusion criteria were reviewed in full. Various reports and websites from international organizations (OECD, WHO), national health authorities and accrediting bodies, research organizations, professional associations, consumer organizations, health insurers and health plans, private press agencies and rating companies were examined.

Introduction

Title

Problem to be addressed:The WHO-FIC survey administered in 2012 by WHO-SEARO reportedthat completeness of death registration is still inadequate in SEAR countries. 6 of 11 SEAR countries have estimated completeness of deathregistration under 50%. The remaining 5 countries have estimated completeness of death registration greater than 70%, with DPR Korea and Sri Lanka having 80-90% and Thailand at above 90%. Across all SEAR countries Cause of death (CoD)certification practices need strengthening, even in countries with high completeness of death registration, around half of COD’s are still ill defined. Thus rendering less accurate Mortality statistics for publicHealth decision making. Majority of deaths in the SEAR occur outside health facilities, for these community deaths, lay reporting needs to be supplanted with verbal autopsy. Medical certification of CoD practices for deaths in health facilities also needs strengthening, to ensure underlying CoD is correctly identified. Every minute, at least one woman dies from complications related to pregnancy or childbirth, every dying woman has a story to tell. That story can be captured using verbal autopsy lined to the Maternal Deaths Surveillance and Reporting (MDSR).

Strategic Contribution:

Mortality data collection in 57low income countries over 25Years from 1980-2004, shows that progress in obtaining Mortality statistics from CRVShas been negligible, only Increased from 5% to 9%.

There is an urgent need to adopt innovative means to obtain better mortality data from CRVS systems, and investment is these approaches is essential to make exponential improvements in CRVS systems over the next 3-5 year period

Abstract. Never in history has the pace of change of fertility and mortality been changing so quickly as in the past decade. Health decision-makers need reliable mortality data to make more targetedinterventions to help save lives. Proper mortality statistics would help produce more health for money and enable decision-makers to identify the leading causes of death and establish what the “most neededservices” are. The South East Asia Regional strategy for strengthening the role of the health sector in improving CRVS and the Electronic Cause of Death Integrated Reporting System (eCODIRS) have beendeveloped as enablers to improve mortality statistics from routine CRVS systems.


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Authors: Ms Jyotsna Chikersal, Regional Adviser Health Situation and Trend Assessment, WHO- South East Asia Regional Office(WHO-SEARO); Purvi Paliwal, Technical Officer, WHO-SEARO

Title

Methods & Materials


Results

With a focus to completeness of birth and death registrationand quality of CoD, in South East Asia Region of WHO, 8 of 11countries have undertaken comprehensive assessmentsof their CRVS systems using the WHO tool.

Electronic Cause of Death Integrated Reporting System (eCODIRS)-An Innovative Approach for generating better quality mortality statistics from routine CRVS systemsBased on the lessons learnt from the CRVS assessments, as Health’s contribution to strengthening CRVS, eCODIRS concept has been developed. The rationale behind the eCODIRS is to mobilize and empower community health workers to act as notifiers of births and deaths and to conduct verbal autopsies for deaths outside health facilities, thereby improving mortality statistics from routine CRVS data. eCODIRS is being piloted in Bangladesh, Indonesia, Nepal and Timor-Leste The application of VA techniques and data collection methods will be done either on nationally representative sample or complete coverage of the full population, based on the size of the population. The health sector is an important stakeholder both as a producer and end user of mortality statistics.

ECODIRS as an enabler to mobilize community health workers to notify births, deaths & conduct Verbal Autopsy for most probable COD

Conclusions

To strengthen mortality statistics from routine CRVS systems in the SEAR, eCODIRS & the Regional strategy offers a way forward to :

1. Galvanize political will and multi-stakeholder engagement in strengthening mortality statistics from routine CRVS as a critical development agenda

2. Generation of reliable vital statistics from civil registration data and their use in policy and decision-making

3. Use ICT as an enabler for community mobilization and building the capabilities of Community Health Workers for collecting quality CoD data, as well as notification of births and deaths and reporting of ICD coded Medically Certified Cause of Death (MCCD)

4. Create demand for health and vital statistics, enabling service delivery and planning

5. Engage Development partners for aligned and sustainable support for improving cause specific mortality data, based on nationally representative CoD data as in Table 1.

Table1: Clusters of countries in SEAR according to characteristics of CRVS systems and key recommendations for action

.

Based on the findings of the comprehensive assessments of CRVS, to provide unified direction and galvanize political commitment for strengthening mortality statistics from routine CRVS system, a “Regional Strategy for Strengthening the role of the health sector in Improving CRVS (2015-2024)” has been developed after many regional consultations

Benefits of eCODIRS:

Expected Value Impact of eCODIRS:

Innovative approaches to strengthening mortality statistics from routine CRVS systems in the South

East Asia Region

The authors gratefully acknowledges the support and contributions of all the governments and other agencies in the member countries of region that have extended support in piloting and peer reviewing the eCODIRS concept, developing the Regional Strategy for strengthening the role of the health sector in improving CRVS and in conducting the CRVS comprehensive assessments.

eCODIRS would support in better quality mortality statistics, based on nationally representative CoD data.Based on the lessons learnt from eCODIRS implementation, a Regional Strategy for improving mortality statistics in the SEAR countries would be developed

Countries (Population size)

CRVS strengths

Limitations Recommendations

India(1236.68 million)

Indonesia(246.86 million)

Bangladesh(154.69 million)

Legal frameworkHuman resources

Bangladesh has a nationally representative SVRS. ICD-10-based hospital reporting is increasing. An initiative for electronic lifetime health record for rural population began.

Administrative and accessibility challenges leading to patchy completeness; weak community awareness and barriers to access including costs. Lack of awareness and skills in certification.

Public awareness campaigns.

Removal of barriers to access.

Collaboration with funeral authorities to report deaths.

All deaths to be reported by age and sex with reporting by CHWs to registration authorities.

Sample Registration system (SRS) with VA for all deaths and MCCD to provide state/province level data

Scale up over 2–3 decadesThailand(66.78 million)

Sri Lanka(21.09 million)

DPR Korea(24.76 million)

High completenessEfficient data compilation

Poor cause ascertainmentLow utilization of data

Train physicians to accurately certify COD.

Introduce VA using WHO tools in collaboration with registration authorities.

Implement VA and validation studies on periodic basis

Analyse data using validation studies to generate periodic estimates for policy use

Myanmar(52.79 million)

Nepal(27.47 million)

Myanmar has a long history of data compilationNepal has increasing CRVS coverage in past decade

Poor completeness in all countries.

Lay reported COD, very limited implementation of MCCD for hospital deaths

Public awareness campaigns. Removal of barriers to access.

Collaboration with funeral authorities to report deaths.

All deaths to be reported by age and sex with reporting by CHWs to registration authorities.

Strengthen / implement SVRS with VA for all deaths.

In Myanmar and Nepal, first establish sentinel surveillance sites, to develop and test strengthened registration/ protocols

In all three countries, scale up over next 5–10 years to achieve full coverage by incremental growth of SRS sample cluster size

Maldives(0.33 million)

Bhutan(0.74 million)

Timor-Leste(1.11 million)

Small populationsHomogenous ethnicity++High or complete CRVS coverage, high MCCD – 96% deaths in facilities in Maldives

Human resources-High dependency on expatriate physicians who are employed short term

Geographic dispersion

Complete CRVS coverage VA for deaths outside hospital; strengthen MCCD

Introduction

Title

Accurate mortality and cause-of-deathdata are essential to public healthplanning. However, the quality of suchdata needs to be routinely assessed. Arecommended way of assessment is toquantify the proportion of deathsattributed to uninformative or ill-defined causes [1-4] also termedgarbage codes (GCs) [1, 4-5].

CARPHA maintains a regional databaseof cause-of-death data, populated bydata received from its member stateson an annual basis. We aimed to assesthe quality of the national mortalitydata in our regional database.

National cause-of-death data in the English- and Dutch-speaking Caribbean, 2000-2010:

A quality assessment

Abstract The Caribbean Public Health Agency (CARPHA) maintains a regional database of cause-of-death data, which ispopulated by data submitted by the English- and Dutch-speaking Caribbean. Data for the period 2000-2010 were extractedand analysed using four types of “garbage codes” developed by Naghavi et al. (2010) [1]. This was then compared to areview of CARPHA initiatives conducted over the same time period. The proportion of garbage codes observed variedsubstantially over time and between countries. There is evidence to suggest that CARPHA training initiatives have led to animprovement in the quality of cause-of-death data in member states.


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Authors: Sarah Crooks, Angela Hinds, Esther Bissessarsingh, Nicholas EliasCaribbean Public Health Agency (CARPHA)

Title

Results & Discussion

Data for the period 2000-2010 wasassessed and included: age, genderand ICD-10 underlying cause of death(UC) codes.

UC codes were grouped according tothe classification proposed by Naghaviet al. (2010) [1]. These are:

An analysis of the total proportion ofgarbage codes reported annually, forthe period 2000-2010 was conducted.

CARPHA initiatives to improve quality ofcause-of-death data, over the sametime period, were also reviewed. Suchinitiatives included training in ICD-10mortality coding and training ofphysicians in the correct completion ofmedical cause-of-death certificates.

Conclusions

Conclusions

Methods & Materials

Results are outlined in Table 1.For the 11 year period:• 211 country-years national cause-of-

death data available• 433,459 total deaths• Proportion of annual deaths attributed

to GCs varied widely by country andtime; ranges from 11% - 48%.

For the period 2000-2004:• 32% of reported data had 30-50% GCsFor the period 2005-2010:• proportion of reported data with 30-

50% GCs reduced to 12%.Reduction coincides with traininginitiatives which began in 2005 thattargeted mortality coding and physiciancompletion of medical cause-of-deathcertificates.

References

Type 1 Causes that cannot or should not be considered as underlying causes of death

Type 2 Intermediate causes of deathType 3 Immediate causes of deathType 4 Unspecified causes within a larger

cause grouping

1. Naghavi M, Makela S, Foreman K, O’Brien J, Pourmalek F, Lozano R. Algorithms for enhancing public health utility of national causes-of-death data. Population Health Metrics. 2010;8(1):9.

2. Zemach R. What the vital statistics system can and cannot do. American Journal of Public Health. 1981;(74):756–8.

3. Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Jha P, Stout S, et al. A scandal of invisibility: making everyone count by counting everyone. The Lancet. 2007 Nov;370(9598):1569–77.

4. Mathers CD, Ma Fat D, Inoue M, Chalapati R, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bulletin of the World Health Organization. 2005;83:171–177.

5. Murray C, Lopez A, Harvard School of Public Health, World Health Organization, World Bank. The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996.

The proportion and distribution ofGCs varies substantially over thetime period under review andbetween member states. This maybe as a result of variations in thelevel of training and understandingof both certifying physicians andmortality coders throughout theregion. Despite the variations, therehas been a general decline in theproportion of GC’s which may beattributed to the CARPHA traininginitiatives aimed at improving thequality of cause-of-death data.However, it is clear that furthertraining and education campaignsneed to be conducted and targetedto both certifying physicians andmortality coders.

The relationship between proportion ofGCs and knowledge of physicians andcoders was also documented by Naghaviet al. as a cause of differing distributionsof GCs over time and across countries [1].

An analysis of the different types of GCsfor each member country indicated that18 out of 21 countries reported deathsmost frequently attributed to GC Type 2.The reporting of intermediate causes ofdeath by certifying physicians indicatesthat either physicians do not know theunderlying conditions causing death or arenot sufficiently trained in completing themedical cause-of-death certificate.

Table 1 - Proportion of Deaths attributed to Garbage Codes by CARPHA Member State, 2000-2010

28,8

23,6

20,4

15,7

14,8

16,3

9,8

7,3

7,4

5,7

5,9

11,2

5,8

13,9

5,5

5,1

DC in Catalonia are being coded by Iris except the stillbirths DC, DCthat imply legal intervention and DC of deaths due to diabetes andhypertension because of certification problems. The results presentedrefer to all the DC coded by Iris (V4.2.3) corresponding to all deathsoccurred in Catalonia during 2013.

Since 2011, two methods to detect disagreements between manualcoding and Iris have been implemented:

1. A sample of 5% of the DC coded by Iris is manually recoded (meanof 300 DC monthly). From this review a short list (2013, N=63codes) of frequent discordant codes is issued. The list is updatedwhen inconsistencies are detected and solved. The short list includesall the codes that do not fit with some of the expressions in thedictionary.

2. A long list (2013 N=8,847 codes) of unusual underlying cause(UC) (not errors) previously defined is systematically checked andreviewed in all the already cases coded by Iris. The cases reviewedare infrequent codes or rare codes according to age and sex. Onlysome of these UC codes coincide with Iris “plausibility check” but thelist includes also a significant number of codes “other …” and“external causes”.

Introduction

The Mortality Registry of Catalonia (MRC)implemented the Iris automatic coding system in2010 after a preparatory period that involved:Comparison of Iris results with the formermanual coding (2006), development of abilingual dictionary (Catalan-Spanish) and thestandardization tables (2007-09), and a shorttraining in multiple causes coding (2009).The implementation of the Iris software for theautomatic coding of causes of death hasimportant advantages. It increases the internalconsistency of causes of death coding, improvesthe international comparability of mortalitystatistics and reduces the time spent in codingprocedures. In addition, taking in consideration“the time interval” information has been positivebecause MRC used not to consider it for manualcoding.The expressions used by doctors on the deathcertificate (DC) change over time and varygeographically, which requires periodic updatesof the dictionary.

The experience of Catalonia in coding mortality data with Iris

Abstract This poster describes the process of detecting incongruence in assigning code to multiple cause expression and of the improvement of the dictionary in the use of Iris software in Catalonia.


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Authors: Puigdefàbregas Anna1, Freitas Adriana1, Gispert Rosa1, Molina Purificació1, Gibert Alfred1, Zaragoza Sílvia1, Tresserras Ricard2

1 Mortality Registry, Department of health, Catalonia, 2 DGRPRS, Department of health, Catalonia

Methods & Materials

Among the 60,726 DC coded in the year 2013, about 7.4% of UC (4,512) was reviewed: 2,578 from the long list and 1,934from the short list. A 28% of those reviewed from the short list have been changed (57% of them were J988, 10% wereJ980, 14% were N18.-). Among the codes reviewed from the long list, 509 have been changed (20% of reviewed). UCreviewed are distributed throughout all the chapters of the ICD10.

Results

MRC has encountered some difficulties in assigning ICD-10 codes to frequent local medical expressions that are not alwaysproperly used by the certifiers and do not fit well with the expression included in the dictionary.It is necessary to improve the accuracy of ICD codes because a small shade of the expressions can determine the selectionof the UC of death.

Conclusions

Short list codes

DCreviewed

Changed ICD10 code Why are reviewed?

N % N %

A09.- 99 5.1 17 3.1Correct allocation of 4th character, and Iris UCselection

C77.- to C79.- 27 1.4 27 4.9Invalid UC (Iris rejected but not alwaysmanually corrected)

F05.9 0 0.0 0 0.0One expression=2 codes to choose manually(change introduced 2012)

F10 to F19 [.0] 0 0.0 0 0.0Difficulty in assigning code to ambiguousexpression

G21 [.8, .9] 14 0.7 12 2.2 Certification misleading

J98.0 162 8.4 53 9.7Difficulty in assigning code to ambiguousexpression

J98.8 905 46.8 311 56.8Insufficient accuracy of code regarding to usedexpression

N03.- 1 0.1 1 0.2 Not always primary disease

N18.- 519 26.8 75 3.7Difficulty in assigning code to ambiguousexpression: 4th character.

N28.- 15 0.8 7 1.3Difficulty in assigning code to ambiguousexpression

X59.9 192 9.9 44 8.0Insufficient accuracy of code regarding to usedexpression

Table 1:Detected cases in which the selection of UC can be improved and the reason of the review. Short list

I Confirm and clarify infectious germII D codes: check behavior (signs of malignancy?)

III-IV-VDifficulty in assigning code to ambiguous expressions (e.g. anemia, malnutrition, mental disorder)

VI-XIPrecise 4th character of ICD10 code. Considered "secondary" (certification misleading)

VII-VIII-XV-XVI Infrequent disease as cause of deathIX Local habits of certification X-XII-XIII-XIV Difficulty in assigning code to ambiguous expressions

XVIIDifficulty in assigning code to ambiguous expressions. Often Multiple Cause coded manually

XVIII To try to improve the accuracy of the code

XXDifficulty in assigning code to ambiguous expressions. Often Multiple Cause coded manually

Chart 1:Detected cases in which the selection of UC can be improved and the reason of the review. Long list

Chapters distribution (%) of DC reviewed (N=2,578)

Chapters distribution (%) of DC that changed ICD10 code (N=509)

Introduction

Title

To date, mortality coding training and support for the Pacific has primarily been provided on an ad hoc basis to individual Island Countries and Territories. While this approach may build capacity in-country, it can be expensive and has a short-term focus due to a lack of enabling factors such as poor candidate selection for training, and lack of continuing support for and recognition of people who have done the training. It has also not recognised the improved level of support that could be provided to Island Countries and Territories by taking a regional approach to building infrastructure and capacity that would be of broader benefit to all.

Abstract


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Sue Walker1 AJ Lanyon2, James Eynstone-Hinkins2, Nicola Hodge31Queensland University of Technology, 2Australian Bureau of Statistics, 3University

of Queensland

Title

Methods & Materials

Results

As no one single agency is responsible for vital statistics and civil registration in the Pacific, the Brisbane Accord Group (BAG) was established to coordinate, facilitate and support investments in health information systems. Partner agencies of the BAG include the University of Queensland, the Queensland University of Technology, the Australian Bureau of Statistics, Secretariat of the Pacific Community (SPC), UNFPA, UNICEF, Fiji National University, University of New South Wales and the WHO.

The BAG has recently sought country feedback on potential options to deliver a strengthened and sustainable model for mortality coding training and support for Pacific Island Countries and Territories.

The options presented for consideration were:

1. Establishment of long-term attachments for mortality coders in countries with more developed CRVS systems2. Sponsoring Pacific participants to study relevant degrees at regional universities3. Establishment of a mobile team of expert coders4. Establishment of a regional shared

resource centre.

Conclusions

Testing the model:

The model will be pilot tested by a mobile team in November 2014 in Fiji, after which a final proposal will be provided to the BAG to establish a more sustainable model to support causes of death coding and reporting across the Pacific. Funding has been provided to the ABS by the Australian Department of Foreign Affairs and Trade to support the pilot test.

Initial team members will include the ABS Program Manager for Health and Vital Statistics, two expert coders from ABS and QUT and an ABS staff member experienced in the use of Iris.

Specific outcomes for the pilot test have been established. These are to:

1. Test the viability of the model for providing support;

2. Discuss the issues and challenges in creating a regional shared resource centre. These relate to issues around countries sending uncodedhealth data to a regional centre for coding and analysis;

3. Remove the back-log of uncodedmortality data (within reason);

4. Provide on-the-ground capacity building and skills development in mortality coding;

5. Develop a formalised support mechanism for coding queries;

6. Provide basic summary statistics on mortality.

As a result of the outcome and recommendations from the Fiji pilot test, the next steps for coder support in the Pacific will be determined.

Fourteen countries responded to the survey with their preferences for short term and long term solutions.

Short term solution:

The majority of respondents favoured the establishment of a mobile team of expert coders.

The main reasons for supporting this model were• the ability of the team to provide

onsite training to staff, so that coders remain in-country (and able to perform their regular duties)

• the team could assist in clearing any backlog of uncoded data.

The second-highest rated model was sending coders overseas on attachments. However a number of respondents noted the significant time-lag in this approach, and the need to have appropriate solutions to address coding issues now.

Longer term solution:Respondents favoured the establishment of a regional shared resource centre, as an appropriate long-term solution.

Many countries felt that this option would not be suitable now, as work will need to be done on developing clear memoranda of understanding in regard to data sharing and maintaining confidentiality. Allowing coders to train overseas at universities was also rated as another possible long-term solution, once the short-term coding needs of countries are met.

VITAL STATISTICS - CAPACITY BUILDING IN PACIFIC ISLAND COUNTRIES AND TERRITORIES

A Pacific Vital Statistics Action Plan (PVSAP) has been developed with the aim of strengthening civil registration and vital statistics (CRVS) systems by supporting the building of capacity in the 15 Pacific Island Countries and Territories. While muchwork has been done on improving birth registration, more work is needed on strengthening death registration and certification, and the accurate coding and reporting of cause-specific mortality. A model for providing training and support for mortality coding to provide sustainable capacity in the countries is under development.

Introduction

Title

In order to improve the quality ofmaternal mortality information andevaluate the compliance with theMillennium Development Goals (MDG),since 2003 the Intentional Search andReclassification of Maternal Deaths(ISRMD) has been implemented by theMinistry of Health in Mexico supportedby the Mexican WHO FIC CollaborativeCentre (CEMECE).

This procedure involves research,documentation and analysis to confirmor correct the causes of:

a) maternal deaths (notified)

b) a selection of deaths among womensuspected of hiding a maternaldeath

To achieve this, it is necessary to carryout several activities throughout thecountry.

Beneficial effects of intentional search and reclassification of

Maternal Deaths in Mexico

Abstract On the occasion of achievement of the Millennium Development Goals, was implemented in Mexico since 2002the intentional search and reclassification of maternal deaths. This procedure has also contributed to: the ICD-10dissemination, monitoring the quality of death certificates out, training physicians on the correct filling of death certificatesand the detection of problems of maternal deaths coding, which must be corrected to improve the information.


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Torres L, Jimenez A, Rhenals A, Piña M, Urióstegui, R, Yáñez M.Mexican WHO FIC Collaborative Center, Mexico (CEMECE)

Title

Methods & Materials

a) Every year 10% to 30% ofmaternal deaths misclassifiedoriginally, have been found byinvestigating.

b) This procedure has improved thematernal mortality informationquality and changed the distributionof causes of death (higherpercentage of indirect obstetricdeaths and increased of O96 andO97 categories).

c) Representing an extraordinaryopportunity to conduct moretraining workshops for doctors in thewhole country to: i) fill out thedeath certificate correctly and ii)select the suspected cases.

Results

Activities:

1. Research and review of maternal deaths confirmed, by maternal mortality committees.

2. Review and ratification or rectification of the causes of death for the CEMECE.

3. Selection of female deaths whose underlying causes of death are:

i) ill-defined, ii) intermediate or iii) garbage codes, which are

suspected of hiding a maternal death.

4. Investigation of female deaths (suspected of hiding a maternal death) and ratification or rectification of the causes of death.

5. Seeking maternal deaths in other data sources.

6. Correction of official mortality data base and

7. Producing and disseminating of the annual report.

Results

The ISRMD has contributed to: Improving the reliability of maternal mortality information and general mortality.

One of the most important findings of the ISRMD is the necessity to review the ICD-10 coding procedures and definitions, particularly indirect obstetric causes to reduce the probability to misclassification. This activity is keyconsidering the MDG, because in 2016 the "Strategies for Ending Preventable Maternal Mortality (EPMM)“ should be implemented.

The difficulties in recording causes of maternal death, their codification and classification, have been recognized by the WHO FIC Network, that is why is mandatory to reduce the confusion attributable to the definitions and procedures in ICD-10, in order to improve the reliability, validity and interpretation of MMR among countries.

Fig. 1: Selection and investigation of confirmed and suspected maternal deaths,

2012

Fig. 3: Maternal deaths matched & misclassified , corrected after

investigation

Fig. 2 Workshop training for doctors and coders on filling out the death certificate

and ISRMD2013, Guerrero, Mexico

d) Difficulties in using the definitions and coding procedures of maternal mortality in ICD-10 have been detected, which affect the certification and coding procedures

e) Discussion papers and technicalreports have been elaborated: IRSMD

in Mexico, its effect in causes distribution: Torres L. et all. Salud Pública de México / vol. 56, no. 4, julio-agosto, 2014

http://bvs.insp.mx/rsp/suscripciones/

Conclusions

Proposals

1. Definition of maternal death. In the following sentence: "..but not from accidental or incidental causes“, the word incidental should be eliminated

2. A note or instruction: if a woman dies during pregnancy, childbirth or puerperium and presents severe infectious disease or a serious chronic disease, should be considered as indirect obstetric death, need to be included in ICD-10 [email protected]

Title

Quality of discharge summaries of Japanese Hospitals


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Osahiro Takahashi, Shozo Kawai, Shujiro Otsuka, Fumihisa Miyauchi, Kazuo Matsumoto, Koichiro Miki, Makoto Anan, Yasuo Arai, Toshio Oi

Japan Society of Health Information Management, Japan

Title

Methods & Materials

Abstract Discharge summaries including nonsurgical, surgical and mortality cases from 130 Japanese hospitals were collected, and 650 summaries of each group were analyzed according to their contents. Ninety nine percent of them were written with electronic health recording system, and their volume was two pages in average. The format of discharge summaries was not unified, but the actual description of summaries was satisfactory for most sections except for few items such as information related to allergy and ICD codes of final diagnoses. Discharge summaries are written for every single patient discharged from Japanese hospitals, but their quality in a few cases was found to be somewhat desired from the viewpoint of the importance of them in patient referral from hospital to clinic or nursing home. Standardization of discharge summary formats of discharge summaries were considered to be necessary.

Introduction

Discharge summary is completed for all patients discharged from hospital in Japan. They are used as a part of information provided to primary care institutions to which patients are referred, and the contents are very important in terms of smooth patient referral. However the quality of them had not been evaluated. We took a survey of discharge summaries of Japanese hospitals, and investigated the quality of them.

1. Format: The format of discharge summaries was not unified, but basically all summary forms included sections for final diagnoses, names of doctors, history of present illness, clinical progress during the hospital course and the final outcome.

2. Description: Ninety nine percent of them were written with electronic health recording system, and only 1% was hand-written. Their volume was two pages in average. The actual description of summaries was satisfactory for most sections, but information related to allergy and ICD codes for diagnoses were not included in some cases. Details of informed consent and discussion about the hospital course of patient were also not described in some cases. Descriptions regarding the findings at discharge were rather insufficient especially in surgical cases.

Results

Discharge summaries from 130 Japanese hospitals, including 16 university hospitals and 55 regional leading hospitals, were collected. They included nonsurgical cases, surgical cases and mortality cases, and 650 summaries of each group were evaluated for their contents.

Conclusions

Although discharge summaries are written for every single patient discharged from Japanese hospitals, their quality was found to be somewhat desired from the viewpoint of the importance of them in patient referral from hospital to clinic or nursing home. Standardization of discharge summary forms and education of doctors and health information managers regarding improvement of the contents of discharge summaries were considered to be necessary.

3. Underlying cause of death: underlying causes of death on death certificates corresponded to those from discharge summaries at the four character level of ICD10 in 56.3%, and the accuracy of death certificates was still rather desired.

4. Guideline and Manual: Some hospitals prepared guidelines and manuals related to discharge summaries. Many of them were basically focused on processes of summary making, and the instructions about the contents were not included in them.

0% 20% 40% 60% 80% 100%0% 20% 40% 60% 80% 100%

Discussion

Informed consent

Allergy

Final outcome

Findings at discharge

Hospital course

Findings on admission

Hx. of present illness

ICD of final diagnosis

Final diagnosis

Name of attending doctor

Discribed Not discribed

0% 20% 40% 60% 80% 100%

Graph1 Descriptions of discharge summariesNon-surgical cases Surgical cases Mortality cases

Non-surgical

cases

Surgical cases

Mortality cases

Total

Handwriting

8 7 6 21

Electricalrecord

642 643 844 1,929

Total 650 650 650 1,950

Table 1 1,950 Discharge summaries

Analyses included the following areas.1. Format of the summary2. Actual description of the summary3. Underlying cause of death in mortality

cases4. Guideline and Manual for discharge

summary

Introduction

Title

One of the main uses of electronic clinical records (ECR) should be supporting thedecisions at point of care. TheEQA is a synthetic indicator thatcombines 23 clinicalsubindicators, regardingdifferent diseases and clinicalsituations. It was designed in 2006 and the objective was toobtain an indicator that wouldmeasure quality of careprovided to a populationassigned to a primary careteam (PCT). Primary careprofessionals could consult theirclinical indicators in a websiteaccessible from theirworkstations, along with a listof their patients who are notmeeting the establishedcriteria. Since 2007, theinformation has been updatedmonthly and results for eachprofessional compared with hisor her surroundings and withtheir baseline scores.

EQA: A CLINICAL DECISION SUPPORT SYSTEM DERIVED FROM THE ELECTRONIC MEDICAL RECORDS


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Manuel Medina, Ermengol Coma, Francesc FinaSISAP, Barcelona

Title

Methods & Materials

Since early 2007 to december2013, the number of professionals accessing theirresults has remained between5000 and 6000 individualsevery month. This means that, on average, approximately 71% of all PCT professionals haveconsulted the site once a monthand 94% at least once a year.

Together with this relevant use of the online tool to view EQA results, an ongoingimprovement has beenobserved in most of the qualityindicators. Some examples are an increase of 134,3% (25,6% in 2007 to 60% in 2013) of patients with heart failuretreated with beta-blockers, 17% increase (56,6% to66,1%) of patients withadequate control of theirdiabetes mellitus 2 (HBA1c < 8%) or 30,8% increase (30,8% to 40,3%) in alcohol screening.

Only the flu vaccinationindicators decreased between2007 and 2013, probablyfollowing a global trend afterthe H1N1 influenza outbreak.

Acknowledgemnts or Notes

Results

Data used to compute the EQA indicadors are obtained fromthe ECR. Only codificated data are used: ICD-10 code fordiseases, ATC-7 forprescriptions and a local classification for laboratorytests and clinical variables.

The system stores the monthlyresults of EQA indicators foreach PCT along with theindividual access to thewebsite.

We study the evolution of theindicators and the accessesbetween January 2007 and December 2013.

Conclusions

The PCT use the providedinformation in a regular basissince 2007.

Almost all the monitorizedindicators increasedsignificantly in this period.

Table 1: EQA ICD-10 codes.

EQA would not be possible without the work of all healthcare profesionals of Catalan Institute of Health. We also thank all the people involved somehow in the process of the creation of EQA.

Figure 1: EQA website

Introduction

Title

Importance of the training corpus in an automatic diagnoses coding system

Abstract


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Authors: Conesa A1; Lozano-Rubí R1; Farreres R2; Castellon E2, Pastor-Duran X1. (1) Medical Informatics. Hospital Clinic- University of Barcelona. (2) Words for Knowledge Information Technology S.L.

Title

Methods & Materials

Results

With this refinement, we got to reducethe error rate of automatic coding to1.25% and reached coding rates near90%.

The last measure to optimize ourresults was taken on February 2012and consisted in the addition of a newlevel of analysis, primarily forexpressions corresponding to bonefractures, that involve an importantpercentage of the diagnoses in thedatabase.

Currently, our levels of automatic andcorrect coding in the ED exceeds 90%regularly.

The availability of solutions that enable automatic coding of clinical data allows facing diagnosis registration in medicalenvironments that on a daily basis generate large volumes of information. However, the quality of the initial data used in anautomatic diagnosis coding software is essential to ensure its efficiency and continuity.

The Emergency Department (ED) ofHospital Clinic provides care daily to350 patients which receive whendischarged a report that always has ,atleast, one diagnosis in natural languagereported by doctors. These diagnosesare also kept in our HIS.

Before the implementation of theautomatic diagnoses coding system(June 2010), the administrative staff ofthe area assigned an ICD-9-CM code toevery medical diagnosis using a cataloginstalled at HIS to help them. Thiscoding was not validated or supervisedlater.

Ruled out the possibility of manuallyencode emergency activity, we choseto implement a coding engine based onartificial intelligence technology thatallowed the semantic analysis ofnatural language expressions and theassignment of ICD-9-CM codes inrelation to available models, which inour case were codes and expressionspreviously assigned by administrativestaff in the ED.

CodingSuite™ is a platform thatreceives written diagnoses by a doctorthrough a web service and assigns anICD-9-CM code and a confidence index(CI) of the coding by analyzing thesemantic proximity in relation tomodels. In addition, it includes areview of coding software that adds tothe database new benchmarks with aCI=100. In CodingSuite™, thelikelihood of a code identifying adiagnosis is the result of the product ofprobabilities assigned to each level ofanalysis performed.

Initially, CodingSuite™ was trainedwith a corpus corresponding to oneyear of activity of the ED (130,000combinations of diagnoses and ICD-9-CM codes), and showed a highproportion of inconsistencies due tolack of precision in coding (over 15%of error). It was trained again afterrecoding by experts the most frequentinconsistencies.

Afterwards, the platform and the dailyreview of cases not achieving a 75% ofCI were both implemented in June2010.

During the first three months,percentages of automatic codingincreased, but we observed thatCodingSuite™ was assigning wrongcodes of diagnoses and was notlearning properly. Consistent errors inthe training data, resulted in adispersion of reference models aftersuccessive trainings and, as aconsequence, in a decrease of previousIC, in a gradual increase in the queueof errors to review and in a lower effectof experts proposals.

In January 2011, we decided to removeall the diagnoses that have not alreadybeen validated by experts (approx.60,000), and right after the percentageof wrong codes dropped dramatically to1%.

On March 2011, we took otheradditional measures like the automaticrecoding of the review queue, a higherfrequency (weekly) of databasetraining and a decrease of IC level from75 to 66%.

Figure 1: Automatic diagnoses coding with CodingSuite™.

Figure 2: Monthly and global results of automaticcoding. June-December 2010

CodedConfirmedReviewed

Conclusions

1. CodingSuite™ is able to learn tocode automatically diagnoses inan Emergency Department of ahospital.

2. However, the quality of the initialdata used with an automaticdiagnosis coding software isessential to ensure its efficiencyand continuity.

3. It is advisable a continuedmonitoring of coding results,especially in the early stages ofimplementation of such a system.

Figure 3: Monthly and global results of automaticcoding. 2011

Figure 4: Monthly and global results of automaticcoding. 2012



Introduction

Title

In the late 80s, all the regional administrations -named officially Autonomous Communities- of Spain, had transferred responsibilities to code the underlying death cause of Death Certificates from the National Institute of Statistic. This fact, promoted a growing regional interest to improve quality on mortality statistics, and therefore in medical certification of causes of death.

Autonomous Communities started to do workshops targeted to medical students and certifying physicians. In that sense, it raised the need for common materials and a teaching methodology to standardize the training of doctors, with goals focused on quality and comparability of mortality statistics.

Medical self-training in Death Certification The Certifica website

Abstract This free online course (www.murciasalud.es/certifica) is addressed to physicians to learn in didactic units: a) how to fill out correctly a Medical Death Certificate in the WHO international format; b) to understand the usefulness of a good certification of death causes, on vital statistics and health research; besides c) to do real and practical certifications, with commented evaluations. Furthermore, one of the units shows how to prepare and perform a face-to-face workshop. The Certifica could be adapted to national legislations and translated to other languages.


C425


Authors: Cirera L*, Aguinaga E, Navarro C, and Certifica group**.Regional Health Council of Murcia, Spain

Title

** Certifica group: Covadonga Audicana, Jesús Carrillo, Sara Cerdeira, Rosa Gispert, Beatriz González, Consuelo Martínez, Purificació Molina, Rosa Mª Pérez, Anna Puigdefàbregas, Agustín Roca, Miguel Ruiz, Luis-Alberto Sangrador, José Juan Rodríguez-Sendín, and their public institutions.

Chart 1. The Certifica principal selection screen: Presentation,

Decalogue, Credits & Agreements, Teacher’s materials for a workshop,

and the four Didactic Units

Chart 2. Example of one Death Certification exercise to fill in

What is Certifica?

Agreements

The Certifica was the output of a collaborative effort between four Autonomous Communities (Basque Country, Castile and León, Catalonia, Galicia and Murcia), with the initially support of the Ministry of Health, the National Institute of Statisticscollaboration, and later reinforced by the Physicians’ General College of Spain.

The Certifica was previously made in a compact disk, but from 2009 it was redesigned and located in a website (www.murciasalud.es/certifica), which is maintained by the Regional Health Council of Murcia.

Therefore, Certifica is a free self-training program addressed to physicians to learn didactically how to fill in properly a death certificate in four units:

1. Legal Issues2. Filling in a Death Certificate3. Utility of Mortality Statistics 4. Exercises on Certification

Legal Issues – Unit 01 reviews Spanish law aspects relating to medical certification of deaths. It also provides information about the court proceedings in any violent death or suspicious of criminality.

Filling in a Death Certificate -Unit 02 describes and explains death certificate sections, and how to fill in them properly; as well, others WHO concepts and recommendations. All of that, with examples.

Utility of Mortality Statistics -Unit 03 shows how causes of death could be analyzed in several indicators and described by age, time, place, and gender, plus their combinations.

Exercises on Certification –Unit 04 allows practicing real certifications, with on-line corrected results and commented evaluations.

The Certifica web pages had 25,996 accesses recently (1/1/2013 to date). Several visits came from a specific online course for physicians in their specialist training period in Murcia region.

This educational program could be adapted to national legislations and translated into other languages.

Chart 4. Summary evaluation of the exercises done of Death Certification

Contact

* Contact: Dr Lluís Cirera [email protected] or +34 (9)68 365747.

Chart 3. Commented results of a exercise of Death Certification

Background

• In Chile, the generation of VitalStatistics involves National Institute ofStatistics (INE), Civil Registration andIdentification Service (SRCeI) and theMinistry of Health, in compliance withthe interinstitutional agreements.

• All deaths are registered on the nationalmedical death certificate (CDM) accordingto the national decree No 460 dated in1970.

• The Statistics and Health InformationDepartment (DEIS) is in charge ofcoding of underlying causes of deathusing ICD-10. This process iscentralized at national level.

• The proportion of deaths certified bydoctors is 99.7.

• The proportion of ill-defined causes ofdeath (ICD-10: R00-R99) was 2.6 in2012.

• After finishing the generation processof mortality information, the officialinformation is published two yearslater.

• Strengthening of the quality ofmortality information is one the mostimportant goals of the NC and as anactive member of Latin American andCaribbean Network for improving vitalstatistics (RELACSIS), the NC startedactivities in 2013 to implement theMMDS adapted for using in Spanish byNational Institute of Statistics ofMexico (INEGI).

Mortality Medical Data System (MMDS) implementation process in Chile

Abstract This poster presents the activities carried out by the National Center of Chile for WHO FIC to implement theMMDS in the mortality coding. A field test conducted in June showed that the automatized coding is more reliable than themanual coding (93.4 % versus 81.2%). Maternal deaths, external causes and neoplasms were excluded of the field test.


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Authors: Carrasco X.; Piedra D.; Guerra E.; Velozo L National Center (NC) for WHO FIC from Chile, Ministry of Health

Title

Methods & Materials

Methods & Materials Methods & Materials

Phase 3 Integration of the coded fileto the National System of VitalStatitisc

The coded file (LOT) obtained in thesecond phase was integrated to themortality data base.

4. The field trial of updated MMDSversion was carried out on June thisyear focusing on:

•Feasibility, realibility and benefits ofusing the System. The timing by manualand automated codification was alsoconsidered.

A representative sample size was taken -268 death certificates (95% confidenceintervall and 7% error).

•Maternal deaths, external causes andneoplasms were excluded of the field trialdue to the limitations of MMDS for codifyingthese conditions.

•The cases coded by three coders and theMMDS were compared each other andwith the results of the Gold Standard(seniors coders from the NC)

•The results demonstrated that theMMDS is more reliable than manualcodification.

In order to test the MMDS a protocolwas conducted including the followingactivities:

1. Technical discussion about the MMDSrequirements with Lic. Javier Solisfrom INEGI and the national team.

2. Reviewing and adjusting theprocedures to register causes ofdeath as the MMDS requires.

3. Adapting the structure of themortality system for generating fileswith the same MMDS structure.

4. Training the national team (coders) ofDEIS.

5. The version of MMDS tested wasupdated including the latest versionof ICD-10 updates.

6. Coding field tests using the MMDS.

All necessary procedures were identifiedand modified before the field tests.

As results of these activities:

1. The MMDS was included in the flow ofgenerating mortality process on June,2013

Note: MMDS was included to the proces ofcoding and the coded files are integratedto the local label systems.

2. Training workshop on how to use theMMDS (handbooks and trainingmaterial were developed) on July2013

3. Technical meeting with INEGIadvisory on August 2013. In thismeeting all procedures were verifiedand the field trial was carried out inthree phases:

Phase 1 Information extraction

Internal processes were made easily toensure a complete register of causes ofdeath on the death certificate.

A sample of records was extracted fromthe National System of Vital Statisticsaccording to MMDS structure.

Phase 2 Coding process

Each component of the systems wastested: i) orthography checking, ii)MICAR application, iii) manualcodificationl U00, ACME softwareperformance and iv) evaluation.

All technical recomendations were usedto make sure:- dictionary use- local terminologies commonly used

and careful about accepting words orterms.(DICT.dbf and BBD.dbf files).

•The field trials shows the realibility andbenefits of using the MMDS and its keyrole to improve mortality informationquality.

•The MMDS is easy to use in real-lifecontexts in Chile. Around 65% of deathscould be coded by using the system.

•It is important to follow up the projectfor implementating the system bychecking and adapting local dictionaries.

•The National Center has developed aplan to implement the MMDS as a routineprocess.

Conclusions

Field trial of codification of Underlying Cause of Death, 2014

ProcessCorrect Wrong

Automatized 93.4% 6.6%

Manual 81.2% 18.8%

Further information:[email protected]@minsal.cl

http://www.deis.cl/

TitleStart

End

Deaths

National Institute of Statistics

Civil Registration and Identification

Vital Statistics System

Reports System

Coded Records

MMDS

File *dbf

File *.lot

Vital Statistics flow (Modified)

Ministry of HealthDEIS

Data base

closed

Virtual Course on Medical Coding Information basedon the International Statistical Classification of

Diseases and Related Health Problems, Tenth Revision (ICD-10)

Amanda Guadalupe Navarro Robles (CECACE-DF, México) Adriana Orellano (CACE, Argentina)

Introduction

Methods & Materials

Conclusions

Distance education is a particular way to createa space to generate, promote and implementsituations in which students learn. The virtualtutoring is a teaching activity performed by anexpert in distance learning and content withnew teaching strategies to guide learning, guideand facilitate the use of digital resources andeducational materials promoting interactionwith and among students through technologicalmeans, to motivate them to achieveautonomous learning based on the developmentof their potential which is done withoutgeographical, physical and temporal limitations.

Is the fact that there is a high mobility of staffencoder and formed into other areas not relatedto this activity a common reality. This hasgenerated the need for new methods such asthe use of Internet, in response to the growingdemands of training.

The course was held from 10 March to 31 May2014, with a duration of 300 hours, consisted of8 modules, including learning resources: ModuleStructure, Content (resource reading), GoodPractice exercises to be made by the student,slides related to each subject and the evidenceon important points, used for distance learning,which should be studied sequentially.

Theoretical and practical study modules:

Two groups where Mexico and Argentinacoordinated part of the region were generatedwas counted three tutors in each area, whoguided learning students, resolving doubts,controlling and directing the activitiesthroughout the course.

Initial and final evaluations were conducted andeach module so that the final evaluation of eachstudent's average.

After completing the course, a survey thatallowed to know the profile of the students, andtheir comments and recommendations areapplied at the same.

The course concluded successfully,confirming once again that distanceeducation is a viable and effective option.

Based on the positive experiences of thisfirst course at the request of the countriesin the region to train more coders, theRELACSIS felt the need to issue a secondcourse within the period betweenSeptember and December 2014.

Of the 58 students who completed thecourse, the majority are in the age group of35-39 years, followed by 30 to 34 andunder 30, which indicates that it has ayoung population, ensuring greaterpermanence active work in differentinstitutions and countries; with what theyhave opportunity to gain experience in theirworking time.

75% were female and 25% male. Just overtwo-thirds of the students perform functionsexpressed coding to ICD-10; in 23% ofthem, even their main activity is to code;while 29% do not perform this activity.

The principal activities of coding isperformed: death certificates, hospitaldischarges and outpatient.

37% of them said that has taught coding,which favors the formation of other coders,and will act as virtual tutors in the secondcourse; and will be supported for theircountries in future courses.

Regarding the interest aroused by thiscourse; students expressed their intentionto continue training on topics of mortality(43%), morbidity (30%), 26% in medicalprocedures, and 1% on other topics.

85% of students stated that the access tothe virtual environment was easy and 15%,it was very easy. Appreciation Course ingeneral is favorable; 91% said it was easy,and the remaining 9%, which was veryeasy.

41% of students indicated that theunderstanding of the different modules waseasy and convenient, 53% said it was toodidactic, and only 6% found it difficult tounderstand; therefore, 93% believe thatthis course is satisfactory andrecommended.

Results

1.Basics distance education2.Medical Terminology and Anatomy3.Overview of the International Classification ofDiseases4.Basic structure of ICD-105.The diagnostic coding6.Rules and guidelines for the recording andcoding of Mortality7.Rules and guidelines for the recording andcoding of morbidity8.statistical feature

Additionally, 2008 edition of the ICD-10.

currently encoding?

Age Group Sex

Its main activity is toencode?

Activities Coding

Interest receivable Training:

They have taught courses in coding

Findings of the environmentAccess to environment

Degree of satisfactionUnderstanding modules

Participating Countries



C427

For information: [email protected]@gmail.com

Abstract In the search for strategies for training in medical coding information, the need to create a training course e-learning was proposed, based on the existing in Mexico and Argentina, in order to contribute to the training of coders proper management of the ICD-10, using the virtual environment of the OPS. Derived from this design the content and the first course was held with this modality which lasted three months and the participation of 14 countries of the Region.

Introduction

The translation of classification updates is a necessary implementation step for non –English speaking countries. During the translation process, several problems may arise that should be considered in the classification implementation. These may be due to differences in language structure, or to differences between updates and official classification versions, or they may concern the position of updated terms/sentences within the text, or the choice of a lead term when the English term is an adjective, or the consistency with previous translations.

The collaborative effort to implement updated classifications: the lesson learned in developing and using web tools and services to translate, update,

browse, and publish ICD-10.

Abstract Web tools were developed to ensure translation consistency and publication of complete, searchable online versions of WHO-FIC, starting from ICD-10. The AVATARC translation environment as well as the files of updated ICD-10 volumes (2013 as a basis) that the Italian CC has prepared could be used by other countries. The publication rights of the online versions for implementation and update purposes need to be regulated with/by WHO.


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Frattura L.1, Grippo F.2, Frova L.2, Alicandro G.2, Tonel P.1, Simoncello A.1, Munari F.1, Castelpietra G.1, Terreni S.3, Veos C.31Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC; 2Italian National Institute of Statistics (Istat), Rome; 3Insiel, Trieste

Methods & Materials

ICD-10 Volume 1 ClaML file was updated both in English and in Italian. The ICD-10 browser was consequently updated in both languages. Similarly, Volumes 2 and 3 DOC files were updated. A list of problems with the previous Italian translation and with

Acknowledgements

Results

Considering the flowchart shown in Figure 1, ICD-10 cumulative updates 1996-2013 were translated. They were divided into two groups (1996-2009 updates and 2000-2013 updates), and the implementation years were taken into account, according to ISTAT needs for mortality coding purposes. The second group of updates was translated using a collaborative approach thanks to the support of web services available in the Italian Classification Portal. Volume 1 updates were loaded into a specific web platform (AVATARC) where both the English text to be translated and the proposed Italian translation were present (Figure 2). Comments on and proposals of translation modification were collected. After agreement on all translations was reached,

Conclusions

1. Agreement between Italian Ministry of Health and Friuli Venezia Giulia Region, 2010-2012; 2013-20152. "Progetto It.DRG", funded by National Health Service 2004 to realize strategical objectives under the National Health Plan, according to art. 1, comma 34, Law n. 662/1996 (CIPE Decision 23 March 2012 for assigning to the Emilia Romagna region the amount allocated for the realization of the "It.Drg Project").

The classifications updates translation is a challenge that requires the definition of rigorous criteria. Those who translate need to have available the different updated versions of the English ClaML files, for reference, in the same environment where the translation is shared. The AVATARC translation environment as well as the files of the updated ICD-10 volumes English version that the Italian CC has prepared could be used by other countries. It would be desirable to consider these issues as well as publication rights of the online versions for implementation and update purposes.



References1. Gongolo F., Simoncello A., Francescutti C. New tools for

translation in a collaborative web environment. WHO-FIC Network Annual meeting 16-22 October 2010, Toronto, Canada

2. Capezzuoli A., Grippo F., Saccoccio T. et al. ICD10 Online in Italian: new perspectives for users, epidemiologists and coders. WHO-FIC Network Annual meeting 12-18 October 2013, Beijing, China

Volume 1 ClaML file was updated in both languages (www.reteclassificazioni.it). Translation of Volumes 2 and 3 updates was done starting from DOC files. Translation of terms and definitions were verified and checked for consistency with previous translations by using the English and Italian ClaML files (2000, 2009 and 2013).

Figure 2 – Italian Classification Portal –AVATARC, view for users with REVISION grants

Figure 1 – «Inspirational» flowchart regarding the translation and approval of the ICD-10 updates: ICD-10 Italian implementation«rehearsal».

the English updates was prepared. Specific questions were submitted to the secretariat of the ICD-10 update process.

Introduction

Title

The Caribbean Public Health Agency(CARPHA) provides technicalsupport in the area of public healthto 24 member states (CMS) whichinclude all English- and Dutch-speaking Caribbean countries andHaiti. CARPHA was legallyestablished in July 2011 by an Inter-Governmental Agreement signed byCaribbean Community (CARICOM)member states and began operationin January 2013. The Agencycombines the functions (and muchof the staff) of five pre-existingCaribbean Regional Health Institutes(RHIs).

One of these RHIs, the CaribbeanEpidemiology Centre (CAREC), fromthe early 1990’s, provided technicalsupport to implement, evaluate andimprove use of the Family ofInternational Classifications (FIC) inthe Caribbean. CARPHA continues toprovide those key services andfunctions to all English- and Dutch-speaking Caribbean countries andHaiti. CARPHA has essentially beenworking in this area for over twodecades.

A review of CARPHA initiatives to support FIC Implementation in the English- and Dutch- speaking Caribbean over the ten year period 2004-2013

Abstract The Caribbean Public Health Agency (CARPHA) provides technical support to implement the Family ofInternational Classifications in 24 member states. In the area of strengthening mortality surveillance systems, CARPHAprovides training for mortality coders and physicians responsible for completing the medical cause-of-death certificate;evaluates existing national surveillance systems; audits coded data; develops applications tools to strengthen nationalsystems and acts as the regional repository for national mortality data. Recently, training for trainers in morbidity codinghas been completed and a plan to strengthen national health information systems has been developed.


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Authors: Sarah Crooks, Marsha Ivey, Angela HindsCaribbean Public Health Agency (CARPHA)

Title

Methods

Results

All activities conducted by CARECand CARPHA to implement, evaluateand improve FIC use in memberstates for the most recent 10-yearperiod 2004-2013 will be reviewedand presented.

Mortality Coding

Training Activities

• Four (4) members of CARPHA staff trained in ICD-10 mortality coding and underlying cause-of-death selection

• Eight (8) workshops conducted with participation from CMS

• MMDS introduced to CARPHA member states in 2007:• Installation and training in 13

countries conducted• Three (3) members of CARPHA

staff trained in MMDS.

Physician Training

Activities

• Instructional video on the correct completion of the medical cause-of-death certificate developed in-house in 2007• Video distributed to CMS and

regional training institutions• Video used by CARPHA as part

of face-to-face training sessions in 7 member states.

Technical Support to

CARPHA Member

States

• In-country support:• National mortality surveillance

system evaluations and mortality data audits conducted routinely in member states;

• Support to complete processing of cause-of-death certificates (data entry, coding, data analysis) as needed.

• Remote technical support: • Coordination of the Caribbean

Mortality Coders Network• Troubleshooting on mortality

coding and software-related issues.

Application Tools

• An in-house national mortality data capture and reporting system (Mortbase) developed:• Currently being used in at least

10 CMS• New version is currently under

development due to upgrades in IT operating systems and revisions to ICD.

Data Collection

• CMS submit annual mortality data to CARPHA

• Data are validated in conjunction with focal persons in member states

• Data are collated and stored in the CARPHA regional mortality database.

Outputs

• Production of routine cause-of-death reports, publications and conference presentations

• Physician training video on correct completion of the medical cause of death certificate

• Data shared with PAHO/WHOroutinely, for inclusion in reports for the Americas and for submission to WHO.

Results

Over the ten-year period underreview, CARPHA has providedtechnical support to strengthen FICimplementation in both the areas ofmortality and morbidity. In the areaof mortality surveillance, technicalsupport has been long-standing,while work to support morbiditysurveillance began in 2013.

Activities completed over the tenyear time period 2004-2013 aredocumented in Figures 1 and 2.

Figure 1: Mortality-related activities provided by CARPHA, 2004-2013

• Train-the-trainers workshop in ICD-10 morbidity coding in December 2013:• CARPHA staff (3 persons)

trained in ICD-10 morbidity coding

• Four (4) member states (10 persons) participated in a

• Training workshop funded and coordinated by CARPHA and facilitated by Sue Walker, Queensland University of Technology, Australia.

Morbidity Coding Training Activities

• Regional strategy for technical support developed for strengthening data availability data quality and use of information for health planning in the Caribbean region.

Technical Support to Strengthen National Health Information Systems

Figure 2: Morbidity-related technical support provided by CARPHA, 2004-2013

Conclusions

CARPHA has provided extensivetechnical support to member states tostrengthen national and regionalmortality surveillance systems.Furthermore, activities in the area ofmorbidity surveillance began in 2013.

CARPHA’s role in providing technicalsupport in FIC implementation throughtraining and education, evaluationsand audits and support in the area ofstrengthening health informationmanagement systems is critical forsustaining improved mortality andmorbidity surveillance for theCaribbean region and to support thework of the WHO-FIC network.

Over the time period under review,CARPHA has also participated innumerous network-related meetingsand is a member of the WHO-FICEducation and ImplementationCommittee, as well as a member of themortality forum.

Disease Pearson’s CC Stand. Admission Ratesmin max

Prevalencemin max

Hypertension 0.544 88.78 681.58 13.5% 39.7%

Heart Failure 0.589 238.87 908.21 1.2% 5.8%

Diabetes Mellitus 0.563 65.67 505.93 5.7% 16.9%

We found significant correlationsbetween the prevalence ofhypertension and the age-sex-standardized HTN admission rate, theHF prevalence and HF admission rates,and the DM prevalence andhospitalization rates for diabetic long-term complications (table 1).

Introduction

Title

Population-based hospital admissionsfor certain chronic conditions areassumed to be sensitive to ambulatorycare and serve as a proxy for quality ofprimary care. Institutions such as theAgency for Healthcare Research andQuality (AHRQ) and the Organizationfor Economic Co-Operation andDevelopment (OECD) use theseindicators - based on the ICD-10 codedprincipal diagnosis of an adulthospitalization - for comparative publicreporting.Previous research showed markedgeographic variations across all 16German states and indicated thatregional prevalence of the conditionhas a significant impact on admissionrates (chart 1).We investigated regional variations ofselected ambulatory care sensitiveconditions at the small area level.

Consideration of Small Area Health Disparities Using ICD-10 Coded Data: Association of Avoidable Hospital

Admission Rates and Prevalence Estimations

Objective

Research objectives are whether ICD-10 coded hospital admission rates of certain chronic diseases correlatewith small area prevalence estimates and whether adjustment for prevalence reduces regional variation.


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Drösler SE, Knorr S, Czihal T*, von Stillfried D*, Weyermann MNiederrhein University of Applied Sciences, Krefeld, Germany

*Central Research Institute of Ambulatory Health Care, Berlin, Germany

Methods & Materials

Age-sex-standardized admission ratesshow marked variation acrosscounties: Hypertension rates vary from97–682 per 100,000 population across23 counties of Thuringia. HF admissionrates vary from 357-908 across 36counties in Rheinland-Palatinate andDM long-term complications rates varyfrom 76-506 across 96 Bavariancounties (chart 2).

Results

We performed a retrospective cross-sectional study using 2011 hospitaladministrative data from the GermanDRG database administrated by theFederal Statistical Office. Forprevalence adjustment, an ordinaryleast squares unweighted regressionmodel was estimated for eachadmission rate using the prevalence asthe predictor variable. The studypopulation consisted of patients 15years or older discharged from 1692acute care hospitals across all 402German counties. The CentralResearch Institute of AmbulatoryHealth Care in Germany provided 2011prevalence data at the county levelincluding prevalence of Diabetesmellitus (DM), Hypertension (HTN),and Heart Failure (HF). These ICD-10coded data were estimated from theambulatory care diagnosis databaserepresenting about 90% of ambulatorycare treatment in Germany.

Conclusions

Between-county variation in chronicdisease prevalence may explain asubstantial proportion of variation inpotentially avoidable hospitalizationrates, thereby confounding unadjustedcomparisons across small areas.Performance measures that have beenstatistically adjusted are less variablethan unadjusted measures andillustrate the effect that adjustmentcan have on county rankings.

Chart 1: Association of DM long term admission rates and DM prevalence on state level (2010 data)

Chart 3: Hypertension admission rates before prevalence adjustment

Table 1: Age-sex standardized admission rates and prevalence, n= 402 counties and cities with county rights.

Variation among admission rates de-creased substantially after prevalenceadjustment, e.g. coefficient ofvariation dropped from 33.5 to 28.1for Hypertension (charts 3 and 4).

Chart 2: Ratios of minimum and maximum admission rates per state

State (number of counties)

Chart 4: Hypertension admission rates after prevalence adjustment

Prevalence adjustment has a subs-tantial impact on county ranking.Regarding the HTN admission rates, therank position of 55 counties was alteredby more than 100. A similar effectoccurs for DM (63 counties) and HF (56counties).

Contact: [email protected]

Introduction

Title

Long ago, primary health care professionals have been claiming the right to easily access to the datasets of their patients. Since now, in the primary care centres from de Catalan Institute of Health had a simple tool where you could list health problems o treatments separately and the output was in a pdf format. Because of this need, the DBS was designed and implemented.

DBS: BASIC HEALTH DATASET AVAILABLE FOR EVERY PRIMARY CARE PROFESSIONAL

Abstract A dataset of clinical data has been created according to the primary care professional needs. Professionals can query this dataset containing clinical data through a web form available from their computerized clinical record program. Formation has been done all around the territory. And this tool has been used for more than 20% of the professionals and its use is increasing month by month.


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Authors: Fàbregas M, Ramos F, Medina M, Camús J, Mercadé AInformation system for primary care services. Information System Department.


Title

Methods & Materials

243 reference professionals all around the territory have been formed on the use of DBS; and they had the duty to disseminate the knowledge acquired from the training. The data we present is from January to May 2014. 4,028 family physicians and 4,125 nurses have used the web form, making a total of 11,752 and 10,761 access respectively. It is 22.6% of the physicians that have used the tool at least once, and 20.1% of the nurses. The number of users increases progressively (chart 1): there were 698 physician users in January, 649 in February, 735 in March, 947 in April and 999 in May. For nurses was: 670, 542, 732, 1,078 and 1,103.


Results

Each family physician and nurse that has population assigned is able to easily query his patients’ dataset. This dataset is updated monthly. It contains, by patient, demographic data such as age, sex, nationality and date of last visit. It has a set of 37 chronic healthcare problems using ICPD classification to group the ICD-10 codes that use the computerized clinical record (table 1), 21 pharmacological groups containing all their active substances (table 2). It also contains 27 health variables referring to measurements, laboratory results, substance abuse data or tests (table 3). The queries to the dataset are made through a web form available from the computerized clinical record program and allow combining all the information available. The output is a list of patients with the values of the variables submitted and a virtual visit can be assigned to these patients in order to access to the computerized clinical record in 2 clicks. Training of the tool has been made throughout the territory.

Conclusions

We thank all the professionals who have provided ideas to improve the tool to make it more useful for them.

This tool has satisfied some of the primary health care professionals who had the need to consult data of their patients in order to improve quality of care or to perform small research on their patients.

Terminal care Chronic complex patient

Atrial fibrillation Stroke

Iron deficiency anaemia Anxiety

Sleep apnoea Osteoarthritis

Asthma Domiciliary care

Chronic bronchitis Ischemic heart disease

Dementia Depression

Diabetes mellitus 1/2 Dyslipidaemia

Epilepsy Goitre

Gout Benign prostatic hyperplasia

Liver disease Hyperthyroidism

Hypothyroidism Hypertension

Urinary incontinence Heart failure

Peripheral vascular disease

Migraine

COPD Malign neoplasm

Obesity Osteoporosis

Peptic disease Chronic renal disease

Coagulation disorders Valvulopathy

Table 1. Health problems available in the web form

NSAID Analgesics

Sedatives and hypnotics Antiplatelet and anticoagulant

Antidepressants Antiulcus

Cardiovascular not antihypertensive

Corticosteroids

Oral hypoglycaemic Insulin

Lipid-lowering agents Other antihypertensive

Beta blockers Calcium antagonists

Antihypertensive combination

Diuretics

ACE & ARA2 Drugs for asthma and COPD

Drugs for osteoporosis Drugs for prostate

Other psychoactive drugs

Chart 1. Number of users per month, 2014

0

200

400

600

800

1000

1200

1 2 3 4 5

Num

ber

of u

sers

Month

Physician Nurse

Table 2. Pharmacological groups available in the web form

Physical activity and advice

Alcohol consumption, tobacco consumption

Barthel, Pfeifer Creatinine, albumin creatinine ratio, glomerular filtration

Charlson index Total, HDL, LDL cholesterol, triglycerides

Blood glucose, glycatedhemoglobin

FEV1, FEV1/FVC

BMI, weight, height INR

Potassium Cardiovascular risk

Systolic and diastolicblood pressure

TSH

Table 3. Clinical variables available in the web form

Introduction

Title

The epSOS (European Patient Smart Open Services) project was set out to develop, pilot and evaluate cross-border ehealth services (Patient Summary and e-Prescription), to improve the quality and safety of healthcare for citizens when travelling to another European country.

Before the implementation of a cross-border service, a qualitative study of barriers and facilitators among health professionals (HP) was carried out to explore end-users views and attitudes of these services.

Abstract

The epSOS project was set out to develop, pilot and evaluate cross-border ehealth services (Patient summary and ePrescription). A qualitative study among health professionals was carried out to explore end-users views regarding the use, potential impact , barriers and facilitators.


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Moharra M1; De Cool1 M; Vallvé C2; Almazán C1.1. Agency for Healthcare Quality and Assessment of Catalonia2. Xarxa Consultors

Title

Methods & Materials

‘…There was a place where the higher category was cancer, and one of the side categories was "and other known cancers, disorders...". So this caused a serious problem where the patient appeared to have cancer in the Hungarian document, while in the original the patient had a kind of inflammatory disorder…’(man, physician).

‘


Results

Study Design:Qualitative analysis through two focus groups conducted with 7 physicians and 7 pharmacists coming from 6 Member States: Croatia, Finland, Hungary, Italy, Portugal and Spain. A semi-structured guideline was followed in both sessions (Table 2) Data AnalysisThe meetings were audio taped and transcribed verbatim. Emerging themes were grouped by category and the information was condensed, reflected and interpreted by all researchers. In the analysis, items that were discussed were interpreted as potential impact, barriers and facilitators to epSOS services.

Discussion

Strengths and limitations of coding within health records and drug terminology have already been discussed in previous studieshighlighting the need to reach consensus among health professionals and alignment of guidelines in order to avoid erroneous input and ensuring medical safety.

Recent studies on cross-border services have highlighted the need to harmonise health information in order to improve continuity and quality of care across Europe.

Table 2: Focus group guideline

1. Round of introductions

2. A 10-15 minute overview of epSOS project (with simulation service)

3. Debate 1. Experience with epSOS

¬Opinion on aspects related to the experience with epSOS (usability, availability, access, language,privacy, patient safety, etc.)

¬What are the potential advantages of epSOS

¬What are the potential disadvantages of epSOS

4. Debate 2: Barriers and facilitators. Exploring Barriers and facilitators for the implementation of the epSOS Service

¬What factors facilitate using epSOS services

¬What factors prevent using epSOS services

Opinions and attitudes among health professionals towards the coding of clinical information: lessons

learnt from the epSOS project.

Setting:The study was performed with physicians and pharmacists coming from the Participating Nations piloting epSOS services: patient summary and ePrescription (Table 1).

Service Content

Patient Summary Demographic information: age, gender.Clinical information: allergies, diagnosis, medical devices, implants and surgical procedures.

ePrescription The ePrescription service includes the currently available ePrescriptionsfor the medications that could be dispensded in the patient’s home country at that moment.

Conclusions

• The differences between European countries regarding its coding systems is an issue affecting any cross border project, epSOS not being an exception.

• To implement a cross-border ehealth service physicians and pharmacist should trust in the clinical information.

Main themes identified and selections of HPs’ comments

• The results may inform key aspects to European and national authorities in the development of standardise guidelines to facilitate the implementation of a cross-border ehealth service.

1. Data reliability in relation to the coding system, was the most often recurring barrier. Participants were mainly concerned with the differences between coding systems used by European countries, either for clinical information or for drugs.

2. Conversion between coding systems and problems related to transcoding were seen as a threat for data reliability, which can generate serious discrepancies in data and can induce critical errors.

The idea is amazing, brilliant, but the project itself needs improvement. One improvement is the coding system, definitely, and what will happen with the drugs, with the two or more active substances, ingredients. We don't have a solution for that…’(woman, pharmacist).

3. However, transcoding was seen as unavoidable, because of the huge amount of data involved. There was consensus on the idea that physicians should be aware of the risk of losing or inaccurate information due to transcoding.

‘…if you're going to transcode then it would mean that every country would have to have their own local versions of ICD9CM, ICD10 and later ICD11. And this means that this is a huge burden of work. It's much easier and much more manageable to do the transcoding and accept the possible loss …’(physician, man)

The epSOS project was partially fundedunder the ICT Policy Support Programme(ICT PSP) as part of the Competitivenessand Framework Programm by the EuropeanCommission.

Table 1: Patient sumamry and ePrescriptiondata set

Introduction

Title

Total hip replacement (THR) is one of the most successful and cost-effective medical interventions.

However, recent studies have raised concerns on an increased risk of potentially lethal events in the weeks/months following surgery.

Early mortality following THR can have not only an obvious effect on patients but also on healthcare systems by dramatically reducing cost-effectiveness.

We therefore aimed to develop and validate a clinically useful predictive tool to identify patients at high risk of death in the year following primary elective THR surgery.

A tool to predict post-operative mortality in the firstyear following total hip replacement surgery: results

from the PRESS-UP cohort study.

Abstract Total Hip Replacement is one of the most cost-effective interventions available. We propose an eHealth tool that can be used to identify patients at high risk of early (1-year) mortality following THR surgery.


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Authors: A Roso1, C Tebe2, M Espallargues2, J M Pons2, and D Prieto-Alhambra1,3

1.Idiap Jordi Gol, Barcelona, Spain; 2. Agency for Health Quality and Assessment of Catalonia (AQuAS); 3.Musculoskeletal Epidemiology, NDORMS, University of Oxford

Title

Methods & Materials

Out of 11,427 patients with THA, 251 (2.2%) patients died in the year following surgery.

The final set of predictors in the model, and their odds ratio/s, are reported in detail in Table 1.

Value for the area under the ROC for death was 85.2%. HL goodness of fit test and observed and expected plots (Figure 1 and 2) showed good calibration.


Results

Design and participants: We conducted a population-based cohort study using routinely collected data from computerized primary care records and pharmacy dispensations covering >80% of the Catalan population (www.sidiap.org) linked to the Catalan Arthroplasty Registry (RACatfor its acronym in Catalan language). All patients undergoing a THR in 2005-2012 (according to RACat) for any reason excluding hip fracture or cancer were included. Data on pre-specified (based on previous literature) potential predictors of early mortality were obtained from the SIDIAP database.

Measurements: a) Outcome: death in the year following primary elective THR surgery. b) Potential predictors: age, gender, body mass index, smoking, alcohol drinking, previous osteoporosis/fractures, diabetes, auto-immune conditions, anxiety/depression, Charlsoncomorbidity index, number of primary care visits (previous year), indication for THR, and drugs usage in the previous year: non-steroidal anti-inflammatories, oral steroids, atypical analgesics, anticoagulants, anti-osteoporosis drugs, antibiotics, antidiabetics, aromatase inhibitors, proton pump inhibitors, tricyclic antidepressants.

Statistics: Logistic regression models were fitted to model the association between these predictors and death. Backwards-stepwise methods were used to identify key predictors in these models. Discrimination of the final model was assessed using area under the receiver operator curve (ROC), and calibration was studied using predicted vs observed risk plots. Multiple imputation by chained equations was used to handle missing values.

Conclusions

The PRESS-UP Study is funded by the Spanish Government of Health (Instituto de Salud Carlos III, FIS Grants 2011).Daniel Prieto-Alhambra receives partial funding from the National Institute for Health Research (NIHR, United Kingdom).

A simple clinical predictive tool including patient characteristics, lifestyle factors, indication, co-morbidities, previous primary care visits, and drug usage is able to accurately predict 1-year mortality following THR.

External validation of the tool is needed to ensure applicability to different populations.

This could be used as an eHealth tool to inform patients and physicians about potential risks and benefits to expect from planned THR surgery.

Table 1: Predictors of 1-year mortalityfollowing THR in the final model.

Odds Ratio 95% Confidence

Interval

Age (per year) 1.08 1.06‐1.10

Gender Women 0.62 0.46‐0.85

BMI <25 (REF) REF

25 to <30 0.58 0.41‐0.82

30 to <35 0.42 0.26‐0.70

35 or above 0.44 0.23‐0.86

Charlson Index 0 REF

1 1.83 1.18‐2.85

2 1.49 1.01‐2.20

≥3 2.04 1.44‐2.89

Polyarticular OA 0.71 0.52‐0.97

Previous fracture 0.70 0.47‐1.04

Previous GP visits Lowest (1st

quintile)

REF

Highest (5th

quintile)

1.61 1.17‐2.20

Smoking Never REF

Current 1.95 1.13‐3.39

Alcohol drinking None REF

Mild / Low risk 0.57 0.37‐0.90

Indication Hip OA REF

Inflammatory

Arthritis

2.74 1.67‐4.49

Others 4.97 3.48‐7.09

Avascular

Necrosis

0.41 0.19‐0.85

NSAID use Lowest (1st

quintile)

REF

4th quintile 0.60 0.41‐0.89

Anticoagulants 2.00 1.26‐3.18

Calcium/D

supplements

0.65 0.46‐0.92

Aromatase

Inhibitors

2.99 1.26‐7.07

Figure 1: Predicted versus Observed number of Deaths

Figure 2: Observed versus Predictednumber of deaths (Y axis) for each riskdecile (X axis).

Introduction

Title

International comparisons allow to identify differencesin practices that could have impacts on healthcarequality outcome indicators.

Objectives:

To compare symptomatic venousthromboembolism events (VTE) thatoccurred in hospitalized patients undergoinghip arthroplasty among five countries(Switzerland, France, Canada, New-Zealand andthe State of California-US).

To explore potential factors that couldexplain differences between these countries.

An International Comparison of Venous Thromboembolism Events Occurring in Hospitalized

Patients Undergoing Hip Arthroplasty: Potential Confounders May Impact Results

Abstract Aims: To perform international comparisons of venous thromboembolism events (VTE) that occurred in hospitalized patients undergoing hip arthroplasty among five

countries (Switzerland, France, Canada, New-Zealand and the State of California-US) and to explore potential factors that could explain differences between thesecountries.

This study showed that important confounding due to various practices between countries should be taken into account to interpret the results. Limitations include thepossible under-coding of ultrasonography examination in several countries.


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Jean-Marie Januel1,2, Bernard Burnand2, William A. Ghali3, and The International Methodology Consortium for Coded Health Information (IMECCHI)

1University Institute of Graduate Studies and Research in Health Care, University Hospital of Lausanne, Lausanne, Switzerland2Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland

3Department of Community Health Sciences, Institute of Public Health, University of Calgary, Alberta, Canada

Methods & Materials

Using hospital routine data from three consecutive years, a totalof 63’661 hospitalized patients undergoing hip arthroplasty wereincluded from Switzerland, 419’736 from France, 99’697 fromCanada, 14’235 from New-Zealand, and 103’840 from the Stateof California, USA.

Total VTE occurred in 0.37% (0.32% - 0.42%) of these patientsin Switzerland, 1.41% (1.37% – 1.44%) in France, 0.16%(0.13% – 0.18%) in Canada, 0.84% (0.69% – 1.00%) in New-Zealand, and 0.66% (0.61% – 0.71%) in California.


Results

We thank all other co-authors of this study: Chantal M Couris(Canada), Phil Hider (New-Zealand), Richard H. White (California,USA), Hude Quan (Canada), Beate Danielsen (California, USA), MinhDuong-Hua (Canada), Marie-Annick Le Pogam (Switzerland), CyrilleColin (France), and Patrick S. Romano (California, USA).

The Swiss part of this study was supported by a Sinergia grant(CRSII3_132786) from the Swiss National Science Foundation (SNSF),Bern, Switzerland.The French part of this study was supported by the French Ministry ofHealth and the Haute Autorité de Santé.

This study showed that important confounding due to various practices between countries should be taken intoaccount to interpret Patient Safety Indicators. Two key issues resulted from this study: First, differences inpractices across countries provide information for a better understanding on health systems and on hospitalorganization. Second, this study clearly raises the question of choice and of level of variables to be included in amodel for appropriate risk-adjustment in comparisons. One limitation was the possible under-coding ofultrasonography in the participating countries.

In conclusion, potential confounding factors should be identified and considered in, international, comparisons.These factors may help to better understand differences due to the different organization of healthcare systems.

Conclusions

CONTACT: [email protected]

Cross-sectional study in five countries (Switzerland,France, Canada, New Zealand, State of California,USA). Routinely collected hospital discharge summariesfor acute care patients. Independent analysesconducted in each country.

VTE occurrence rates in hospitalized patientsundergoing hip arthroplasty were calculated usingthe corresponding Patient Safety Indicator (PSI)*.

Occurrence rates of symptomatic deep veinthrombosis (DVT) and pulmonary embolism (PE)were calculated similarly.

We compared estimates from each country againstan external benchmark (evidence-based)estimating the pooled rate of in-hospitalsymptomatic postoperative VTE occurring inpatients undergoing hip arthroplasty and whoreceived appropriate prophylaxis using a meta-analysis (Januel et al. JAMA. 2012).

We explored potential confounding factors toperform comparisons using univariate analyses.

We used Poisson regression models (independentlyfor each country) to assess incidence rate ratio(IRR) as relative risk (RR) using an identical set offactors.

A. Relation Between VTE (PSI 12) and the Number of Secondary Diagnoses Increase B. Relation of the Distribution of Secondary Diagnoses and VTE

0.00

0.01

0.02

0.03

0.04

0.05

Ob

serv

ed p

roba

bilit

y of

VT

E

3 4 5 6 7 8 9 10=<2 11+

Number of Second Diagnoses Coding Fields

Switzerland France Canada New-Zealand California-US

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Ob

serv

ed V

TE

occ

uren

ce r

ate

(%)

0

1

2

3

4

5

6

7

8

9

10

Med

ian

num

ber

of s

eco

nda

ry d

iagn

ose

s

Switzerla

nd

France

Canada

New-Zealand

California-U

S

COUNTRY

SDx VTE 95% Confidence interval

Q1 Q2 Q3 Q4

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Ob

serv

ed e

ven

t occ

ure

nce

ra

te,

%

VTE DVT (only) PE (only) DVT+PE

Type of thromboembolic events stratified by quartile (Q) for systematic ultrasound

Independent variables Switzerland France Canada New-Zealand California - US

IRR (95% CI) IRR (95% CI) IRR (95% CI) IRR (95% CI) IRR (95% CI)

Sex (F) 1.05 (0.81-1.37) 1.36 (1.29-1.44) 1.08 (0.78-1.49) 1.01 (0.70-1.47) 1.07 (0.92-1.25)

Age, y

≤59 (Reference) 1.00 1.00 1.00 1.00 1.00

60-84 0.75 (0.49-1.13) 1.45 (1.33-1.58) 0.63 (0.37-1.06) 0.85 (0.49-1.50) 1.11 (0.87-1.42)

≥85 0.65 (0.40-1.07) 1.42 (1.28-1.59) 0.46 (0.26-0.84) 0.54 (0.28-1.06) 0.85 (0.63-1.13)

LOS, d

≤7 0.82 (0.58-1.15) 0.75 (0.69-0.82) 0.24 (0.13-0.45) 0.23 (0.13-0.39) 0.20 (0.16-0.24)

8-17 (reference) 1.00 1.00 1.00 1.00

≥18 2.22 (1.62-3.05) 2.00 (1.88-2.14) 1.72 (1.20-2.46) 1.46 (0.89-2.38) 1.40 (1.08-1.82)

SDX, count

≤2 (Reference) 1.00 1.00 1.00 1.00

3-6 4.44 (2.99-6.59) 1.61 (1.51-1.71) 4.71 (1.99-11.18) 7.73 (3.79-15.76) 4.22 (2.12-8.41)

7-10 13.27 (8.55-20.61) 2.07 (1.88-2.27) 12.01 (4.81-29.98) 10.54 (4.60-24.13) 11.44 (5.79-22.60)

≥11 18.95 (10.52-34.13) 2.48 (2.16-2.84) 20.68 (8.10-52.83) 9.47 (3.38-26.50) 18.49 (9.29-36.80)

Co-morbidities

Cardiac arrhythmias 1.04 (0.73-1.48) 1.03 (0.95-1.12) 0.73 (0.37-1.43) 0.71 (0.41-1.25) 1.14 (0.96-1.35)

CHF 0.68 (0.41-1.13) 1.19 (1.06-1.35) 0.69 (0.32-1.50) 0.69 (0.33-1.45) 0.86 (0.70-1.07)

COPD 0.69 (0.42-1.15) 1.04 (0.94-1.15) 0.86 (0.39-1.86) 0.89 (0.41-1.90) 0.90 (0.75-1.08)

Diabetes 0.83 (0.56-1.21) 0.84 (0.76-0.92) 0.82 (0.55-1.21) 0.53 (0.26-1.05) 0.71 (0.58-0.87)

Renal Failure 0.51 (0.32-0.83) 0.89 (0.75-1.04) 1.18 (0.48-2.91) 0.78 (0.37-1.66) 0.89 (0.72-1.10)

Rheumatic disease 0.20 (0.03-1.37) 0.78 (0.57-1.07) 1.04 (0.14-7.74) 1.64 (0.63-4.27) 0.59 (0.38-0.93)

Liver disease 0.48 (0.15-1.56) 0.70 (0.53-0.94) 1.60 (0.39-6.54) 1.86 (1.00-3.46) 0.69 (0.42-1.15)

Coagulopathy 2.40 (1.42-4.07) 1.65 (1.34-2.03) 1.46 (0.46-4.59) 3.70 (1.89-7.26) 0.89 (0.66-1.18)

Any tumor 0.70 (0.33-1.48) 1.25 (0.89-1.75) 1.73 (0.73-4.10) 0.33 (0.04-2.63) 1.29 (0.82-2.02)

STWM 0.97 (0.42-2.27) 1.23 (0.98-1.56) 1.00 (0.33-2.99) 0.32 (0.08-1.31) 1.82 (1.30-2.55)

Dementia 0.74 (0.46-1.21) 0.89 (0.78-1.02) 0.90 (0.52-1.55) 0.40 (0.20-0.81) 0.54 (0.37-0.79)

Obesity 0.74 (0.45-1.23) 1.08 (0.98-1.20) 0.34 (0.05-2.57) 1.04 (0.82-1.33)

Ultrasound procedure code 10.64 (4.21-26.86) 6.15 (5.84-6.48) 3.98 (2.76-5.74)

Death 7.08 (4.69-10.68) 2.52 (2.18-2.91) 3.44 (2.20-5.39) 2.98 (1.25-7.11) 3.52 (2.63-4.73)

Year

First (reference) 1.00 1.00 1.00 1.00 1.00

Second 1.01 (0.74-1.38) 0.98 (0.92-1.04) 0.62 (0.42-0.92) 1.10 (0.71-1.69) 0.97 (0.81-1.15)

Third 0.95 (0.69-1.31) 1.06 (1.00-1.12) 0.81 (0.56-1.16) 1.07 (0.68-1.68) 0.84 (0.70-1.01)

Model Performance

LLnull / LLmodel -1 556.20 / -1 336.97 -31 052.99 / -27 704.05 -1 177.1 / -953.67 -688.34 / -582.49 -4 129.53 / -3 482.89

LR test (P value) 438.46 (<.001) 6 697.88 (<.001) 446.85 (<.001) 211.69 (<.001) 1 293.28 (<.001)

Deviance GOF (P-value) 2 201.94 (1.000) 43 612.09 (1.000) 1 591.35 (1.000) 926.98 (1.000) 5 593.79 (1.000)

Pearson GOF (P-value) 58 691.94 (1.000) 390 718.30 (1.000) 81 784.48 (1.000) 10123.42 (1.000) 94 951.49 (1.000)

ABBREVIATIONS: VTE = Venous Thromboembolism; PE = Pulmonary Embolism; DVT = Deep Vein Thrombosis; LOS = Length of Stay; SDx = Secondary Diagnosis; CHF = Congestive Heart Failure; COPD = Chronic

Pulmonary Disease; STWM = Solid Tumor without Metastasis.

*PSI were developed by the US Agency for Healthcare Research and Quality based on the use of ICD-9-CM codes to measure in hospital adverseevents. Then, a selection of these PSI were adapted by the IMECCHI using ICD-10.

FIGURE 1. VTE occurrences using stratification on three LOS periods: shortLOS (≤7 days), medium LOS (from 8 to 17 days); and high LOS (≥18 days).Bars represent proportions of patients in each LOS category for each country.

A. Hip Arthroplasty Patients with Length of Stay (LOS) ≤7 days*

B. Hip Arthroplasty Patients with Length of Stay (LOS) from 8 to 17 days*

C. Hip Arthroplasty Patients with Length of Stay (LOS) ≥18 days*

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LOS VTE 95% Confidence Interval

Figure 1 displayscountry specificVTE occurrencerates, ac-cording to3 length of stay(LOS) classes.Most patientshospitalized inSwitzerland andFrance were in theintermediate LOSclass, while mostpatients inCalifornia, Canadaand New-Zealandwere in the shortstay class.

According to therespective LOS,comparisonsshowed thatFrance, New-Zealand andCalifornia providedhigher rates thanthe benchmark:0.58% (0.35% -0.81%) Figure1(B).

FIGURE 2. Relation between VTE estimated using PSI and number of secondary diagnosiscoding fields: (A) observed probability of VTE according to number of secondarydiagnoses; (B) observed VTE occurrence rates by country, according to the distribution ofsecondary diagnoses (Median and Inter-quartile range 25th – 75th percentiles).

Table 1. Incidence Rate Ratio as Relative Risk of factors associated to VTE inhospitalized patients undergoing hip arthroplasty estimated by Poissonregression model with robust variance estimator.

Figure 3. Occurrence rate of VTE over hospital proportionquartiles for use of ultrasonography before hospital dischargein patients undergoing hip arthroplasty using data from France.

In Figure 2(A) the number of codedsecondary diagnoses was associated withthe observed probability of VTE, althoughdifferently between countries. Using themedian and inter-quartile range [25th– 75th

percentiles], the distribution of the numberof secondary diagnoses was 2 [0 – 4] inSwitzerland, 2 [0 – 3] in France, 2 [0 – 4]in Canada, 2 [1 – 4] in New-Zealand, and 4[3 – 9] in California, respectively .

The proportion of patients who received anultrasonography, according to recordeddata, was 0.09% in Switzerland, 17.35% inFrance, and 0.31% in California (Figure2(B)).

The exploration of data from Franceindicated that the use of ultrasonographybefore hospital discharge was related tohospital characteristics (Figure 3).

Poisson regression models provideddifferences in level of risk factors to VTEover the five countries.

Introduction

International Diabetes Federation (IDF) estimates that in 2013 8.3% of adults, 382 million people over the world have diabetes including 46% of them being undiagnosed*2.Nevertheless, in advanced countries,

glycemic control have become more manageable these days and it is more common to live long with diabetes and die with other diseases such as cancer or by having severe complications. From a perspective of mortality

statistics, this means diabetes may not appear directly in the underlying cause of death (UC) statistics, as they are more likely to be reported in Part II of a death certificate. This study tries to describe the feature of such widespread noncommunicable disease on death certificates, and what we can learn from the abundant information provided there.

Diabetes as an underlying disease: what we can learn from diabetes hidden in the

death certificate

Abstract Diabetes mellitus is one of the four major noncommunicable diseases notified by WHO along with cardiovascular diseases, cancer and respiratory diseases*1. It is known well as an underlying disease that increases risk of other causes of death (CoD), which is becoming more visible as ageing advances and people live long with diabetes. This study has focused on diabetes reported in death certificates to understand its characteristics and value its significance as a risk factor.


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Authors: Kaori Nakayama, Emiko Oikawa, Keiko Yatagai, Miyuki Mizuguchi, Mika Watari

Title

Methods & Materials

As expected, around 76% of the diabetes were reported in Part II of the death certificate. And in around 71% of the certificates, other diseases was selected as an UC .

References

Results

From published official statistics, death due to diabetes (E10-E14) in Japan was 14,486 cases, 1.15% of the total 1,256,359 cases from all CoDs(2012 final data). This study has focused on the 2012 death certificates of Japan with mention of diabetes, which accounted for a little below 3 times of the said 14 thousand cases selected as an UC, and extracted 1,000 representative cases by simple random sampling. The most frequent age group was from 80 to 89, and the ratio of men to women was around 3 to 2. The extracted data was then analyzed

from the following aspects:1. How diabetes are reported on these

certificates2. The distribution of underlying cause

of death.For the second aspect, comparison

was also made to published data of all CoDs, and to a preceding study based on clinical questionnaire surveys of 18,385 cases including 1,750 autopsy cases during 1991 to 2000 *3.

It should be noted that the extracted certificates was coded specially for this research and the data may differ from official statistics. In addition, comparability limitation exists in some part as the preceding study does not specify ICD codes.

Conclusions

*1: Global status report on noncommunicable diseases 2010, WHOhttp://www.who.int/nmh/publications/ncd_report2010/en/

*2: IDF Diabetes Atlas, sixth edition, 2013http://www.idf.org/diabetesatlas*3: Nigishi Hotta et al. “Causes of death in Japanese diabetics: A questionnaire survey of 18,385 diabetics over a 10-year period” Journal of Diabetes Investigation Vol. 1 Issue1/2 Feb/Apr 2010

Table 1. Distribution of the reported diabetesTotal

Diabetes selected as UC

Other diseases selected as UC

Diabetes in Part I 237214 23

Diabetes in Part II 76378 685

Total 1000 292 708

Distribution of the UC is shown in Figure 1. The category used in the preceding study, which focuses on major complications of diabetes and related diseases, was used for comparison.

Figure 1. Distribution of Underlying Causes of Death

The upper right circle 2) which is the result of this study, and the two graphs below 3), 4) based on figures from the preceding study are the data focusing on diabetes. ‘Vascular diseases’ (pink) including diabetic nephropathy, ischemic heart diseases, and cerebrovascular diseases takes up a large share compared to 1) the circle graph of the total 1.2 million deaths in the top left.Another aspect found in 2) is that the

share of ‘neoplasms’ (red purple) is quite small compared to the others.The share of ‘other’ (light blue grey)

is large in 2) but this was because it includes diabetes unspecified (E149) which are probably classified elsewhere in preceding questionnaire survey.

• The characteristic of the reported diabetes supported the assumption that many diabetes are reported in Part II and do not appear directly in UC statistics.

• One interesting finding was that diabetes with other complication bunched in E1-.6, existed more than the other complications specified by a fourth character (i.e. coma, gangrene etc. ), and that it was consisted of myocardial or cerebrovascular conditions that are majorcomplications of diabetes. It might become important to identify these complications in the future ICD codes.

• Comparison of the distribution of UC also highlighted important issues. While it supported the fact that diabetes is an important risk factor for ‘vascular diseases’ and other specific CoDs, the result that the share of ‘neoplasms’ being quite small, may suggest that doctors tend not to report underlying diseases when they think the UC is obvious. This possibility of underreporting may interfere future studies through multiple cause of death analysis, calling for improved education and training.

Table 2. Distribution by type of complication

Looking at the reported diabetes by type of complication, renal complication (diabetes with an ICD fourth character .2) was observed most frequently. Leaving out diabetes without mention of complication (.9), the second place was ‘other complications’, which mostly were myocardial or cerebrovascular conditions.

47.4%

12.5%

4.2%

2.1%

1.0%

0.7%

32.2% Renal (.2)

Other (.6)

Peripheral circulatory (.5)

Coma (.0)

Ketoacidosis (.1)

Neurological (.4)

Unspecified (.9)

Characteristics of the reported diabetes

Distribution of underlying cause of death

Acknowledgements

We would like to thank the Vital, Health and Social Statistics Division of the Statistics and Information Department at the Ministry of Health, Labour and Welfare for providing valuable data, and Dr. Naoko Tajima and Dr. Kayo Waki for providing expert insight that encouraged us much in carrying out our research.

Introduction

Title

The global expansion of type 2 diabetes sets a major challenge for health care providers throughout the world. This condition is associated with adverse long term health consequences and is costly both in human and health economic terms. In all countries, a significant proportion of people affected are undiagnosed, creating an opportunity to improve outcomes through early intervention, particularly through reduction in cardiovascular risk. Electronic diabetes registers promote structured care and enable identification of undiagnosed cases. They require consistent coding of the diagnosis in the electronic medical record (EMR). We investigated the potential of EMRs to identify undiagnosed diabetes and to support diabetes management in a large US primary care population. We compared the results with those of the UK, where the use of electronic diabetes registers is more consistent.

Recognising undiagnosed diabetes in the US using primary care data

Abstract

Up to 25% of the diabetes population may be undiagnosed in the US. Use of electronic medical records provides animportant, under-utilised opportunity to identify those with biochemical evidence of undiagnosed diabetes and to providehigh quality, structured care. This requires consistent use of diabetes registers through standardised electronic coding ofthe diagnosis. The results of a comparative study between the US and UK are reported here. Simple algorithms applied toprimary care electronic records identify patients both with un-coded diabetes and with probable undiagnosed diabetes.High quality diabetes care is positively associated with electronic coding of the diagnosis.


C436


Tim A. Holt1, Candace Gunnarsson2, Paul Cload3, Susan Ross2

1 Nuffield Department of Primary Care Health Sciences, Oxford University, UK2 S2 Statistical Solutions, Cincinnati, Ohio, US3 GE Healthcare, Chalfont St Giles, UK

Methods & Materials

We included 11,540,454 electronic records from over 9000 primary care clinics across the US. Only 62% of 1,110,398 records indicating diagnosed diabetes contained a diagnostic code (Fig. 2). Of 10,430,056 non-diabetic patients, at least two abnormal fasting or random blood glucose values were present in 0.39% (n=40,359), and of those remaining, 0.22% (n=23,261) had at least one documented HbA1c >=6.5% (48mmol/mol). Of 622,260 with known diabetes for at least 15 months, achievement of a range of care quality indicators is reported (Table). US records containing a diagnostic code were associated with significantly higher achievement compared with un-coded case records (P < 0.01), but were still generally lower than results from England.


Results

Cross-sectional survey and retrospective observational cohort analysis using a nationally representative US database (GE Centricity, Fig. 1). We compared the quality of care in those with coded and un-coded diabetes in the US with that of England, based on recognised clinical indicators. Un-coded cases with diagnosed diabetes were identified on the basis of medication usage.

Conclusions

This US study was funded by GE Healthcare and was recently published in CMAJ-Open:

Holt TA, Gunnarsson C, Cload P, Ross S.Identification of undiagnosed diabetes and quality of diabetes care in the US: Cross-sectional survey of 11.5 million primary care electronic records. In press with CMAJ Open.

An original UK study leading to this work was published in the British Journal of General Practice:

Holt TA, Stables D, Hippisley-Cox J, O’Hanlon S, Majeed A. Identifying undiagnosed diabetes: cross-sectional survey of 3.6 million patients’ electronic records. Brit J Gen Pract 2008;58:192-196.

Simple algorithms applied to primary care EMRs identify patients with probable undiagnosed diabetes. However this opportunity depends on consistent electronic coding of the diagnosis. Such coding was associated with improved care quality in this study. Electronic diabetes registers are under-used in US primary care and provide opportunities to facilitate the systematic, structured approach that is established in the UK.

US England†Number Data element within the 15 months

prior to last visit on record (for US)Total Recorded

Diagnosis

ONLY

Medication ONLY

Both Diagnosis and Medications

England(based on last

recorded data element value)

N=622,260(%)

N=56,492(%)

N=228,926(%)

N=336,842(%)

N= NA(%)

1 with a record of BMI 57.3 54.2 49.2 63.4 94.7

2 with a record of HbA1c 59.2 49.8 40.4 73.5 97.2

3 in whom the last HbA1c is <7% 33.8 45.9 23.8 38.6 53.8



6 with a record of the presence or absence of peripheral pulses

no recorded data for these measures 91.1

7 with a record of neuropathy testing no recorded data for these measures 90.8

8 with a record of retinal screening no recorded data for these measures 90.9

9 with a record of blood pressure 88.0 86.7 81.5 92.7 98.3

10 in whom the last blood pressure is <145/85

67.6 66.9 62.1 71.4 80.6

11 with a record of micro-albuminuria testing (not including patients with proteinuria)

33.4 24.5 21.4 43.0 88.5

12 with proteinuria* or micro-albuminuria who are treated with ACE inhibitors (or A2 antagonists, ARBs)

85.7 57.1 95.0 85.8 80.0

13 who have a record of serum creatinine

69.3 70.0 54.1 79.6 97.0

14 who have a record of total cholesterol 59.7 61.5 43.5 70.4 96.0

15 whose last measured total cholesterol is <5 mmol/l

44.6 41.6 33.0 53.0 83.0

16 who have had influenza immunization in the preceding September 1 to March 31

no recorded data for these measures 90.4

Figure 1: Coverage of the US by the GE Centricity database

Figure 2: Identification of un-coded and undiagnosed diabetes in the Centricity database

Table: Achievement of diabetes care quality indicators between the US and England, and between the coded and un-coded US primary care populations

Figure 3: Variation in the prevalence of undiagnosed diabetes (UDM) as a proportion of undiagnosed and diagnosed diabetes (UDM+DM) identifiable through electronic records in the US

Total database population*N=11,540,454

Total database population*N=11,540,454

No recorded diagnosis of or medication for diabetes

N=10,430,056

No recorded diagnosis of or medication for diabetes

N=10,430,056

Diagnosis of diabetes or diabetic medications recorded

N=1,110,398

Diagnosis of diabetes or diabetic medications recorded

N=1,110,398

Diagnosis only = 114,273Medication only = 422,584Both = 573,541

Diagnosis only = 114,273Medication only = 422,584Both = 573,541

Patients on diabetic medications but with a diagnosis of Polycystic Ovaries and no diabetes code were left in this sample

Patients on diabetic medications but with a diagnosis of Polycystic Ovaries and no diabetes code were left in this sample

Remaining populationN=10,268,888

Remaining populationN=10,268,888

Less than 2 abnormal AGORN=10,228,529

Less than 2 abnormal AGORN=10,228,529

2 or more abnormal AGORN=40,359

2 or more abnormal AGORN=40,359

Diagnosis of pre‐diabetes/impaired glucose tolerance N=158,876

Diagnosis of pre‐diabetes/impaired glucose tolerance N=158,876

Gestational diabetes N=2315Gestational diabetes N=2315

Patients with no abnormal HbA1c on recordN=10,205,268

Patients with no abnormal HbA1c on recordN=10,205,268

Patients with at least one abnormal Hba1c (>6.5%) on record N=23,261

Patients with at least one abnormal Hba1c (>6.5%) on record N=23,261

Definition 2‡

N=23,261

Definition 2‡

N=23,261Definition 1§

N=40,359

Definition 1§

N=40,359Definition 3ǁ

N=63,620

Definition 3ǁ

N=63,620

Distribution of numbers of abnormal AGOR:AGOR Number of patients0 10,152,4441 76,0852 17,7843 7,8804 or more 14,695

Distribution of numbers of abnormal AGOR:AGOR Number of patients0 10,152,4441 76,0852 17,7843 7,8804 or more 14,695

AGOR=Any Glucose On Record* September 2009 download§ Definition 1: ≥2 abnormal AGOR=RBG ≥11.1 or FBG ≥7.0‡ Definition 2: not meeting AGOR criteria for undiagnosed diabetes, but with HbA1c >6.5%ǁ Definition 3: ≥2 abnormal AGOR=RBG ≥11.1 or FBG ≥7.0 OR with HbA1c >6.5%

Title

The standardization of coding episodesof care using the CIM 9 (Catalantraslation of the InternationalClassification of Diseases version 9(ICD-9)) is key to ensuring a correctinterpretation of the results of theCatalan Arthroplasty Register (RACat)and to compare it with other registers.The aim of the present study was topresent the results of the informationsent to the RACat corresponding to the2005-2013 (first trimester) period, thecharacteristics of the operatedpatients, types of surgical proceduresand prostheses survival at 1, 3 and 5years after primary surgery using theICD-9 codes to encode the informationof the reason for the surgery.

Abstract


C437


THE CATALAN ARTHROPLASTY REGISTER (RACat):SUMMARY RESULTS FOR THE PERIOD 2005-2013.Marinelli Marcella 1,2,, Tebé Cristian 1,3, Martinez Olga 1, Nardi Joan 4, GirosJoan 5, Espallargues Mireia 1,2

1 Agència de Qualitat i Avaluació en Salut de Catalunya (AQuAS) Catalan Arthroplasty Register (RACat), 2 CIBER Epidemiología ySalud Pública, CIBERESP, Spain, 3 Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), 4 HospitalUniversitari de la Vall d’Hebron, President of the Advisory Committee of RACat, Spain, 5 Consorci Sanitari Integral, President ofthe Catalan Society of Orthopaedic Surgery and Traumatology, Spain

Title

Methods & Materials

In the last three years primary andrevision exhaustiveness exceeded the80% and 50%. 46,251 knee and33,075 hip primaries were included inthe study. Of 46,251 knee prostheses,41,868 were not revised (censored),118 and 70 were revised for acute andchronic infections and 619 formechanical complications. Of 33,075(11,367 partial (PHA) and 21,698 total(THA)) hip prostheses, 29,293 werecensored (9,706 partial and 19,587total), 63 were revised for acuteinfections (15 PHA and 48 THA), 29were revised for chronic infections (9PHA and 20 THA), and 418 formechanical complications (112 PHAand 306 THA). Women were morefrequent among knee and hipprostheses. 24,357 (73.7%) and27,919 (57.2%) of patients were >74years old at the moment of a primaryhip and knee surgery. Osteoarthritiswas the main cause of primary kneeand hip surgery with 98.6% and52.4% of cases. 69% of the primaryknee arthroplasties were cemented,64.9% and 38.7% of the THA and PHAwere non-cemented, respectively. Thecumulative risks of revision at one,three and five years were 1.55%,2.51%, 3.01% for PHA, 1.39%, 2.53%and 3.58% for THA and 0.75%, 2.98%and 4.22% for knee prosthesis.

Results

RACat data were linked to theMinimum Basic Data Set at HospitalDischarge (MBDSHD). ICD-9 codeswere used to encode the first andsecond procedures of the MSDSHD.Only the hospitals with at least 70% ofinformed primary and first revisionprostheses in the last three years wereincluded in the survival analysis. Fineand Gray survival regression modelsadjusted for sex, age and Elixhauserindex and considering death ascompeting event were fitted.

Conclusions

This study showed summary resultsfor the RACat during the period 2005-2013 using the ICD-9 codes to identifyprimary and revision prostheses. Therisk of revisions at 1, 3 and 5 yearswere estimated for THA, PHA and TKA.Potential outliers hospitals wereidentified using the funnel plots.

Introduction

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All Patients70% exhaustivity

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Chart 1: Cumulativerisk of revisionsconsidering all thehospitals included inthe RACat during2005-2013 and thebest informers for theperiod 2010-2012

Risk of revision 1 year 3 years 5 years

THA 1.39% 2.53% 3.58%

PHA 1.55% 2.51% 3.01%

TKA 0.75% 2.98% 4.22%

Table 1: Cumulative risk of revisions at 1, 3and 5 years for the best informers.

Comparison between centers wasrealized using the Funnel plots andconsidering a Poisson regression modeladjusted for age, sex and Elixhauserindex. Each point represents a centerand the two lines represent theconfidence interval at 95 % and 99.8%compared to the RACat averagerevisions.

,01

,5

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Standardized Rate of revision observed / expected per centre TKA

Conclusions

Conclusions

Those centers located above theupper range present a number ofrevisions observed above theexpected values and are consideredas possible outliers.

Conclusions

Abstract The retrospective cohort study is based on knee and hip prosthesis of the Catalan Arthroplasty Register(RACat) linked to the minimum basic dataset at hospital discharge (CMBDH) between 2005-2012.

Only the hospitals with at least 70% of informed primary and first revisions prosthesis were included in the analysis.Firstly, Fine and Gray adjusted regression model was fitted. Secondly, the funnel plots were also analysed.

Chart 2: Funnel Plots of the best informerswith CI 95% and 99.8%.

person

physician

The inductive analysis of 32 case-histories resulted in 33 defined PERI-codes, classifying all PERI in the cases. The 33 codes were grouped in seven defined and mutually exclusive code-families: “Aspects between patient and formal care provider”, “social environment and family”, “functioning/ behavior”, “life history/ non- medical experiences”, “personal medical”, “socio-demographics” and “work circumstances”

PERI is used in the process of decision-making in family medicine and thus might be registered in the health record at least for scientific use cases. The classes of PERI found in our study might serve as a basis for the development of future classification tools. They might support the further development of ICPC or the still empty component “personal factors” in the International Classification of Functioning, Disability and Health (ICF). PERI codes could help to asses the person-centeredness of health care in multiple settings.

Introduction

Abstract To be a patient mostly is only a small aspect of the person to be cared for. Therefore care should be person centred. However, person related information (PERI) cannot be coded with current medical classifications. We therefore set out to identify the content of PERI in narrative case reports from family medicine. The classes of PERI found might serve as an empiric basis for a future classification tool enabling research on the influence of PERI on medical decisions


C438


Diego Schrans1,4, Dirk Avonts1, Thierry Christiaens1, Sara Willems1, Kaat de Smet1, Kees van Boven3,4, Pauline Boeckxstaens1,4, Thomas Kuehlein2,41 Department of Family Medicine and Primary Health Care, Ghent University, Belgium.2 Allgemeinmedizinisches Institut des Universitätsklinikums Erlangen, Germany.3 Department of Primary and Community Care, Radboud University Nijmegen, The Netherlands.4 Member of the WONCA International Classification Committee (WICC)

Title

Acknowledgements

Results

To answer our research question we chose a design analogous to the first steps of most qualitative studies. Twelve experienced FPs from nine different countries - familiar with the concept of person-centeredness - were prospectively asked to write down narrative case histories of their patients, where personal factors played a role in their decisions. The case histories were anonymized and transcribed. In an inductive process they were consecutively coded by three researchers independently (triangulation), according to classes of PERI that influenced the process of care. The coding was accomplished with the help of the free software package RQDA. The classes found were discussed and agreed upon after each case history. This common code set

Conclusions

We thank our country coordinatorsDaniel Pinto (Portugal), Henry Lawson (Ghana), Sebastian Juncosa (Spain), Gustav Kamenski (Austria), Ferdinando Petrazzuoli (Italy), Gustavo Gusso (Brazil), Than Liem Vo (Vietnam) for collecting the case histories and Mike Klinkman (USA) and Shabir Moosa (South Africa) for support.

What influences our decisions in family practice? –A qualitative study in search for person related

information (PERI)

Methods & Materials

was then applied deductively to the following cases and thereby refined. The process continued until saturation was reached. Again in triangulation the classes were grouped into code families and further clustered into domains in a consensus process.

information”, “socio-demographics” and “work/ employment related information” (Table 1). The code families were clustered into four domains: “Social environment and extended family”, “medicine”, “individual” and “work and employment”.

The International Classification of Primary Care (ICPC-2) is a related classification in the WHO-FIC. It was developed by the Wonca International Classification Committee (WICC) out of preceding versions. ICPC-2 was especially designed to meet the information needs of primary health care. Coding with ICPC-2 enables statistical reporting of reasons for encounter, health problems and care processes. The best physician should not be the one who uniformly applies a standard procedure to every patient, but the one who correctly modifies and adapts the current best knowledge to the circumstances and needs of the individual patient. In person centered care personal needs, concerns and preferences should be taken into account in medical decision making. A family physician’s (FP) everyday work is person-centered. Person-related factors may influence many clinical decisions in primary care. A working-group of the Wonca International Classification Committee found that person related information (PERI) currently cannot be coded sufficiently with the International Classification of Primary Care (ICPC-2). Therefore we wanted to know what types (classes) of PERI influence care processes and should be documented and coded.


C501-541 ICF

C501 Developing a Common Ontology for ICF

Robinson Nicol; Millar

C502 Functioning properties - A first step toward ICD-ICF joint use

Selb; Robinson Nicol; Kennedy; Stucki

C503 ICF education needs: a survey of FDRG members and collaborators

Sykes

C504 Enhanced informed decision-making in the health system: ICF as a standard for reporting functioning information

Prodinger; Tennant; Brinkhof; Bickenbach; Cieza; Stucki

C505 ICF-Primary Care van Boven; Ten Napel; Vlek; OldeHartman; Schers

C506 The mICF Collaborators Group – A Worldwide Initiative

Snyman; Kraus de Camargo; Gong

C507 User requirements for a mobile ICF application

Snyman; Kraus de Camargo; Gong

C508 Developing a mobile application for ICF - Literature review component

Saleeby; Sykes; Martinuzzi; Snyman; Kraus de Camargo; Della Mea; Paltamaa; van Gool; Mostert

C509 Application of ICF in computing system for long-term care insurance in Korea

Kang; Jeong; Choi

C510 Model Disability Survey Cieza; Officer; Kostanjsek; Posarac; Sabariego; Bickenbach

C511 Development of a grading instrument of functioning for Brazilian citizens: Brazilian Index of Functioning - IF-Br

Riberto; Franzoi; Xerez; Blanco; Kahn

C512 Use of the ICF in Education and Training of Social Workers

Saleeby

C513 Development of Criteria to Review ICF Literature

Saleeby; Sykes; Martinuzzi; Hough; Lee; Leonardi; Leplege; Maribo; Ten Napel; Paltamaa; Snyman; Tomes

C514 The ICF update platform – what issues do reviewers raise?

Jelsma; Cuenot; Gongolo; Sykes

C515 How to deal with meaning ambiguity in international classifications on disability in five different languages.

Rodrigues; Frattura; Cuénot

C516 Valuable Capabilities. Towards an extensive adoption of the ICF in ASPACE

Mauri; Acevedo; Jimenez; Reyes; Jimenez

C517 Adaptation and standardization of the use of the ICF Core set for individuals with traumatic spinal cord injury in the acute context

Patricia Carla; Juliana; Camila; Soraia Assad Nasbine; Marcelo


C518 Adaptation and standardization of the use of the ICF Core set for spinal cord injury for individuals with non-traumatic etiology

Juliana; Patricia Carla; Camila; Marcelo

C519 The development of an ICF Coreset for Lymphedema

Viehoff; Heerkens; Ravensberg; Hidding; Damstra; Ten Napel; Neumann

C520 Lighthouse Project Hand: Using the ICF Core Sets for hand conditions in clinical routine - implementation in Clinical Information Systems

Coenen; Dereskewitz; Cieza; Kus; Rauch; Rudolf; Consortium

C521 Using International Classification of Functioning, disability and Health to identify function of individual with lower limb amputation (ICF- Amputation core set).

Pongakkasira; Wichainchai; Suvapan

C522 Exploring the desired content of an 'International Classification of Functioning' (ICF) item set for multimorbid patients in General Practice’

Emmen; van Boven; Ten Napel

C523 ICF: THE CYPRUS PROJECT PAPADOPOULOU; DROSOU; IOANNIS; KARISTINOS; FILIPPOU; et al.

C524 To kill two birds with one stone: how to automatically combine standard terminologies and nomenclature with ICF Environmental Factors for epidemiological and statistical purposes.

Castelpietra; Bassi; Frattura

C525 How to automatically expand ICF-EF in order to better describe care and living environment factors at country level: steps toward a multicenter project on the biopsychosocial determinants of outcomes

Frattura; Anttila; Nurmi-Koikkalainen; Snyman; Bassi; Simoncello; Terreni; Soranzio

C526 How to describe the workplace using and expanding the Environmental Factors component of the ICF: the first version of the “Workplace assessment schedule”

Bassi; Frattura; Simoncello; Paolone; Gorini

C527 How to ask questions about performance while considering facilitators and barriers: the first web version of the “Web Activity and Participation Performance Inventory” (WAPP.In).

Frattura; Bassi; Simoncello

C528 How to expand ICF Environmental Factors (EF) starting from ISO-9999 Classification: toward a “hybrid” standard terminology?

Bassi; Simoncello; Castelpietra; Frattura

C529 Registration of personal factors of patients in the general practice: which are important to register according to general practitioners? A Delphi study

Stoop; van Boven; Ten Napel; Uijen


C530 Grouping Body Functions (BF) and Activity and Participation (AP) categories in children functioning assessment: a new core set or some ontologic suggestions?

Frattura; Bassi; Simoncello; Terreni; Veos

C531 Interventions coordination in Health-Education interface for Early Childhood special needs using ICF C-Y

Cid

C532 A standardised disability flag for Australia

Cooper-Stanbury; Hargreaves

C533 Toward the system-wide implementation of the ICF in clinical and rehabilitation practice to describe functioning along the continuum of care

Prodinger; Bickenbach; Cieza; Stucki

C534 Measuring Disability and Health in Emergencies: implementing a disability survey using WHODAS 2.0 in the Typhoon Yolanda affected areas of the Philippines

Leonardi; Kostanjsek

C535 Monitoring community-based rehabilitation (CBR) and use of the ICF

Madden; Lukersmith; Scarf

C536 Adaptation of the definition of 'assistive products' from a 'health' perspective

Bougie; Heerkens; Bickenbach; Khasnabis; Inoue

C537 Classifying disability services activities in the 21st Century: applying ICF to ISIC

Madden; Fortune

C538 Clinical Practice Guideline for the Assessment of Function in Head and Neck Cancer

Stier-Jarmer; Cieza; Tschiesner; Sabariego; Kirschneck; Becker; Harréus

C539 Functioning after infectious encephalitis in the light of ICF

Laxe; Bernabeu; Tormos

C540 Methodology of Data Providing on the Options of ICF-based Rehabilitation Assistance

Shoshmin; Lebedeva; Shestakov; Besstrashnova

C541 Persons with Disabilities Instrument (CPD for its Spanish acronym) of 0-17 years and 18 years and over (development of administrative registration in Mexico)

Avendaño-Badillo; Galicia-Amor; Lopez; Valerio; Velazquez

Introduction

After wide consultations within WHO and with partners andrelevant international stakeholders including IHTSDO, it wasagreed that the development of a formal ICF knowledgeframework and common ontology for ICF is a criticalrequirement necessary for the advancement and modernimplementation of ICF in countries. This links with workalready done jointly between WHO and IHTSDO and driverswithin WHO to update the existing ICF support and tools andwithin IHTSDO to undertake development of this area ofSNOMED CT. The resulting end products will be integratedinto existing and future health information systems to allowfor a more effortless integration of ICD and ICF with SNOMEDCT to support the delivery of care to individuals, whilesupporting analysis for producing more extensive,comprehensive statistics on population-wide functioning,improved prediction models for long-term patient costs andoutcomes, and more evidence to better inform relevant policydevelopment. Following the model of ICD-11 development,there will be formal linkages between SNOMED CT and ICF.IHTSDO will begin the work in late 2014, planning release inJanuary 2016, while WHO has proposed a longer timeline.For both components of the work, however, there will be jointcontribution and management in line with the establishedagreement.

Developing a Common Ontology for ICF

Abstract - The World Health Organization, in consultation with an international group of stakeholders in the areas of terminologies, functioning ,and disability, has developed a collaborative project proposal to modernize the International Classification of Functioning, Disability and Health (ICF) for seamless integration into existing and future health information systems in support of better data collection. This work is in collaboration with the IHTSDO who are undertaking revision and updates to SNOMED CT in this area, in order to better record information related to individual care delivery, enabling monitoring of progress, and capturing of outcomes.


C501


Dr Molly Meri Robinson Nicol1 and Ms Jane Millar21Classifications, Terminologies, and Standards, World Health Organization (Switzerland),

2 International Health Terminology Standards Development Organisation (Denmark)

Title

Project Goals

Acknowledgements

Dr T. Bedirhan Ustun, Dr Kent Spackman, Other members of the WHO-IHTSDO Joint Advisory Group

Create a “common ontology” for ICF based on modern information sciences which provides a representation format to identify each functioning and disability concept with its defining characteristics linked to SNOMED CT.

Build upon the common ontology to modernize ICF and support seamless integration into health information systems with SNOMED CT.

Enable tools for compiling health statistics and information related to functioning and disability concepts and interventions supporting her, care delivery, insurance, billing and reimbursement systems, and accurate statistics to support policy development.

Rationale

Project Deliverables

ICF – SNOMED CT Common Ontology Benefits

This proposal, when implemented, will link data collection practices related to functioning and disability with global norms and standard development activities for health information systems. Such work will enhance international public health tasks on global statistics, surveillance and universal health access, while enhancing basic and clinical research around functioning and disability. This should all be derived from information collected initially to support the care of individuals.

These project activities will also create an international platform and a network for sharing knowledge and securing cultural sensitivity. The deliverables will support equal access to global public goods in and for all Member States. The future maintenance costs will be low, as the systems will be incorporated more fully into the WHO Family of International Classifications (WHO-FIC) and use the same update and revision mechanisms as are in design for ICD. For SNOMED CT, updates will become part of the normal release cycle with Members and Affiliates be able to make requests for change.

1. Knowledge Framework, including:a) A full “Content Model” for ICF concepts

b) Value sets for population of the content model fully

linked to SNOMED CT, the ICD X-chapter, and other resources.

2. ICF Web Portal, including:a) Collaborative Authoring Toolb) Unique Resource Identifiers (URIs) & Web Servicesc) Multi-lingual Representation of ICF Conceptsd) Links to SNOMED CT

3. Updated ICF Update and Maintenance Strategy

A first step towardICD-ICF joint use

Abstract Recognizing the merits of jointly using ICD and ICF, WHO introduced so-called functioning properties in the 11th revision of the ICD (ICD-11). Functioning properties (FP) are ICF categories in the component of activities and participation (A&P) that are identified as being the most relevant for more fully describing the impact of a health condition on a person’sfunctioning for a particular health condition. To tackle the challenge of specifying or “populating” FPs for the thousands ofhealth conditions in ICD-11 WHO and the functioning Topic Advisory Group (fTAG) decided to start out with a selection of the most frequent health conditions encountered in rehabilitation. This poster outlines the multi-stage process that led to populating FPs for 101 rehabilitation-relevant health conditions.


C502


Selb M1,2, Robinson Nicol MM3, Kennedy C4, Stucki G1,2,5, 1 ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI), Nottwil, Switzerland;

2 Swiss Paraplegic Research, Nottwil, Switzerland; 3 Classifications, Terminology and Standards, World Health Organization, Geneva, Switzerland; 4 Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services,

Washington DC, USA; 5 Department of Health Sciences & Health Policy, University of Lucerne, Lucerne & Nottwil, Switzerland;

Title

In the 2012 special report Toward the joint use of ICD and ICF: Acall for contribution1 and in a paper by Escorpizo et al. on theimportance and methods of linking disease and functioning2, theauthors encouraged the complementary use of the ICD and the ICFin clinical practice.

Recognizing the merits of jointly using the ICD and ICF, WHOintroduced so-called functioning properties in the ICD-11 revisioncontent model. Functioning properties (FP) are ICF categories in thecomponent of activities and participation that are identified as beingthe most relevant for more fully describing the impact of a healthcondition on a person’s functioning for a particular healthcondition1,2.

As reported at the 2012 WHO-FIC meeting in Brasilia, a list of 103rehabilitation-relevant health conditions was generated as a startingpoint for identifying or “populating” respective FPs. A guidancedocument (presented at 2011 WHO-FIC meeting) was developed toguide the FP populating process or the “ICD-ICF joint use initiative”.In addition, online tutorials were provided to an internationalmultidisciplinary group of clinicians who answered the call tocollaborate as published in the aforementioned special report.

This poster outlines the multi-stage process that led to populatingFPs for the 101 rehabilitation-relevant health conditions.

Based on a re-evaluation of the list of rehabilitation-relevant healthconditions, 10 non-disease specific conditions were deleted:drownings, fires, joint arthroplasty, other intentional injuries, otherunintentional injuries, poisonings, road traffic accident, self-inflictedinjuries, violence and war. In addition, 11 conditions for which ICFCore Sets were available were added. For the resulting 101 healthconditions, the following guiding principles applied for deciding onthe ICF categories to use as FPs:

Respective condition-specific ICF Core Set3

e.g. bipolar affective disorders OR FPs identified byclinician who replied to the call for collaboratione.g. Fracture of femur

Related ICF Core Set e.g. Amyotrophic diseases,Spina bifida, rheumatic heart disease, tuberculosis

Adaption of ICF Core Set e.g. Birth asphyxia

Disability Set4 (see poster Prodinger et al. “Toward thesystem-wide implementation of the ICF in clinical andrehabilitation practice to describe functioning along thecontinuum of care”)

The table below shows some examples of health conditions thathave been populated using the above-mentioned procedure.

Introduction Methods and Results

Principle 1

Principle 2

Health Condition ICD-10 Code Concept Titles from ICD-11 Beta-browser (Stand Nov.2013) ICF set used to populate FPs

Amyotrophic diseases (amyotrophic lateral sclerosis) G12.2 Amytrophic lateral scelerosis

Parent Motor neuron disease Use ICF Core Set for neurological conditions post-acute

Ankylosing spondylitis and other spondylopathies M45, M48-M49

Ankylosing spondylitis;Spondylopathies are Other specificed conditions associated with the spine and Conditions associated with the spine, unspecified

ICF Core Set for Ankylosing spondylitis (AS) Use ICF Core Set for AS for all spondylopathies

Bipolar affective disorder F31 Bipolar and related disorders ICF Core Set

Birth asphyxia and birth trauma P21.0 Birth asphyxia Adapt ICF Core Set for CP as discussed in Beijing

Chronic obstructive pulmonary disease J44 Chronic obstructive pulmonary disease ICF Core Set

Endocrine disorders E20-35

Disorders of the parathyroids and parathyroid hormone system; Disorders of pituitary hormone system; Disorders of the adrenal glands and adrenal hormone system; Disorders of the gonadal hormone system; Polyglandular dysfunction

Disability Set

Fracture of femur S72 Fracture of femur FP identified – collaborating expert Fracture of lower leg, including ankle S82 Fracture of lower leg, including ankle Take FP of fracture of femur

Hand conditions G56, M65, S52, S60-69, T23, T92

Mononeuropathies of upper limb ,Synovitis and tensosynovitis; Fracture of forearm; Injuries to the wrist and hand; Burn of wrist and hand; Sequelae of injuries of arm

ICF Core Set

Leishmaniasis B55 Leishmaniasis Disability Set Low back pain (dorsalgia) M54.5 Low back pain ICF Core Set

Macular degeneration and other sense disorders H00-21, 27-35,43 H35 Disorders of the retina; Disorders of the vitreous; Parent Disorders

of the eyelid (many to list) Disability Set

Rheumatic heart disease I09 Rheumatic heart disease Use ICF Core Set for cardiopulmonary conditions

Rheumatoid arthritis M05-M06, Rheumatoid arthritis ICF Core Set Spina bifida Q05 Spina bifida Use ICF Core Set for SCI

Spinal cord injury G82 Injury of spinal cord at neck level; Injury of spinal cord at thorax level; Injury of nerves and spinal cord at neck level; Tetraplegia ICF Core Set

Tuberculosis and sequelae of tuberculosis A15-A19, B90

Tuberculosis of the respiratory system; Tuberculosis of systems other than respiratory; Miliary tuberculosis; Sequelae of tuberculosis

Use same FP as for COPD

Upper limbs fractures T02.2 Fractures involving multiple regions of one arm Use ICF Core Set for musculoskeletal conditions

Principle 3

Principle 4

The FPs for the 101 health conditions are now visible in the ICD-11 Beta-browser(http://apps.who.int/classifications/icd11/browse/f/en). WHO and the functioning Topic Advisory Group (fTAG) are working to optimizethe visualization of the FPs including resolving a technical issue that has prevented the beta-browser from showing all the entered FPs.

FPs in the ICD-11 Beta-browser

1 Kohler F, Selb M, Escorpizo R, Kostanjsek N, Stucki G, Riberto M. Towards the joint use of ICD and ICF: a call for contribution. J Rehabil Med. 2012;44(10):805-102 Escorpizo R, Kostanjsek N, Kennedy C, Nicol MM, Stucki G, Ustun TB. Harmonizing WHO's ICD and ICF: Importance and methods to link disease and functioning. BMC public health. 2013;13:7423 Selb et al. A guide on how to develop an International Classification of Functioning, Disability and Health core set. Eur J Phys Rehabil Med 2014, Early online4 Cieza et al. : Towards a Minimal Generic Set of Domains of Functioning and Health. BMC Public Health. 2014, 14:218

Introduction

Title

Title

As the World report on disability (WHO and World Bank, 2011) and the global disability action plan for 2014-2021 (World Health Assembly, A67/16) recommend that WHO member states use the International Classification of Functioning, Disability and Health (ICF) for reporting on functioning there is a need for a work force that is familiar with the classification and its use. Without education, implementation of ICF is unlikely to provide consistent and reliable information on which evidence informed policies and plans can be developed. The ICF e-learning introductory module provides material to introduce the classification and outlines potential uses. The ICF Practical manual includes further information and examples of ICF use. Both are nearing completion. With this in mind the Functioning and Disability Reference Group (FDRG) conducted a survey of its members and collaborating ICF experts to determine not only their needs for new educational materials but also what they already have and could share.

ICF education needs: a survey of FDRG members and collaborators

Abstract: With the near completion of the ICF practical manual and the introductory module of an ICF e-learning tool the Functioning and Disability Reference Group considered the needs of ICF users and potential users for additional educational materials. A survey undertaken in the first quarter of 2014 ascertained from ICF experts around the world the audiences they teach about ICF, the types of materials they have and would like made available. The results were reported to the Education and Implementation Committee and the Functioning and Disability Reference Group to inform the development of a work plan for ICF implementation and education. This poster presents the results for a wider audience.

11 – 17 October 2014Barcelona, Spain

C503


Catherine SykesWorld Confederation for Physical Therapy

Methods

A six item questionnaire was set up using SurveyMonkey and a link circulated to FDRG members and collaborators. The survey was open for 2 months, and reminders given. A copy of the questionnaire was circulated to The Education and Implementation Committee members. Descriptive results are presented together with supplementary comment by respondents.

Results

Respondents: There were 17 responses by due date and a further 3 responses added later. Table 1 provides the number of responses per WHO region. The following countries were represented: Argentina, Australia, Brazil, Canada, Denmark, Finland, France, Italy, Netherlands, South Africa and Thailand.

Table 1: Number of responses per WHO RegionEastern Mediterranean 0Western Pacific 1South East Asia 1Africa 2Europe 7Pan Americas 9

Main audiences for ICF education:The main audiences taught about ICF by the respondents were health professionals; students, service providers and researchers. Half or less taught government officials and health administrators and only 20% taught people with disabilities or statisticians. See chart 1. Other audiences taught were university faculty, teachers and administrators from labour and education services.

Chart 1: Main audiences for ICF education

Conclusions

ICF content: The main types of content already held is introductory. Some respondents have materials on clinical applications and educating others about ICF, but more is needed by the majority of respondents. See chart 2. Comments suggest that materials on ICF application are required.

Chart 2: ICF content

Types of educational material: Chart 3 shows that there was a strong call for electronic and visual rather than textual products. Translations of existing materials and materials supporting application of the ICF in specific contexts are highlighted by the dark purple bars as were massive open online courses (MOOCs), e-learning applications video/film clips and case studies. There appears to be enough introductory material already developed and ready for sharing.

References:1. World Health Organization and World Bank. World report on Disability. Geneva: WHO 2011.2. WHO Global Disability Action Plan 2014-2021. World Health Assembly 2014. 3. World Health Organization International Classification of Functioning, Disability and Health. Geneva: WHO 2001

Chart 3: Types of materials

Sharing and working with othersTable 2 shows the types of materials respondents have and are willing to share together with an indication of their willingness to work with others to develop materials.

Conclusions

Table 2: Sharing and working together

1 There is a call for a range of ICF education materials.

2 The types of materials needed are visual and electronic.

3 The content should apply to specific applications including clinical, administrative and disability eligibility.

4 There are a range of materials already available and a group of people willing to share and work together.

This information provides a basis for developing a plan of work for 2014 and beyond.

1WHO (2001). International Classification of Functioning, Disability and Health. Geneva: WHO. 2Post et al. Design of the Swiss Spinal Cord Injury Cohort Study. Am J Phys MedRehabil 2011, S5-S16. 3Cieza, A. et al. Towards a Minimal Generic Set of Domains of Functioning and Health. BMC Public Health, 2014, Vol. 14:218. 4Kirchberger, I. et al. ICF Core Sets for individuals with spinal cord injuryin the early post-acute context. Spinal Cord 2010, 48(4), 297-304. 5Cieza, A. et al. ICF Core Sets for individuals with spinal cord injury in the long-term context. Spinal Cord 2010, 48(4), 305-312. 6Cieza, A. et al. ICFlinking rules: an update based on lessons learned. J Rehabil Med, 2005, 37(4), 212-218. 7Christensen, K. B., Kreiner, S., & Meshab, M. (Eds.). (2013). Rasch Models in Health. London: ISTE Ltd and John Wiley & Sons Inc.

Background

Title

Health and its related system become increasinglycomplex. Its governance, financing, servicedelivery, human resources, as well as medicines,products and technologies need to be coordinatedand integrated to prevent undesired consequencesfor the individual and society. For the individualuncoordinated and fragmented service deliverymay lead to adverse events and redundantinvestigations. Negative consequences may arisefor society due to inefficient use of resources, itsimpact on quality of services, and ultimately highcosts of uncoordinated systems.Decisions at all levels of the health system – inclinical practice (micro-level), in health servicesprovision and payment (meso-level), and in policyand program planning (macro-level) rely on timely,reliable and understandable health information. Forefficient communication and cooperation, theavailability of health information that builds upon acommonly agreed conceptual framework and isunderstood by all stakeholders in the healthsystem becomes crucial.In 2001 the International Classification ofFunctioning, Disability, and Health (ICF) wasendorsed by all member states of the World HealthOrganization (WHO) as a standard for describingfunctioning and disability. Functioning constitutesthe operationalization of health.1 Although the ICFhas existed for more than 10 years, its utility as astandard for reporting functioning has not yet beenexploited to its fullest. As functioning informationis already being routinely collected, a system thatbuilds upon existing data collection processes andbrings existing practices of data collection togetherinto a unified framework of reporting is needed. Inthis paper we propose one approach towardsreporting functioning in a standardized manner byusing the Swiss Spinal Cord Injury Cohort Study(SwiSCI)2 as a case in point.

Enhanced informed decision-making in the health system: ICF as a standard for reporting functioning information


C504


Prodinger B1,2,3, Tennant A1,2, Brinkhof M1,Bickenbach J1,2,3, Cieza A1,3,4,5, Stucki G1,2,31Swiss Paraplegic Research, Switzerland; 2ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI), Nottwil, Switzerland; 2Department

of Health Sciences & Health Policy, University of Lucerne, Switzerland; 4Faculty of Health and Social Sciences, University of Southampton, UK; 5Institute for Public Health and Health Care Research, Ludwig-Maximilians University, Munich, Germany.

In developing SwiSCI, existing tools and methods facilitated the process toward selectingwhat domains to assess and identifying relevant instruments and items to assess thesedomains (Table 1). The ICF Generic and Disability Set3, as well as the ICF Core Sets for SpinalCord Injury (SCI)4,5 guided the specification of the ICF categories to be assessed which arethe unit of the classification. Literature reviews were contacted to identify existinginstruments and items for assessing each ICF category.

References

Table 1: Aspects to consider and relevant methods in the process toward standardized reporting

Abstract Information about health is at the core of decision-making at all levels of health systems. Informed and fair decisions buildupon relevant information that is transparent to any stakeholder in the system. The World Health Organization (WHO) has developed auniversal operationalization of health, the International Classification of Functioning, Disability and Health (ICF) as a standard fordescribing functioning and disability. It is the aim of this paper to propose an approach towards reporting functioning in a standardizedmanner based on the ICF by using the Swiss Spinal Cord Injury Cohort Study (SwiSCI) as a case in point.

This paper outlines oneapproach towardstandardized reporting offunctioning informationbased on existing methodsfor data collection.It integrates aninternationally agreed uponconceptualization andclassification of health withits operationalization tofoster a comprehensive andreliable foundation fordecision-making at alllevels of the health system.

Questions to be answered

Specification of the relevant elements from the ICF and relevant tools and methods

What to assess? ICF categories are the unit of the classification. ICF Core Sets provide short lists of the ICF categories most relevant for a particular health condition or in a given setting.3 Thus, ICF Core Sets can guide the process toward identifying the domains to be assessed for a given purpose.

How to assess? Given that there are numerous existing methods and modes for data collection, e.g. self-report instruments, clinical tests and investigations, expert observations., there is no a priori need to develop new instruments. ICF Linking Rules6 provide the methods to link the content of existing instruments and their items to the ICF.

How to report? A standard scale from 0 to 100 serves as a foundation for any method for presenting and visualizing data. The Rasch measurement model7 provides the methods to establish comparability between instruments or tests mapping on to a common ICF category.

Toward a standardized reporting of functioning information: Swiss Spinal Cord Injury Cohort Study (SwiSCI)2 as a case in point

Figure 1: Illustration of theco-calibration of items fromdifferent instruments towardaggregating the informationof ICF categories within anICF chapter.The upper part of Figure 1shows the distribution of theSwiSCI study populationalong the scale for b1 Mentalfunctions. In applying theRasch measurement model alogit scale reveals. This scalecan be transformed into amore user-friendly scalefrom 0-100 as shown in themiddle part of the Figure.The lower part of Figure 1shows how the scale from 0-100 can then serve as afoundation for coding withICF qualifiers or to presentthe distribution of theperson’s abilities related tob1 Mental functions visually,e.g. with a boxplot.

ICF Category Item included in SwiSCI Response formatb130 Energy and drivefunctions

Fatigue Rating scale from 0 (insignificant problem) to 3 (chronic problem)

b134 Sleep functions Spinal cord injury secondary condition scale (SCI-SCS)

Dichotomous

b152 Emotional functions

Mental health subscale of the SF-36 Rating scale from 1 (All of the time) to 6 (None of the time)

Discussion

Table 2 illustrates the process for the ICF categories specified in Chapter b1 Mental functionsand the identification of relevant items. To aggregate the information within this chapter,methods within the Rasch measurement model can be applied to co-calibrate the data fromthe identified items. The different response formats and direction of the response scales (e.g.lowest score is insignificant vs. problem all of the time) need to be accounted for.

Table 2: Example for the specification of items to asses an ICF categories identified as relevant to being assessed

Acknowledgments

The authors would like toacknowledge the extensivesupport of Carolina SaskiaBallert in this project.

Once the items are co-calibrated and satisfy the requirements for aggregating information,they can be integrated into a scale for b1 Mental functions from 0-100. This scale can now bedeployed for varying ways of presentation as shown at the bottom of Figure 1.

Introduction

Title

In the Netherlands the International Classification of Primary Care (ICPC) is the leading classification, used bygeneral practicioners for registration of sign and symptoms, diagnoses andinterventions. The ICPC is taylored tothe practicioners needs, it is a verycondensed classification, with a required level of detail. It offers onecategory/placeholder wherefunctioning would fit, but without further detail. That is why the International Classification of Functioning, Disabilty and Health (ICF) is gaining interest to fill this gap. The ICFs’ conceptual framework reflectsthe for Primary Care desiredorientation. From the GPs’ point of view, ICPC and ICF are considerred tobe complementary. However, in itspresent format, the classificationswithin ICF are not suited (toelaborated) for everyday practice, theyneed to be ‘transalated’ to becomeusefull and applicable for General Practice.

ICF-Primary Care

Abstract


C505


Kees van Boven¹, Huib Ten Napel¹ ², Hans Vlek³, Tim OldeHartman¹, Henk Schers¹

¹Department of Primary and Community Care, Radboud university medical centre, Nijmegen, ²Dutch WHO-FIC Collaborating Centre, Bilthoven, ³Vilans, Utrecht, all in The Netherlands

What & How

Acknowledgements

Why

The authors express their gratitude to all patients, GPs’ and institutes, contributing to this project.

In Primary Care multimorbidity is increasingly emerging. A disease-oriented approach, focussing on the treatment of signs and symptoms froma disease/biological perspective only, is not helpfull in situations where the patient is confronted with limitationsand restrictions, related to his or hershealth problems.

For most patients with multiple chronicdiseases, the aspects related to beingable to perform self-care and the quality of life are very important, andoften more important than the treatment for a disease or the diseasemanagement, e.g. like for diabetes.

For most patients functioning as such, and participation as part of that, is crucial. It is for this reason a different orientation or approach has to bedeveloped for everyday General Practice. The patients functioning is regarded to be a crucial part of thisdifferent approach.

Example ICF Primary Care Questionnaire

The ICF Primary Care Questionnaire is based on the results from a preceding study, performed by the departments’ ICF-research team. –see poster-From this research a list of 54 ICF items resulted.These items have been rephrased as natural language questions, with possible relevant answering categories, e.g. Memory function has been phrased as: How is your memory?The possible answer categories are also phrased in natural language, see the example below.

To assess if the ICF PC Questionnaire is fit for purpose, our present research focusses on:- Does the questionnaire provide a validrepresentation of the most relevant aspectsof functioning for patients withmultimorbidty?- Does the questionnaire, by filling out bythe patient, contribute to undertake actions by the GP and/or the Patient?

In order to support systematic classification in General Practice, within the registration and documentation, anICF based questionnaire is under development, with which functioning, including participation of people with oneor more chronic diseases –multi-morbidity- can be described and measured.This poster describes the rationale and initial development of the patient-questionnaire based on ICF.

Research Questions

Before you are going to complete the ICF-PC questionnaire. Please read the questions carefully before you complete the questions together with the patient. In this questionnaire you mark what has emerged from the discussion with the patient and what you and the patient think about the questions. We ask for feedback after each part/topic of the questionnaire.

TOPIC

ANSWER REMARK

1. Functions

1.1. How is your memory?

o I remember everything o I sometimes forget things o I often forget something o I forget everything

1.2. How is your mood in general?

o Always good o Usually good o My mood sometimes changes o I often feel depressed o I am always depressed

1.3. How is your energy?

o I am always physically fit o I am almost always physically fit o I am often physically not fit o I am never physically fit

1.4. How do you sleep?

o I always sleep well o I often sleep well o My sleep is varying/alternating o I generally sleep poorly o I sleep badly

1.5. Can you read the small print in the newspaper (with glasses or contact lenses if necessary)?

o Yes, without difficulty o Yes, with some difficulty o Yes, with great difficulty o No, I can not, I do not read anymore

The ICF-PC Questionnaire is available for testing purposes. Contact: [email protected]

[email protected]

Introduction

Title

The ICF is a framework developed by the WHO, documenting information on functioning as dynamic interaction between a patient's health condition, environmental factors and personal factors, facilitating decision-making and continuity of care. ICF highlights the need for a diverse team of service providers, but also represents a paradigm shift in how to approach health and healthcare. At the annual meeting of the Functioning and Disability Reference Group (FDRG) of the World Health Organisation’s Family of International Classifications (WHO-FIC) in 2013, it was agreed to encourage the development of a collaborative to investigate the development of a mobile application for the ICF.

The mICF Collaborators Group –A Worldwide Initiative


C506


Authors: Stefanus Snymana, Olaf Kraus de Camargob, Judy Zhuxi GongbaStellenbosch University, South Africa, bMcMaster University & CanChild, Canada

Title

Methods & Materials

Most of collaborators (n=164) come from Finland (38), USA (19), Canada (16), South Africa (16) and Germany (14). In total 32 countries are represented.The distribution of skills is shown above. Nearly 80% indicated the willingness and possibility to be involved with usability testing of mICF prototypes. We also were able to include over 30% of collaborators as patient/client researchers. The smallest group are collaborators with expertise in data architecture, coding and algorithm development. We have some expertise in health informatics and other ICF applications. More expertise seems to be needed in the areas of data synchronisation and database development. Individual collaborators offered to broker connections to other IT specialist and working groups.


Results

We conducted an online survey to assess the needs requirements to develop a mobile App to collect and analyze ICF data. The survey was posted on the SurveyMonkey server on 09/06/2014 and for this analysis data until 31/08/2014 were used. At the end the respondents had the option to continue to be involved in the project as collaborators. They were asked to share their specific skills to contribute.Requests to participate in the survey were sent to the FDRG participants and further distributed through professional networks using email, Facebook and Twitter.The responses were analyzed with descriptive statistics of the focus areas mentioned above to identify gaps that need to be filled within the collaborative.

Conclusions

This survey was supported by the FDRG group of WHO-FIC and the respective academic institutions of the authors, Stellenbosch University, McMaster University and CanChild Centre for Childhood Disability Research.

Our survey gathered an international group of collaborators with a broad skill set to take forward the development of a mobile application for the ICF. The worldwide representation is an important aspect to allow for future big scale data collection and analysis.The collaborative is an open community and additonal members are welcome and can take the survey on the link above.

Chart 1: Number of collaborators per country

Chart 2: Distribution of expertise in the collaborative

Chart 3: Expertise in software development

Abstract We present the mICF Collaborator group. This community was established through an international and multilingual survey which ran over three months. The 164 members come from 32 different countries and present with a wide variety of skills and experiences. Additional members, institutional partners and potential funders of this project are welcome.

0

5

10

15

20

25

30

35

40

Collaborators Distribution by Country

0102030405060708090

100

What is your expertise with software development?

0

20

40

60

80

100

120How would you be able to contribute to the development of the mICF?

Introduction

Title

Increasingly mobile phone applications are used to collect and provide health information and facilitate decision making. Currently, no mobile application incorporates the International Classification of Functioning, Disability and Health (ICF), except for emerging prototypes like the ICanFunction Application destined to be used with children and youth (Kraus de Camargo, 2013; Kraus de Camargo, 2012). The ICF is a framework developed by the WHO, documenting information on functioning as dynamic interaction between a patient's health condition, environmental factors and personal factors, facilitating decision-making and continuity of care. ICF highlights the need for a diverse team of service providers, but also represents a paradigm shift in how to approach health and healthcare. At the annual meeting of the Functioning and Disability Reference Group (FDRG) of the World Health Organisation’s Family of International Classifications (WHO-FIC) in 2013, it was agreed to encourage the development of a collaborative to investigate the development of a mobile application for the ICF.

User requirements for a mobile ICF application


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Authors: Stefanus Snymana, Olaf Kraus de Camargob, Judy Zhuxi GongbaStellenbosch University, South Africa, bMcMaster University & CanChild, Canada

Title

Methods & Materials

About 55% of respondents were health service providers and the remainder mostly academic professionals and researchers. Also, about 39% indicated using sms/mobile text messages on a daily basis for their work. 89% use email on a daily basis. The use of mobile health applications on the other hand is still rare, with only 3.6%-7.6% of participants who use various mobile applications.Regarding the hardware use, nearly 100% have access to a computer for work, 58% use a smartphone for work and 33% use a tablet. Traditional mobile phones are rare in this sample with only about 20% users. About 16% were aware of electronic uses of the ICF.

Acknowledgements and Notes

Results

We conducted an online survey to assess the user needs/requirements to develop a mobile App to collect and analyze ICF data. The survey was posted on the SurveyMonkey server on 09/06/2014 and for this analysis data until 31/08/2014 were used. In 41 questions we assessed demographics, professional practice, ICF-knowledge and App-requirements. At the end the respondents had the option to continue to be involved in the project as collaborators.Requests to participate in the survey were sent to the FDRG participants and further distributed through professional networks using email, Facebook and Twitter.The responses were analyzed with descriptive statistics of the focus areas mentioned above to inform the requirements for a technical team to start developing the application.

Conclusions

Literature:Kraus de Camargo, O. (2012). "ICanFunction - The ICF-App Development." Retrieved 01.10.2013, 2013, from https://www.facebook.com/ICanFunction.Kraus de Camargo, O., et al. (2013). The ICanFunction App - The International Classification of Functioning Application - Demonstration Poster. 67th Annual Meeting of the American Academy of Cerebral Palsy and Developmental Medicine. Milwaukee, WI, AACPDM.

This survey was supported by the FDRG group of WHO-FIC and the respective academic institutions of the authors, Stellenbosch University, McMaster University and CanChild Centre for Childhood Disability Research.

Our survey demonstrates that nearly all the respondents have access to electronic communication devices and would like to use them for collecting and reporting health data based on the ICF. The use of mobile health applications is still in its infancy and the mICF App would be a pioneering endeavour. The majority of respondents would like to have such an application to improve patient care with better supported clinical reasoning and decision-making about interventions as well as monitoring functional health over time.

Chart 1: Use of ICF

Chart 2: Current use of mHealth applications

Chart 3: Preferences for data entry

Chart 3: Preferences for data output

Requirements for the mICF App focus on allowing to use the ICF data to assist in clinical reasoning and intervention planning (needs assessment) – 75% and to monitor change in functioning over time –68%. The preferred output mode was an individualised and updatable report for each person assessed – 80%.

Abstract We present the results of an international survey with participants from 36 countries to inform the requirements for a mobile ICF application. Dubbed the mICF, the aims of this project are to build an international collaborative of ICF specialists, as well as experts in health informatics and information technology to investigate the development of a user-friendly mobile application.

0

50

100

150

200

250

What is your experience in using the ICF?

Previous experience

Current use

22%

78%

Have you ever used or are you aware of any computer or mobile phone applications to capture data based on the

ICF?

Yes

No

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Type using your own words what theperson's issues are

Select from a list of ICF-Items if aproblem is present or absent

Select from a list of ICF-Items if aproblem is present or absent and usethe qualifiers indicating the degree of

a problem

Others

As a potential user of the ICF mobile application (mICF), which option(s) would you prefer to enter ICF-related data on your device?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Immediatelyindividualised reportavailable to end user

Individualised report should be available to multiple users (e.g. to other service providers with the individual’s

permission)

Individualised reportsthat can be updated

which would provideinformation on change

over time (e.g. infunctioning)

Provide suggestions fordecision-making based

on algorithms

Report on aggregateddata that was processed

centrally

Other (please specify)

What information would you like to obtain through the mobile application after having submitted the data?

Introduction

Title

Technology is increasingly being utilized to collect and organize health information, facilitate decision-making, and support continuity of care.

Mobile health (mHealth) solutions can increase efficiency of health service delivery and administration, enhance the monitoring of patient health, and facilitate health data collection for clinical practice and other applications.At this time mobile applications incorporating ICF do not exist, only emerging prototypes.

In 2013 the Functioning and Disability Reference Group (FDRG) agreed to form a collaborative to investigate the development of an ICF-based, user-friendly mobile application to (1) assist providers and users of health services in the front line to identify a person's issues in terms of ICF and (2) to amalgamate ICF-related data centrally.

Developing a Mobile Application for ICF –Literature Review Component

Abstract This poster describes the Functioning and Disability Reference Group (FDRG) activities in conducting a detailed literature review and internet search to inform the overall mobile ICF development project.


C508


Patricia Saleeby1, Catherine Sykes2, Andrew Martinuzzi3, Stefanus Snyman4, Olaf Kraus de Camargo5, Vincenzo Della Mea6, Jaana Paltamaa7, Coen van Gool8, Werner Mostert91SIU Carbondale, USA 2World Confederation for Physical Therapy, UK 3Research Branch, Italian CC, Italy 4Stellenbosch University, South Africa 5McMaster University, Canada 6Italian CC, Italy 7JAMK University

of Applied Sciences, Finland 8Dutch CC, Netherlands 9Stellenbosch University, South Africa

Title

Objectives of Literature Review

A literature review is a complex process that can be defined as “an interpretation of a selection of published and/or unpublished documents available from various sources on a specific topic that optimally involves summarization, analysis, evaluation, and synthesis of the documents” (Onwuegbuzie et al).

Task 1: A review of the literature was conducted following the Spring FDRG meeting in London. The term [ICF] was combined with the following terms [application][services][service providers][practice][clinical practice] [profession][professional use][usage][use][implementation] in separate searches of multiple online databases.

Initial searches were limited to English only publications. Articles published in other languages were set aside for a subsequent translation phase. First, abstracts were reviewed and any articles that clearly did not address ICF were excluded. Next, entire articles were reviewed to determine inclusion or exclusion related to the use of ICF.

Content analysis was employed to determine key themes reflected in the literature related to clinical, practice, service, professional uses of the ICF.

Task 2: The compiled literature was reviewed and articles related to ICF and electronic systems or information and communication technology (ICT) was maintained for this component.

An extension of the literature review involved a detailed internet search to capture practical applications that were not published in academic mediums.A table describing how and where the ICF is used in such systems as well as the strengths and limitations of each tool was developed.

Task 3: Another aspect involved the identification of effective mHealthapplications and their characteristics that facilitate decision-making among service providers. These have also been summarized in tabular format.

Task 4: The final element retrieved from the literature describes how service providers in general use mobile applications effectively.


Methods and Activities

As part of the mICF objectives for 2014-2015, a detailed literature review and internet search was initiated in conjunction with other key objectives including the needs requirement survey and a specialized workshop to define project specifications.

Four main components have been incorporated into the literature review:

(1)To identify relevant ICF articles and documentation of how ICF is currently used especially by front line service providers;

(2)To identify current ICF electronic systems and other related ICT systems in terms of strengths and limitations of each tool;

(3)To determine characteristics of effective mHealth applications that enable decision-making on service level (collaborating with mHealthAlliance), and

(4)To evaluate how front line service providers effectively use mobile applications building on the needs requirement survey.

Some Preliminary Findings

For further information, contact:

mICF Literature Review LeadPatricia Saleeby [[email protected]]

mICF Project Lead and FDRG Secretariat Stefanus Snyman [[email protected]]

FDRG Co-Chair Catherine Sykes [[email protected]]

FDRG Co-Chair Andrew Martinuzzi [[email protected]]

*See Onwuegbuzie, Leech, & Collins (2012).Qualitative analysis techniques for the review of the literature. The Qualitative Report, 17(56), 1-28.

Task 1: To date, a total of 87 articles have met inclusion in the literature review based on the key search terms. ICF is being used by various clinicians and practitioners around the world in different settings for several purposes (e.g. develop rehabilitation plans, set goals, determine outcomes).

Task 2: There are limited ICT systems that use ICF. Some developed and developing technologies include FABER, eFROHM, iCAN, BigMove, ICF machine, Revalidatie EPD, and SLU TBI software.

Task 3: High ranking aspects of mobile applications include accessible data by different people at the same time in the field, large quantities of data that can be stored and accessed on small devices, instant information transfer.

Task 4: Case examples are available of mobile applications in service provision (South Africa, Sierra Leone, Handicap International) to be used as reference.

Future Steps

Findings of the literature review and internet search will be disseminated and discussed at the WHO FIC annual meeting. Recommendations will be made to the overall mICF task group and the FDRG Committee.

A FDRG sponsored peer reviewed article will be developed to report the findings from the first phase of this project.

Introduction

The Ministry of Health and Welfare in Republic of

Korea had established “Long-term Care Insurance

for the Aged” service for elderly men and women

above 65 years old or patients who have geriatric

disease (dementia, Parkinson’s disease, stroke)

under 65 years old.

From July 2014, the Ministry of Health and Welfare

came up with a computing system of expanded

policy of “Long-term Care Insurance for the Aged”,

which is the extra grade for dementia. The extra grade for dementia can be given to dementia

patients after a few clinical diagnostic examinations

are taken by a physician.

Those patients, who are diagnosed as extra grade for

dementia, can get long-term care services, which

include cognition training program for three time a

week, home care service, and using nursing home.

Author attempted to applicate ICF in the computing

system for long-term care insurance in Korea.

11-17 Oct 2014Barcelona, Spain


Yong Jin Jeong M.D., Tae Woong Choi M.D., Yoon Kyoo Kang, M.D. Ph.D.Department of Physical Medicine and Rehabilitation, Korea University Medical

Center, Anam Hospital, Seoul, Korea

Application of ICF in computing system for long-term care insurance in Korea

Author performed the linking process between

extra grade for dementia and ICF, and the linked ICF

codes were consisted of body structure (s110

structure of brain), body function (b114 orientation

functions, b164 higher-level cognitive functions),

activity and participation (d530 toileting, d510

washing body parts, d540 dressing, d550 eating)

and environmental factor (e310 immediate family).

Methods and Results

Conclusion

During the process of diagnosing the extra grade

for dementia, physician must perform a certain

number of clinical diagnostic examinations to a

patient and put those information on a computing

system.

Author attempted to make a link between the

Ministry of Health and Welfare and the Statistics

Korea, to transform the patient information and to

make an integrated data base.

The patient information which can be obtained from

this process can be transformed into a certain

framework, given by International Classification of

Functioning, Disability, and Health (ICF).

As the computing system for long-term care

insurance progress since July 2014, a

comprehensive data base of dementia patients in

Korea will be built.

Furthermore, the data base can be used to classify

and analyze all dementia patients’ records and help

to establish and execute a new health care service.

Fig. 1. Process of computing system

Extra grade for Dementia

Long-term care insurance

- clinical diagnostic examination

- questionaire

ICF Body structure

- s110 structure of brain

Body function

- b114 orientation functions

- b164 higher-level cognitive functions

Activity & Participation

- d530 toileting

- d510 washing body parts

- d540 dressing

- d550 eating

Environmental factor

- e310 immediate family

Fig. 2. Linking process between extra grade for dementia and ICF

Extragrade for dementia

Physician ↔ Patient

Ministry of Health and Welfare

Statistics Korea

Data base of dementia patients

Computing system

Patient information Transform into ICF

C509

ModelDisability Survey


C510


Authors: A. Cieza2, A. Officer1, N. Kostanjsek1, A. Posarac3, C. Sabariego4, J. Bickenbach5, S. Chatterji1

1World Health Organization, Geneva, Switzerland, 2Faculty of Health and Social Sciences, University of Southampton, UK, 3The World Bank, Washington, USA, 4Institute for Public Health and Health Care Research, Ludwig-Maximilians-University, Munich, Germany; 5Swiss Paraplegic Research, Nottwil, Switzerland

PHASE 1 - Development

A. REVIEW EXISTING SURVEYS, REPOSITORY179 health and disability surveys identified, available athttp://disabilitysurvey.checkdesign.de/

PHASE 2 - Testing

A. COGNITIVE TESTINGUSA (concluded)University of MichiganNational Center for Health StatisticsMALAWI & CAMBODIA (concluded)Division for Health Statistics, Statistics NorwayNEPAL & CHINA (July & Aug 2014)University of Michigan

B. PILOT STUDIESCAMBODIA Division for Health Statistics, Statistics NorwayAug & Sept 2014, 500 interviewsMALAWIDivision for Health Statistics, Statistics NorwayNov 2014NEPAL, OMAN, CHILEBeing planned

B. STATISTICAL ANALYSIS WITH MICRO DATA

Out of 52 relevant surveys, 12 surveys were selected for statistical analysis using Item Response Theory (Rasch models)

Abstract Article 31 of the United Nation Convention on the Rights of Persons with Disabilities (CRPD) mandatesthat ratifying State Parties “collect appropriate information, including statistical and research data, to enable them toformulate and implement policies to give effect to the present Convention”.

Conceptualizations and approaches to measuring disability are different across countries, perhaps the reason why disabilityprevalence rates vary widely. While considerable effort has been made to improve disability data in several countries, thereis currently no standardized survey instrument that would make it possible:

(i) to collect comprehensive, comparable and relevant information that helps countries construct a complete picture ofdisability; and

(ii) to meet the national obligation of ratifying countries to monitor the implementation of the CRPD.

Having this in mind, the World Health Organization (WHO) and the World Bank (WB) initiated the development of aModel Disability Survey (MDS) in 2011. The MDS represents the first positive attempt to fully operationalise the ICFand in particular the concept of the ‘lived experience’ of functioning and disability.

The MDS is a milestone towards fulfilling one of the three objectives of the recently endorsed WHO global disabilityaction plan 2014-2021: “to strengthen collection of relevant and internationally comparable data on disability andsupport research on disability and related services”.

The Alpha Version of the MDS consists of two functioning sections (26 questions for children, 48 for adults) concerninghow people actually function in 17 domains, in light of environmental barriers and facilitators. Detailed sections abouthealth conditions, environmental factors, health care utilization, and well-being are also included.

The MDS is currently undergoing a series of cognitive and pilot testing exercises, and its implementation in nationaldisability surveys is planned to begin in 2015.

D. EXPERT CONSENSUSDecember 5 and 6, 2012 – GenevaConference including 28 international experts representing 21 different countries

IDENTIFIED DISABILITY & HEALTH SURVEYS PER

WORLD REGION

A. IMPLEMENTATION IN NATIONAL SURVEYS

• Philippines

• Sri Lanka

• Oman

B. DISSEMINATION

• High-level meeting of the General Assembly on Disability and Development on September 23, 2013

• Country-specific dissemination by WHO regional offices

PHASE 3 – Implementation & Dissemination

Model Disability Survey - Alpha Version

INDIVIDUAL QUESTIONNAIRE

Section 1000: Socio-DemographicsSection 2000: Work History, BenefitsSection 3000: FunctioningSection 4000: Environmental FactorsSection 5000: Health Conditions Section 6000: Health Care UtilizationSection 7000: Well-Being

HOUSEHOLD QUESTIONNAIRE

Section 1000: Household roster Section 2000: Children (health conditions & functioning)

http://www.who.int/disabilities/data/mds/en/

Introduction

Title

The ability to identify people withdisabilities is still one of the mainchallenges of the current landscape ofnational public policy. This is not justbecause people with disabilities are aheterogeneous group, with varyingcharacteristics and levels of disability, butalso because they vary in social terms, asthe living conditions of these people may beextremely different, so people with thesame impairments can perform differentlyaccording to the context in which they are.Thus, an instrument that has the ability toidentify those people with differentsocioeconomic conditions andcharacteristics is needed.

Development of a grading instrument of functioning for Brazilian citizens: Brazilian Index of Functioning - IF-Br

Abstract The systems used for disability certification in Brazil vary according to the sectors. By recommendation from the Presidency of the Republic, an interministerial task force with disability experts and advocates was organized to develop a single model of disability evaluation and classification. The working group began with a comprehensive review of biodemographic information of people with disabilities in Brazil, obtained from sources such as the national census, school census, annual list of social information and research of municipal basic information. The conceptual model of the International Classification of Impairments, Disability and Health, thus aspects of body functions, activities and participation and environmental factors were selected, summing 41 ICF categories. Body structures were not considered. Also, ICF qualifiers structure was collapsed to 4 levels and attributed values from 25 to 100, depending on the level of independence. Both categories and their qualifiers levels were described with user friendly terms to promote clear understanding of the impact of assistance from other people and assistive technology for performance. Based on the final adult version, adjustments were made for children in 8 age groups based on the expected functioning development described by the Pediatric Evaluation of Disability Inventory. Additionally, other questionnaires for visual, motor, auditory and intellectual impairments were developed following a qualitative fuzzy logic. Psychometric properties were not calculated.


C511


Franzoi AC*, Xerez D*; Khan P◊; Blanco M†; Riberto M¤.* Federal University of Rio de Janeiro (UFRJ), ◊ Centro Catarinense de Reabilitação; † Institute for Studies on Labor and Society (IETS); ¤ Ribeirão Preto Medical School.University of São Paulo (USP). Brazil

Title

Methods & Materials

Results

1 Collecting inputs aimed at expanding the understanding of the diverse realities of disabled people

2 Focus groups with people with disabilities

3 Consensus meetings with experts3.1 Definition of activities and participation included in the IF-Br 3.2 Definition of the scoring criteria for each activity and participation 3.3 Identification of relevant environmental barriers to be included in the scoring process 3.4 Supplementary Measure Valuation: Linguistic Fuzzy Method 3.5 Preparation of IF-Br for Children and Youth 3.6 Development of Identification Card 3.7 Development of the Socioeconomic Questionnaire

Domains and activities Scoring Environmental barriers

P & T Amb S & R At SSP

1 Sensory domain

1.1 Watching

1.2 Listening

2 Communication domain

2.1 Communication / reception of

messages

2.2 Communication / production of

messages

2.3 Conversation

2.4 Discussing

2.5 Using communication devices

for long distances

3 Mobility domain

3.1 Changing and maintaining body

position

3.2 Reaching, transporting and

moving objects

3.3 Fine hand use

3.4 Moving around indoor

3.5 Moving around inside buildings

not home

3.6 Moving around outdoor

3.7 Using public transportation

3.8 Using individual transportation

as passenger

4 Personal care domain

4.1 Washing oneself

4.2 Caring for body parts

4.3 Regulating urination

4.4 Regulating defecation

4.5 Dressing

4.6 Eating

4.7 Drinking

4.8 Identifying health risks and

problems

5 Domestic life domain

5.1 Preparing light meals

5.2 Cooking

5.3 Doing housework

5.4 Maintaining and properly using

of household objects

5.5 Assisting others

6 Education, work and economic life

6.1 Education

6.2 Professional qualification

6.3 Remunerative employment

6.4 Acquisition of goods and

services

6.5 Managing personal economic

resources

7 Socialization and community life domain

7.1 Regulating behaviour during

interactions

7.2 Interacting in accordance to

social rules

7.3 Relating with strangers

7.4 Family and informal

relationships

FIM scoring IF-Br scoring

7 Complete Independence 100 Total independence

6 Modified Independence 75 Modified independence

5 Supervision

50 Partial assistance4 Minimal assistance

3 Moderate assistance

2 Maximal assistance

1 Total assistance 25 Total assistance

Correlation of the scoring systems for FIM and IF-Br: Conclusions

3.4 Moving around indoors

Scoring 25 – Do

not complete the

task

Scoring 50 –

Partial

assistance

Scoring 75 –

Modified

independence

Scoring 100 –

Complete

independence

Walking or

moving around

inside one’s own

house or annex

areas, if

applicable

The subject is

totally

dependent to

accomplish the

task

Needs

assistance to

accomplish the

task, includes

supervision r

preparation

Needs

adaptation to

accomplish the

task or does it in

a different way

or longer time

Completes the

task independent

and safely

(walks, runs,

climb up/down

stairs)

Example: move

around in a

room, from one

room to another,

in annex areas

like terraces,

garden or

veranda

Example: to

climb up/down

stairs indoors or

to push a

wheelchair

Example: use of

crutches,

wheelchair

Examples of descriptions of scoring levels

Motor impairment

□Score 25 or 50 in any of the tasks, or 75 in all of

the tasks, in the Mobility or Personal Care domains

□The subject can only move around with a

wheelchair.

□ Assistance is not available whenever needed

Chart 4 – Example of the Fuzzy model for motor impairment

Age (years)3 4 5 6 7 8 9-2 13-15

Number of activities in the age-specific tool 30 30 30 32 34 34 38 39

Discussing

Cooking

Doing housework

Assisting others

Professional qualification

Remunerative employment

Acquisition of goods and services

Managing personal economic resources

Intimate relationship

Making oneself choices

Citizenship and political life

Chart 5: Activities excluded from IF-Br for children and youth (marked in black)

This instrument is an example of themodification of the biomedical paradigm ofdisability assessment for a more integrativemodel considering the performance ofactivities and the context are being appliedworldwide.

Introduction

As disability rates increase globally there is a greater need for social workers that are effectively trained and prepared to practice among individuals with disabilities.

Social workers practice in various settings with other clinicians and on inter-disciplinary teams. The use of a common language and system would be beneficial for data sharing and collaboration. Also, social workers regularly conduct assessment, intervention, and evaluation in professional practice.

The International Classification of Functioning, Disability and Health (ICF) provides a useful framework, terminology, and classification to facilitate enhanced training of social workers not only about disability, but also health, mental health, and overall functioning.

Use of the ICF in Education and Training of Social Workers

Abstract This poster describes the integration of the ICF in a graduate level social work course and the usefulness of the ICF in facilitating understanding of functioning, disability and health. Students were able to effectively use the ICF and the ICF Checklist to code various clinical cases, incorporate the information into the development of intervention and treatment plans for those clinical cases, and then determine outcomes based on changing functional status for their individual cases.


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Patricia Welch Saleeby, PhD, MSSA, Southern Illinois University Carbondale, USA

Usefulness of ICF in Social Work

The ICF was incorporated into a two-semester graduate sequence Health and Mental Health Practice I and II led by the instructor, Professor Patricia Welch Saleeby, at the School of Social Work at Southern Illinois University Carbondale (USA).

A total of 22 social work graduate students completed an ICF based training that introduced them to the ICF and key elements of the framework and classification in the first and second semesters.

In the second semester, students each developed their own clinical case and used it as the basis for completing clinical assignments. Each case was required to include information related to a primary and secondary health and mental health condition as well as information about the functioning in various major life areas. Information about the environment and personal factors were also required in the clinical cases.

First, student participants used the ICF and ICF Checklist (Clinician Form for ICF) to code their own case study.

Secondly, they completed A Comprehensive Service Plan (O’Hare, 2007) – a multi-dimensional functional assessment – using their same clinical case.

Subsequently, students were given a follow-up to the same clinical cases (“a second encounter”) that reflected changes in the functional status and environmental/personal factors for their respective case.

Participants used this information to re-code their cases and indicate changes in any qualifiers including environmental barriers and facilitators.


Results

With its inclusion of individual (body structures and functions) and environment factors along with the dynamic between the two aspects (activities and participation), the ICF aligns well with the commonly used social work person in environment approach. Its bio-psycho-social framework fits nicely with the social systems and ecological approaches used by social workers.

The ICF classification, codes, and qualifiers provide an effective tool for social workers to develop appropriate interventions or treatment plans and to track changes in functional status of individual clients based on these interventions and treatments.

The following educational example serves as a pilot-study for demonstrating the potential value of the ICF in clinical practice.

Conclusions

Thank you to Charmaine Crockett, University of Hawaii, for inclusion and sponsorship of ICF sessions and workshops in conjunction with the annual Pacific Rim International Conference on Disability and Diversity.

And to Darla Coffey, President of the Council on Social Work Education, for her support of the ICF in social work.

*O'Hare, T. (2007). Essential skills of social work practice. Chicago: Lyceum.

Students were able to understand the ICF framework which reflects a parallel to social work’s primary guiding frameworks – person in environment, social systems, and ecological approaches.

Students were able to effectively use the ICF classification and codes (Body Structures and Functions, Activities and Participation, and the Environment) in their coding assignments with little difficulty.

Qualifiers were slightly problematic to most students since these were considered too subjective. The environmental barriers and facilitators were easier to both understand and implement. But the concepts of capacity and performance themselves were appealing to social work students because they practice in home, school, and other settings.

Overall, evaluation of ICF training demonstrated the utility of the ICF for addressing treatment and intervention planning as well as determining functional outcomes.

Using the ICF can contribute to improved understanding of health, mental health, disability and functioning among social work graduate students.

Introduction

There has been a growing interest in the ICF as reflected in the increased number of ICF related literature over the past decade. Although a good number of articles represent mapping ICF concepts or codes, the literature is becoming broader in scope.

This literature includes primarily publications regarding the ICF framework and development, utility and application of the ICF, ICF codes and coding, education and training on the ICF, research and empirical studies involving the ICF, and implementation of the ICF in policy as well as clinical and professional practice.

Developing Criteria to Evaluate ICF Literature

Abstract This poster describes the ongoing efforts of the Functioning and Disability Reference Group (FDRG) in establishing criteria to evaluate the quality of the increasing broad range of published ICF literature.


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Patricia Saleeby1, Catherine Sykes2, Andrew Martinuzzi3, John Hough4, Haejung Lee5, Mathilde Leonardi6, Alain Leplege7, Thomas Maribo8, Huib Ten Napel9,

Jaana Paltamaa10, Stefanus Snyman11, Gordon Tomes121SIU Carbondale, USA 2World Confederation for Physical Therapy, UK 3Research Branch, Italian CC, Italy

4North American CC, USA 5Korean CC, Korea 6Italian WHO CC Research Branch Neurological Institute C. Besta 7Universite Paris Diderot, France 8Aarhus University, Denmark 9Dutch CC, Netherlands

10JAMK University of Finland, Finland 11Stellenbosch University, South Africa 12Australian CC, Australia

FDRG Activities

Members of the FDRG task group decided the following criteria were necessary in considering the quality and merit of the publication and its contribution to the overall ICF literature:

1. All components of the ICF framework are considered.

2. All components of the framework and their interactions are considered. Reasons for excluding components are explained.

3. Demonstration of the methods by which the ICF interactions are discussed.

4. Demonstrated awareness of the literature pre-dating the study and relevant reference to ICF literature is provided.

5. Explicit reference to ICF definitions and categories are included.

6. Consistent use of ICF language is demonstrated.

7. Where ICF is linked/mapped to another tool description of the methodology is given.

8. Where linkage between ICF qualifiers and other measures description of the methodology is given.

9. Knowledge translation between different settings is demonstrated.

10. Description of the use of ICF qualifiers e.g. five point scale, three point scale, present/absent, and description of the reason for selection of qualifier use is provided.

11. The person’s perspective is recognized in the reporting.

12. Interaction with ICF derived instruments is clarified.


Updated Criteria

In 2013 at the Beijing meeting the Functioning and Disability Reference Group (FDRG) decided to establish criteria to assist in evaluating the broad range of ICF literature.

At the 2014 FDRG meeting in London, the task group began with the previous work led by John Hough, which determined six main criteria to evaluate literature related to ICF mapping.*

These criteria were reviewed and discussed by the FDRG task group for evaluating ICF literature beyond those publications related to mapping and coding. A total of 12 updated criteria were developed by the task group to better address the broader range of ICF related literature.

Current Tasks

For further information, contact: Patricia Saleeby [[email protected]], or FDRG Co-Chairs Catherine Sykes [[email protected]] and Andrew Martinuzzi [[email protected]], or FDRG Secretariat Stefanus Snyman [[email protected]]

*Hough, J. (2013, October) Need and Rationale for an ICF Mapping Database.Poster presented at the annual meeting of the WHOFIC Network, Beijing, China.

Twenty published papers have been selected to pilot-test the preliminary criteria. Papers have been chosen randomly from several combined ICF literature sources including the WHO Dutch Collaborating Centre Literature Database on ICF.

Selected articles are all published in English as a common language to facilitate the evaluation exercise among international members of the FDRG task group.

Articles originate from different journals and authors, represent various fields and disciplines, and characterize varying types of literature as described in the introduction.

Two FDRG task group members have been assigned to review and rate each article according to the 12 preliminary criteria. Rating sheets are being compared and tabulated to determine if each criteria is feasible for evaluating a diverse literature on ICF. Reviewer comments are also being used to guide adjustments to the initial criteria.

Adherence to the ICF Linking

Rules

Quantitative Methods

Usability in Applied Settings

Applicability in Less Resourced Countries

Conceptual Merit of the ICF Mapping

Suitable Application of ICF Concepts

Future Steps

Results from the evaluation exercise will be reviewed and discussed at the annual meeting. Finalized criteria will be determined by the task group and recommended to the FDRG Committee.

A co-authored paper will be submitted for publication describing both the evaluation process and findings, which will serve as recommendations for consideration to journal reviewers and future authors of ICF related articles.

Introduction

The International Classification of Functioning, Disability and Health (ICF) was adopted in 2001 and, as was expected, increased usage has exposed inconsistencies and deficiencies in the classification. As with the 10th revision of the International Classification of Diseases (ICD-10), the WHO developed the ICF Update Platform, a web-based review tool, which allows the management of the update process through a workflow engine collecting collaborative work of experts on update proposals submitted by users The ICF Update Process (Fig, 1) is carried out by the Council of the World Health Organization-Family of International Classifications (WHO-FIC) through a Committee of voting members representing Collaborating Centres and NGO, the Update and Revision Committee (URC). URC relies upon the content expertise of the WHO-FIC Reference Group for Functioning and Disability (FDRG) and its dedicated sub-group, the Initial Review Group (IRG). The development of the Children and Youth version of ICF (ICF-CY), released in 2007, did not only add content to the ICF, but identified other issues that needed attention. Following the decision to incorporate the amendments made for the ICF-CY into the foundation layer of the ICF, in 2010, a large number of proposals were loaded onto the platform for review. In addition, over the last 4 years, other users have also submitted update proposals for review.All of these proposals underwent a standardised review process, in collaboration with members of the FDRG, and often leading to modification before a final vote by members of theURC. In some cases objections were raised regarding the principle of amendment. In others the problem raised dealt with the placement of additional or amended codes. In many cases the stumbling block was appropriate phrasing and word choice. An analysis of the nature of the reviews proposed and the reviewer’s comments was undertaken to identify the type of issues raised. It was also intended to identify some core issues about the underpinning logic of the classification, the so called ontological issues of ICF.

The ICF update platform – what issues do reviewers raise?

Abstract This poster presents an analysis of the reasons why the proposals were rejected or subjected to extended review with the purpose of guiding the review process in the future. The proposals on the FDRG URC platform were subjected to individual analysis and the comments post-coded into different clusters. The nature and frequency of the comments are presented, together with the outstanding issues that still need attention. The need for an ontological review of the ICF is highlighted.


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J Jelsma 1, M Cuenot 2 F Gongolo 3, C Sykes 41 University of Cape Town, 2 Ecole des Hautes Etudes en Santé Publique (EHESP), 3 Friuli Venezia Giulia

Central Health Directorate 4 World Confederation for Physical Therapy (WCPT), United Kingdom

Methods & Materials

Most of the proposals originated from the CY (87%). They related to Activity/ Participation, followed by Body Functions and Environmental Factors (Fig. 3). Changes in notes were the most common type of proposal, followed by addition of 2nd , 3rd, and 4th level codes (Fig. 4).

Acknowledgements

Results

A data collection template was developed by the authors. Every proposal that was on the platform and that had passed through review by the FDRG was included (144). Proposals in the Initial Review Layer (6) and in Closed Discussion Layer (41) were not included in this review. The first author reviewed each proposal and classified the comments as relating to acceptance or rejection based on a) issues relating to lexical or language use including inclusion of examples and b) ontological which included difficulties with placement in the classification, overlap with other codes and granularity. In addition, issues that were unresolved were flagged and presented. Please note that this poster presents a preliminary analysis.

Conclusions

The review process is made possible by thoughtful participation of FDRG and URC members. Their commitment, insight and dedication are recognised. Funding from the University of Cape Town Research Committee is gratefully acknowledged.

0 10 20 30 40 50 60

Change in note

3 level code addition



Expansion of inclusion critria

Modification in defintition code

Addition/alteration to…

Correction of an error

Addition/alteration of…

Other

A/P59%

B Structure7%

B Function16%

Environment16%

Annex2%

Comparison of time to resolution

Yes No

Ontological Problem

2.0

2.2

2.4

2.6

2.8

3.0

3.2

3.4

Tim

e to reso

lutio

n

Mean Mean±SE Mean±1.96*SE

The mean time for resolution of proposals was 2.8 +/- .98 years, ranging from 1 to 5 years (Fig. 5). Although the time for resolution was longer for the proposals that were finally rejected or with lexical problems identified, this was not significantly longer than those approved (p=.176) and for those without lexical problems (p=.317.). Proposals with ontological problems, on the other hand, did take about 9 months longer to resolve.Lexical problems were identified in 50% of the proposals ranging from somewhat trivial grammatical correction to cross-cultural applicability (e.g. scooting); scientific meaning of words (nutrition) and the inclusion of examples applicable across the life span.Ontological problems were identified in 49% of the proposals. The most common was overlap between codes (23) e.g. Indicating the need for toileting – Self care or Communication? The placement of codes was problematic in 16 proposals (e.g. Play in children as Recreation or Major Life Activity) as were parent/child issues (10) (at what level should Genital Functions associated with arousal of the genitals be inserted?) Applicability across the life span issues were cited in 15 proposals and an important concern was that if there are codes that relate exclusively to children, there should maybe be similar codes and examples for gender or other groups. The degree of granularity (13), consistency with other codes (6), distinction between basic/complex and the use of neutral terms (2) were also questioned.Unresolved issues that need further consideration and which might only be resolved by an ontological revision include inconsistency between “undertaking a single task” and “undertaking multiple tasks” both potentially logical parents of other A&P items, the definition of temporal aspects of functioning, e.g. lags, delays, time taken to complete a task; the overlap between different chapters, e.g. Writing/reading and Communication; the inclusion of activity codes in a developmental sequence, e.g rolling over inserted after standing and bending; and a cross-cultural approach to special educationwithout marginalising children.

The Update process is essential to ensure that the ICF is a living classification, responsive to changes in scientific knowledge, evolving technology and growth in cultural understanding. This preliminary review has highlighted the need for an ontological review to deal with these emerging challenges.

Fig. 5 – Time to resolution – ontological issues

Fig. 1 – The update process

Total on platform

(192)

InitialReview

(6)

Completed reviews

Open discussionLayer

(26)

Closed discussion

layer

(41)

Endorsed by Council

Rejected

(49)

Approved

(69)

Fig. 2 – Current status of the ICF update platform (August 31, 2014)

Fig. 3 – Percentage of proposals by ICF Component

Fig. 4 – Type of amendment

Introduction

Title

From the International Classification of Impairments, Disabilities, Handicaps (ICIDH, WHO, 1980) to the International Classification of Functioning, Disability and Health (ICF, WHO, 2001), knowledge on disability has evolved and the wording has changed in the different languages without a clear relation with Ontology.The authors compare the different meanings of the same word disability across standard classifications and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and propose an ontology perspective.

How to deal with meaning ambiguity in international classifications on

disability in five different languages

Abstract From ICIDH to ICF, knowledge on disability has evolved and the wording has changed in the different languages without a clear relation with Ontology. The authors compare the different meanings of the same word disability, in five languages, across standard classifications and UN Convention on the Rights of Persons with Disabilities (CRPD) and propose an ontology perspective. One of us has proposed to use an acronym to overcome the linguistic barrier with the translation in national languages. The discussion is open to consider the risk not to face the use of the same English terms without referring to a semantic definition before translation.


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Rodrigues J.-M.1, Frattura L.2, Cuenot M.31 Inserm U1142, LIMICS, UPMC UJM (France), 2 Central Health Directorate, Classification Area, Friuli Venezia Giulia Region (Italy), 3 French National School of Public Health (France)

Methods & Materials

References

Results

Three different meanings of the same English term disability in three different standard terminologies were analysed(ICIDH, ICF, UNCRPD) then the translation of these three different meanings in five languages were considered.

Conclusions

1. Frattura L. , Griffo G. Updating Annex 5: ICF, people with disabilities and UN CRPD: implications for statistics and policies monitoring. WHOFIC2011 / D002 Cape Town, South Africa 29 October - 4 November 2011

The different national languages addresses the change in meaning differently making comparisons of words misleading.One of us [1] has proposed to use an acronym to overcome the linguistic barrier with the translation in national languages. In the era of Ontology an alternative proposal may be to associate to the words (e.g Disability) in each language a Unique Semantic Identifier (USI) which explicits the definition of the word allowing not to confuse it with the same word with another meaning in another context. The discussion is open to consider the risk not to face the use of the same English terms without referring to a semantic definition before translation. The positive side of the disability coin is “functioning” and we need to identify it too in an appropriate ontological way .

Language ICIDH ICF UNCRPD

English Disability Disability Disability

French Incapacité Handicap Handicap

Italian Disabilità Disabilità Disabilità

Portuguese Incapacidade Incapacidade Deficiência

Spanish (Castillano)

Discapacidad Discapacidad Discapacidad

Unique Semantic Identifier (USI)

USI 01The inability to perform an activity in a normal manner due to an impairment.

USI 02An umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual and that individual’s contextual factors.

USI 03…who have long-term physical, mental, intellectual or sensory impairments which in interaction …may hinder their full and effective participation in society on an equal basis with others.

ICIDH Disability is defined as: The inability to perform an activity in a normal manner due to an impairment. ICF Disability is defined as: “An umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual and that individual’s contextual factors”. In the same classification, WHO provides a definition for Functioning, in such a way specular, used for describing the positive interaction between an individual and that individual’s contextual factors. On the other hand UNO has approved and defined a UN CRPD which defines persons with Disabilities as Persons ”who have long-term physical, mental, intellectual or sensory impairments which in interaction …may hinder their full and effective participation in society on an equal basis with others”. Such a definition

Table 1 - The table shows the results of the semantic comparison

Figure 2 – The “disability semantic” cloud



allows us to outline the concept of disability, which, without questioning the physical/mental impairment (seen as a precondition), focuses on theconsequences that people with disabilities face in their daily life because of the presence of barriers. The consequences, according to the UN definition, are negative and they regard the restriction to participation in life. Thus, the definition of the UN, although it does not explicitly define what disability is, suggests that disability is the negative consequence of an interaction between a person with impairments and the environment.On the other hand, the issue about what is a positive interaction and what is a negative one is not faced in the “ ICF red book”. The schema suggested in Annex 2 (ICF, pag. 223) is not sufficient to solve the problem on how to distinguish positive from negative interactions.

Introduction

Confederación ASPACE is the biggest non-profit cerebral palsy organization in Spain. It is composed of more than 70 local organizations, 18,000 people with cerebral palsy and about 6,000 professionals plus volunteers. His associates are also non-profit organizations working largely with public funds and providing social services to people with disabilities.

"Valuable Capabilities" is a project of Confederación ASPACE that aims to facilitate an objective assessment of the clinical and functioning profile, and the social situation of people with disabilities. The project is based on the International Classification of Functioning, Disability and Health (ICF) of the WHO.

ASPACE is working to meet this main goals: i) to develop a cloud based software tool around the ICF Classification; ii) to spread the usage of the ICF amongst ASPACE centers and other interested parties; and iii) to carry out research activities based on the data our system will gather.

“Valuable Capabilities”. Towards an extensive adoption of the ICF in ASPACE

Abstract ASPACE is implementing “Valuable Capabilities”, a project whose main goals are: i) to develop a cloud based software tool around the ICF Classification; ii) to spread the usage of the ICF amongst ASPACE centres and other interested parties; and iii) to carry out research activities based on the data our system will gather.


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Authors: Mauri, C., Acevedo, J., Reyes, N., Jiménez, A., Jiménez, J.Confederación ASPACE, Madrid, Spain

Project Development

#2 phaseOne of the main goals is to promote and facilitate the implementation of the ICF amongst ASPACE organizations using a common tool. To do so, we plan to gradually introduce our software among ASPACE entities and other interested organizations. This implementation starts in eight ASPACE organizations that take part in a pilot project. A small group of ASPACE organizations with broad experience applying the ICF, will provide training, guidance and support to their peers. This close collaboration will help to identify difficulties using the web tool and the ICF itself. The tool will be offered for free to ASPACE entities and other organizations.

As far as the research is concerned, we expect to extract knowledge from the data our system will gather. The web tool can become a huge database on the functioning of persons with disabilities. In the short term, we plan to carry out epidemiology studies which shall enable us to broaden our knowledge of diagnostics and functioning of people with cerebral palsy, and to plan further research activities.

Project Innovations

#1 phaseThe first phase involves the development of the cloud based software tool called “Valuable Capabilities”. This tool provides different templates, including some internationally accepted ICF core-sets, to facilitate the assessment of the person according to his/her diagnostic or typology. It also allows to develop new templates using specific categories and qualifiers depending on the situation or group to assess. These templates can be shared or used privately depending on the choice of its author. These features provide great flexibility whilst maintaining the consistency of evaluations with the regulatory framework of the ICF.

Target Population

“Valuable Capabilities” will directly benefit 18,000 people with cerebral palsy of the ASPACE collective in Spain. In addition, the project can meet the needs of many stakeholders, such as other groups of people with disabilities. Therefore, “Valuable Capabilities” wants to count with the complicity of other organizations in Spain. In future we also plan to translate the application to other languages , which would help to reach an even greater number of beneficiaries.

- The change of the viewpoint of the disability when the ICF conceptual framework is adopted. This framework defines disability as a result of the interaction of people with their environment, and defines "participation" as a key element, instead of solely focusing on impairments and physical conditions.

Project Partners

So far, “Valuable Capabilities” has the support of Vodafone Spain Foundation, a non-profit organization that contributes to the promotion of innovation and the use of ICTs to improve the quality of life of people and, especially, of vulnerable groups. The Vodafone Spain Foundation develops technological innovation projects that make life easier for people with disabilities and the elderly. It also promotes ICT training programs to support their personal autonomy and social inclusion and employment, and contributes to the spread of telecommunications in society through publications and reports.

For more information:http://icf.aspace.org

- The development of a common and flexible assessment mechanism for all professionals which is essential for creating projects tailored to the real needs of the users.

- The availability of a software application on the Internet, accessible to all professionals, which enables the usage of the aforementioned evaluation mechanism and which concentrates in a single database a large amount of data.

- Statistical reports generated from this dataset will provide accurate information about the actual situation of functioning and disability (both from a social and clinical point of view) of the group of people evaluated.

Figure 1: Screenshot of the main menu of the software tool.

Figure 2: Screenshot of the template editor of the software tool.

Introduction

Adaptation and standardization of the use of the Core set of the International

Classification of Functioning for individuals with Acute Traumatic Spinal Cord Injury

Abstra INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) describes the functioning of individuals with particular health condition and how context factors can modulate it. Acute traumaticspinal cord injury (ATSCI) has several effects on the functioning. The ICF core set for spinal cord injury (CSSCI) has 31 categories: 9 body functions, 4 body structures, 13 activities and participation and 5 environmental factors and proposes aninnovative evaluation of people with ATSCI, although it has not been used in this context and there are issues regarding standardization. OBJECTIVE: To build and validate an instrument based on the brief ICF Core Set for SCI in the acute contextand test its applicability. METHOD: Based on the description of CSSCI categories, questions and answer alternatives were elaborated with user-friendly detailed terms to guide the application and ensure reproducibility. We assessed 18 ATSCIsubjects (89% men, age: 45 years old), level of injury: 50% cervical, 33.3% thoracic and 16.7% lumbar, 50% AIS A. We applied the questionnaire based on the brief and expanded ICF Core set between March and June 2014. The prevalence ofdisability in each category was defined as the proportion of individuals with qualifiers 1-4. The data were correlated with the Spinal Cord Independence Measure-3 (SCIM-3) (0-100 points) was the main score of disability and subjects were groupedin four groups of 0-25 points, 25-50, 50-75 and >75 points for analysis. RESULTS: The instrument was considered easy by users. SCIM-3 score negatively correlated with the frequency of disability in the categories of the CSSCI. Impairments wasmore frequent in urinary functions, defecation and protective skin also scored high emotional function, pain and muscle strength. For activities and participation: mobility and personal care were more disabled. Main facilitators: immediate family,health professionals, products and technology for personal use in daily living and communication, as well as caregivers and personal assistants. No barrier was identified. CONCLUSION:. Has the advantage of identifying and assessing the impactof environmental factors.


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Patricia Carla Vianna¹, Juliana Nogueira Coelho², Camila de Almeida¹, Soraia Assad Nasbine Rabeh³, Marcelo Riberto¹

1. Rehabilitation Center at the Hospital das Clínicas in Ribeirão Preto, Brazil, 2. Ribeirão Preto Medical School - University of São Paulo, Brazil , 3. Ribeirão Preto Nursing School - University of São Paulo, Brazil.

Methods

Instrument considered easy to use byevaluators.

Body functions (b): Impairments wasmore frequent in urinary, defecation andprotective skin functions. Emotionalfunction, pain and muscle strength alsoscored high.


Results

Location: Rehabilitation Center of Hospitaldas Clinicas, Medical School of Ribeirão Pretoof University of São Paulo (CER-HCFMRP-USP)

18 subjects with SCI

Males 89%; mean age: 45 years

Level of injury: 50% cervical, 33.3%thoracic and 16.7% lumbar, and 50% AIS A

We applied the questionnaire based in thebrief and expanded ICF Core set betweenMarch and June 2014

A score of disability was calculated for eachsubject by summing the qualifiers for eachcomponent (b, d). For environmental factors,this score was separately calculated forbarriers and facilitators

The prevalence of disability in each categorywas defined by the proportion of subjectswith qualifiers 1-4 (for b and d).

Frequency of barriers and facilitators wascalculated for each subject as the number ofe categories with . or + qualifiers,respectively

Data were correlated with the Spinal CordIndependence Measure-III (SCIM-III) (0-100points) and grouped patients into four groupsof 0-25 points, 25-50, 50-75 and >75 pointsfor analysis.

Conclusions

Psychometric properties of reliability andvalidation are further needed.

The instrument based on the ICF core setfor ATSCI was well received byprofessionals

The instrument is able to differentiateindividuals more severely disabled.

It identifies the impact of environmentalfactors.

d5301 Regulating defecation:

Coordinate and manage the defecation as indicating the need to adopt the appropriate position, choose to go to an appropriate place to defecate,

manipulate ante clothes and after defecation and clean themselves after

defecating.Question:a) Do you feel the need to defecate? () Yes () Nob) Can you control the time of defecation? () Yes () Noc) Can you go to the toilet to defecate alone (a)? () Yes () Nod) Can you take off and put your clothes, diapers, alone (a)? () Yes () No

e) Can you wipe after using the bathroom alone (a) () yes () no

Qualifiers Description CIF Adaptation of qualifiers

0 No impairment (0 - 4%)Presents all the positiveresponses

1 Mild impairment (5 - 24%) 4 shows positive responses.

2Moderate impairment (25 -

49%)3 shows positive responses.

3 Severe impairment (50 - 95%)Has at least two positiveresponses.

4Complete impairment (96 -

100%)Displays all negative responses.

8 Not specified -

9 Not applicable -

Chart 1: Example of description of ICFcategories in the format of questions aboutthe descriptor for ICF

Environ. Factors

SCIM III

0 – 24 25 ‐ 49 50 – 74 > 75

FacilitS 18,0 ± 3,5 19,4 ± 2,0 16,5 ± 2,1 16

F 100 % 80 % 100 % 100 %

BarrierS 0,0 0,2 ± 0,6 0,0 0,0

F 0 % 20 % 0 % 0 %

Based on the description of thecategories of ICF Core Set, questions andanswer alternatives were elaborated withdetails that would satisfy their qualifiers toguide the application and ensure thereproducibility of the results. (Chart 1).

Activities and participation (d): disabilityin mobility and personal care were thedomains most often reported.

Environmental factors (e):→Main facilitators: immediate family,health professionals, products andtechnology for personal use in dailyliving and communication, as well ascaregivers and personal assistants.→ Only one subject reported problemswith technology for mobility.

SCIM-III scores negatively correlatedwith the frequency of disability anddisability scores in categories of the bodyfunctions and A&P (Table 1).

SCIM-III scores did not correlate withthe frequency of barriers or facilitators(Table 2).

SCIM-III scores did not correlate withthe amount of help provided byfacilitators (Table 2).

Conclusions

Abstract

Objective

To build and validate an instrument based onthe brief ICF Core Set for SCI in the acutecontext and test it’s applicability.

The International Classification ofFunctioning, Disability and Health (ICF)describes the functioning of individuals withparticular health condition and how contextfactors can modulate it. Acute traumaticspinal cord injury (ATSCI) has severaleffects on the functioning. The ICF core setfor spinal cord injury (CSSCI) has 31categories: 9 body functions, 4 bodystructures, 13 activities and participationand 5 environmental factors and proposesan innovative evaluation of people withATSCI, although it has not been used inthis context and there are issues regardingstandardization

ICF Categories

SCIM III

0 ‐ 24 25 ‐ 49 50 ‐ 74 >75

bS 11,8 ± 4,0 10,5 ± 3,0 7,0 ± 2,8 2,0

F 69,4 % 62,0 % 55,6 % 22,2 %

dS 53,2 ± 6,3 39,2 ± 7,2 22,0 ± 2,8 5,0

F 100,0 % 91,6 % 60,2 % 38,5 %

Table 1: Mean score (± sd) (S) and meanFrequency (F) for body functions and A&Pfor each SCIM III level.

Table 2: Mean score (± sd) (S) andmean frequency (F) and forenvironmental factors for each SCIMIII level.

Introduction

International Classification ofFunctioning, Disability and Health (ICF)describes the functioning of individualswith particular health condition andhow context factors can modulate it.The non-traumatic spinal cord injury(NTSCI) deranges functioning. The ICFcore set for spinal cord injury (CSSCI)has 43 categories: 9 body functions, 4body structures, 21 activities andparticipation, 9 environmental factorsand proposes an innovative evaluationof people with NTSCI, although it hasnot been used in this context and thereare issues regarding standardization.

Adaptation and standarzation of the use ofthe ICF of Spinal Cord Injury for individuals

with non-traumatic etiology

In 2011 the World Health Organization (WHO) published the International Classification of Functioning, Disability and Health (ICF), which is anassessment instrument that relates to functionality and the inability of a person may have a condition resulting from the inability health. It is known that thereare currently many types of non-traumatic spinal cord injury and its impact on the health status of individuals. The ICF is a recognized assessment functionalityof the individuals with this type of injury form, ICF developed the Core sets for spinal cord injury.


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Methods & Materials

Table 2: Frequency of Activities andParticipation according to the scoreOsame


Results

Design: transversal study

Setting: Rehabilitation Center of aUniversitary Hospital in Ribeirão Preto(CER-HCFMRP-USP)

37 subjects non-traumatic spinalcord injury due to any etiology

Women: 68%

Age 44 ± 15 years

Personal Data

March of 2013 to June of 2014

Correlation of the data obtained inthe ICF core set questionnaire withMotor Impairment Scale score ofOsame presented 0-13 points

Analyze data: The Osame scale wasdichotomized into a group of lighter (0-4 points) or severe subjects (≥ 5)

The prevalence of disability in eachcategory was defined as the proportionof subjects with qualifiers 1-4.

From the description of the selectedcategories for the CSSCI easy tounderstand questions and answeralternatives described in detail tosatisfy their qualifiers to guide theapplication of the instrument andensure reproducibility of findings(Picture 1) were prepared.

Conclusions

Proposed a way to apply the ICFcore set for chronic spinal cord injury.

Was well received by professionalswho used it.

Was able to differentiate individualsmore severely disabled.

Advantage of identifying andassessing the impact of environmentalfactors.

Instrument considered easy to use byevaluators. The average score on thescale Osame was 5.4 ± 2.1.

Table 1: Frequency of Body functionsaccording to the score Osame

Picture 1: Description of ICFcategories in the format of questionsabout the descriptor for ICF

Table 3: Frequency of Environmentalfactors according to the score Osame

Juliana Nogueira Coelho¹, Patricia Carla Vianna² Camila de Amleida¹ , Marcelo Riberto³

1.Mestranda the Faculty of Medicine of the University Hospital of Ribeirão Preto, University of São Paulo (FMRP-USP), 2. Master's School of Nursing FMRP.USP, 3.Prof. Dr. FMRP.mriberto @ usp.br, 3. Prof.Dr. th School of Nursing, FMRP-USP.

ABSTRACT

CategoryCIF

OSAME

0 a 4 (%) >5 (%)

Facilitator Indifferent Barrier Facilitator Indifferent Barrier

e110 44 39 17 68 21 0

e115 94 6 0 89 11 5

e120 17 78 6 89 5 5

e150 67 6 28 63 5 32

e155 56 22 22 53 0 37

e310 89 6 6 84 5 11

e340 6 94 0 37 63 0

e355 89 6 6 63 21 16

e580 78 6 17 79 0 5

b152 - Emotional functions:Specific mental functions related to affective behaviors of mental processes

Question: Your disease causes him some emotional problems such asdepression, sadness, crying crisis, fear, anger or anxiety?

Qualifiers Description CIF Adaptation of qualifiers

0 No impairment (0 - 4%)

Hasn't emotions or decontextualized problemswith emotions.

1 Mild impairment(5 - 24%)

Presents a light emotional distress, sometimesless than 1 time per week. Does not disturb

the concentration or daily tasks.2 Moderate

impairment

(25 - 49%)

Presents moderate emotional discomfort morethan once a week, uses drugs for control of

emotions. Emotions or remedies bit difficult toconcentrate or daily activities

3 Severeimpairment

(50 - 95%)

Presents a serious emotional distress, andconstantly gets to have suicidal ideation or

desire to end it all, uses drugs. Have muchdifficulty concentrating or performing dailytasks because of emotions or high doses ofmedication.

4 Complete impairment

(96 - 100%)

Is strongly shaken (a) emotionally, as recentlyattempted suicide, unable to do anything

because of the thoughts / emotions, issedated, social isolation or hospitalizedbecause of the thoughts / emotions.

8 Not specified -9 Not applicable -

It is necessary to develop electronicinterfaces to streamline the collectionand analysis of data obtained byinstruments based on the ICF.

Introduction

Lymphedema is a chronic condition that is characterised by abnormal accumulation of lymph fluid in the body, caused by. damage to or the absence of lymph vessels and/or excessive production of extracellular fluid. Lymphedema can occur in both the upper and lower limbs as well as in the midline (head, neck, abdomen and thorax). Lymphedema can be classified into primary (congenital) and secondary lymphedema. The latter is caused by damage to the lymph vessels or lymph nodes; after an injury, surgery, radiotherapy or due to infection. In the Western world, 80% of lymphedema cases are acquired after cancer treatment as a result of the removal of / damage to lymph nodes (axilla or groin). Lymphedema requires lifelong treatment consisting of compression therapy, skin care and prevention such as weight control and exercises to minimise (recurrent) swelling. Lymphedema draws heavily on a persons functioning.

Development of ICF Core Sets for lymphedema

Abstract


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P.B. Viehoff¹, Y.F. Heerkens², C.D. van Ravensberg², J. Hidding³, R.J. Damstra4, H. Ten Napel5, H.A.M. Neumann¹

¹Department of Dermatology, Erasmus Medical Centre, Rotterdam, ²Dutch Institute of Allied Health Care, Amersfoort, ³Radboud university medical centre, Nijmegen, 4Department of Dermatology, Phlebology and Lympho-vascular Diseases, Nij Smellinghe Hospital, Drachten, 5Dutch WHO-FIC Collaborating Centre, Bilthoven, all in The Netherlands

Fig. 1 Phases of the project

Methods & Materials


Results

With the ICF (International Classification of Functioning, Disability and Health) there is a bio-psycho-social framework and standard language to describe the functioning of a patient with lymphedema. For a more easy application ICF Core Sets were developed following the procedure of Cieza & Stucki (2002) (see Figure 1). In the Core Set development we focussed on three groups: patients with arm, leg and midline lymphedema.

The authors express their gratitude to all patients and experts, who contributed to this project.

Four preparatory studies:Clinical perspective: one cross-sectional study in The Netherlands (publication in preparation) and Australia (publication in preparation). Patient perspective: focus groups (Viehoff et al., Acta Oncologica early online).Expert survey: (manuscript is under review).Researcher perspective: systematic review (Viehoff et al., Disability and rehabilitation, 2013;35(25): 2105-2112). All data from the 4 preparatory studies were ranked.

Conclusion

Consensus conference:The international expert conference was held in Glasgow on the 4th of June 2014. The data were presented to 22 invited international experts in the field of lymphedema. The experts were divided in 3 groups, corresponding with the 3 locations. In a first round, Comprehensive Core Sets were determined based on the ranking of the ICF codes from the first researches. In a second round, Brief Core Sets were composed. Afterwards, all Core Sets were discussed plenary, leading to three Brief and three Comprehensive Core Sets for lymphedema (examplesof the three Brief Core Sets in Tables 1-3).

Table 1 Brief Core Set midline

b1301 Motivationb152 Emotional functionsb1801 Body imageb280 Sensation of painb435 Immunological system functionsb455 Exercise tolerance functionsb7101 Mobility of several joints b7303 Power of muscles in lower half of the body d230 Carrying out daily routined450 Walkingd570 Looking after one’s healthd845 Acquiring, keeping and terminating a job

e1151 Assistive products and technology for personal use in daily living

e310 Immediate familye355 Health professionalse580 Health services, systems and policiese5850 Education and training servicess750 Structure of lower extremity

Table 2 Brief Core Set lower limb

b1801 Body imageb280 Sensation of painb435 Immunological system functionsb455 Exercise tolerance functionsb640 Sexual functionsd155 Acquiring skillsd230 Carrying out daily routined240 Handling stress and other psychological demandsd455 Moving aroundd520 Caring for body partsd570 Looking after one’s healthd850 Remunerative employmentd920 Recreation and leisure

e1151Assistive products and technology for personaluse in daily living

e310 Immediate familye320 Friendse355 Health professionalss710 Structure of head and neck regions740 Structure of pelvic regions760 Structure of trunk

b1263 Psychic stabilityb164 Higher-level cognitive functionsb1801 Body imageb280 Sensation of painb4550 General physical enduranceb4552 Fatiguabilityb710 Mobility of joint functionsb730 Muscle power functionsd230 Carrying out daily routined445 Hand and arm used5 CHAPTER 5 SELF-CARE d570 Looking after one’s healthd5701 Managing diet and fitness d640 Doing houseworkd770 Intimate relationshipsd850 Remunerative employmentd920 Recreation and leisure

e1151Assistive products and technology for personal use in daily living

e310 Immediate familye320 Friendse355 Health professionalss420 Structure of immune systems730 Structure of upper extremity

Table 3 Brief Core Set upper limb

These first versions of the Core Sets forlymphedema need to be validated forspecific health professions andcountries in the future. After validation the Core Sets have tobe implemented nationally (in The Netherlands) as well as internationally. Measurement instruments can becompared with these Core Sets andconsequently adapted.

Purpose: To develop and offer an ICF application to work with in daily multi-disciplinary practice with lymphedema patients. Methods: With some adaptations the development of the core sets followed the method as proposed by Stucki & Cieza(2002). Data from four preparatory studies were discussed in an international consensus conference. Results: A first version of Brief and Comprehensive Core Sets for lymphedema were determined for lower and upper limb and midline locations.

Introduction

An ICF-based assessment addressing the ICF categories of the Brief ICF Core Set for hand conditions (Rudolf et al, 2012) was defined following a multi-step decision-making process (systematic literature reviews, expert survey, consensus conference). This assessment aims to systematically collect standardized data of functioning of patients with any kind of hand injuries and hand diseases in clinical practice along the continuum of care. It is based on the following two-step assessment procedure:

Lighthouse Project HandUsing the ICF Core Sets for hand conditions in clinical routine -

implementation in Clinical Information Systems

Abstract The “Lighthouse Project Hand” aims to operationalize and implement the ICF Core Sets for hand conditions as a monitoring tool in the treatment and rehabilitation of persons with hand conditions in the institutions of the statutory accident insurance in Germany. This poster informs about the implementation of the ICF Core Sets for hand conditions in Clinical Information Systems, which is one task within the project.


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Coenen M1,2, Dereskewitz C3, Cieza A1,2, Kus S1, Rauch A1, Rudolf KD3, Lighthouse Project Hand Consortium1 Chair for Public Health and Health Services Research, Ludwig-Maximilians-University Munich (Germany)

2 ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI) 3 Department of Hand Surgery, Plastic- and Microsurgery, BG Trauma Hospital Hamburg (Germany)


Methods

The ICF-based assessment tool was already tested in a cross-sectional multicenter study involving patients with hand injuries and hand disorders (N=294).

Results – ongoing work

-1- Screening 8 clinical tests, 34 screening questions and 22 medical examinations/observations

-2- Detailed clinical assessment Specific clinical tests if indicated based on the screening.

The Lighthouse Project Hand is a collaborative effort between the Department of Hand Surgery, Plastic-and Microsurgery, BG Trauma Hospital Hamburg (Germany), nine additionalhospitals and the Chair for Public Health and Health Services Research, Ludwig-Maximilians-University (LMU) Munich (Germany). The project is funded by the German Social Accident Insurance (DGUV). The responsibility for the content of this poster lies with the authors.

Example: b265 Touch function

Ten Test Moberg Test

Additionally, the DASH (Disability of the arm, shoulder and hand) questionnaire (Hudak et al, 1996) is being used to address the patient perspective.

The e-tool will be tested in a longitu-dinal multi-center study involving at least 330 patients with the following diagnoses: - Fracture of finger(s) (S62.6, S62.7)- Traumatic amputation of finger(s)

(S68.0, S68.1, S68.2)- Injury of flexor tendon (S66.0, S66.1)- Arthrosis of first carpometacarpal

joint (M18)- Palmar fascial fibromatosis (M72.0)- Algoneurodystrophy (M89.0)- Allergic contact dermatitis (L23, L24,

L25).

Conclusion

The e-tool is structured as follows:

Start page- Shows important patient data

(linkage with CIS & medical records)- Guides the ICF-based assessment- Provides an overview on functioning

status using a predefined algorithm based on the results of the screening

No problem

Mild problem

Severe problem

Screening not performed

- Provides the possibility to request report on functioning status (standardized print version).

Functioning modules- Records information on impaired

body structures using hand graphics- Records data of ICF-based

assessment (screening and detailed clinical assessment) along the continuum of care (body functions, activities and participation)

- Provides information on changes in functioning over time.

Environmental factors module- records data of Environmental

factors (e.g., medication, social support, rehabilitation needs)

In addition, there are other modules to record data or use data of CIS in a standardized way:

- Anamnesis & case history- Treatment procedures (acute, post-acute, rehabilitative)

Detailed clinical assessment indicated

Participants of this study will be followed up for 24 weeks along the continuum of care using the e-tool. Data collection will start in Autumn 2014 in 11 study sides.

The implementation of the Functioning modules in the e-tool was established as follows:

Example: Body structures – Bones

Example: Body functions – b265 Touch function

The longitudinal study will be the starting point to use the e-tool in clinical routine for patients with any kind of hand injuries and diseases along the continuum of care.

References

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). American Journal of Industrial Medicine, 1996; 29(6): 602-608.

Rudolf KD, Kus S, Chung KC, Johnston M, LeBlanc M, Cieza A. Development of the international classification of functioning, disability and health core sets for hand conditions − results of the world health organization international consensus process. Disability & Rehabilitation 2012; 34(8):681-693.

UKBBerlin

BG-Kliniken Bergmannstrost HalleBGU

Duisburg

UK RUBBergmannsheil

BUKHHamburg

BG-KlinikLudwigshafen

BG-KlinikTübingen

BGUMurnau

Rhön-KlinikumBad Neustadt

BGUFrankfurt

For its use in clinical routine an electronic tool (e-tool) is being developed and implemented in the Clinical Information Systems (CIS; medico//s; Siemens Healthcare, Medical Solutions) of the collaborating hospitals.

Introduction

The objective of the study were to identify activities and participation of individuals with lower limb amputation in Thailand by using ICF- Amputation core set and to identify its feasibility.

Using International Classification of Functioning, disability and Health to identify

function of individual with lower limb amputation (ICF- Amputation core set).

Abstract The development of the ICF Core Set for amputee involved a formal decision-making and consensus. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. The preparatory study identified a set of 11 ICF categories at the second and the third level. The ICF amputation core set has the potential to demonstrate activities and participation. It also showed good feasibility.


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Chompunut Pongakkasira1,*, Daranee Suvapan1, Artama Wichainchai1, Bootsakorn Loharnjun1, Wawwaew vongakaluk1, Natthawan Suthison1, Maneerut Huanongharn1, Paramed Plangsan1,

Voravut Mathondang1

1Sirindhorn National Medical Rehabilitation Centre(SNMRC). Department of medical services, Ministry of public health,Muang Nonthaburi Thailand 11000. Correspondence to : *[email protected]

Methods & Materials

There were 310 participants most of them are transtibial amputation level (figure 1) and causes of amputation mostly were road traffic injury (45.5%), blast injury (11.3%) and work related injuries (9.7%) (figure 2). They had mild problem in walking on different surfaces, climbing, using transportation and moderate problem in recreation and leisure.

Results

Relevant ICF categories were identified in a formal consensus process by 12 experts from different backgrounds. The preparatory study identified a set of 11 ICF categories at the second and the third level which were: -d420 (Transferring oneself)

Conclusions

The ICF amputation core set has the potential to demonstrate activities and participation for lower limb amputation patient. It also showed good feasibility.

-d4502 (Walking on different surfaces) -d4503 (Walking around obstacles)-d4551 (Climbing) -d4600 (Moving around within the home), -d4602 (Moving around outside the home and other buildings)-d470 (Using transportation) -d475 (Driving)-d839 (Education, other specified and unspecified)-d870 (Economic self‐sufficiency)-d920 (Recreation and leisure) Pilot study was done and the final template was used.

Acknowledgements

Further study of mobility, work and employment, social and civic life chap-ters should be conducted.The authors thank to SNMRC staffs, health care providers an all partici-pants at SNMRC and Mobile Clinic for prosthesis and orthosis.They also appreciate the valuable advice provided by form Dr. SirinartTongsiri and Dr. Ubonwan Watthana-dilokkul.

Only 25% of participants had no problem in economic self-sufficiency and 49.1% were unemployed (figure 2-13).

IntroductionOne of the key benefits of using the ICF for patients and clients is the integration of the medical and social aspects of his or her health condition. All aspects of a person’s life (development, participation and environment) are incorporated into the ICF, instead of solely focusing on his or her diagnosis. A diagnosis reveals little about one’s functional abilities. Diagnoses are important for defining the cause and prognosis, but identifying problems in functioning is often the key information that is being used to plan and implement interventions in General Practice.

The perception is that a ‘health-functioning’ oriented approach might help GP’s to understand patients’ reactions to complaints and the treatment they receive.

Exploring the desired content of an ICF item set for multimorbid patients in General Practice

Abstract


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Bob Emmen¹, Kees van Boven¹, Huib Ten Napel¹ ²

¹Department of Primary and Community Care, Radboud university medical centre, Nijmegen, ²Dutch WHO-FIC Collaborating Centre, Bilthoven, all in The Netherlands

Method

Why

All about functioningAfter more than 13 years of ICF, people’s functioning is increasingly becoming a big issue.

In The Netherlands the ICF is mainly used in rehabilitation medicine because there is no clear way or implementation to use it in general practice. The full list of items (about 1500) is too lengthy for everyday use in the consulting room and brief core sets have not been developed for general medicine.

To condense the number of items to propose to GP’s, a selection plan needed to be developed. Items were selected through studying a random set of GPs’- National guidelines (on diabetes, heart failure and not-traumatic knee problems) in order to discover which ICF-like items are already used in practice. Those items were assigned to an ICF-code. Also, existing ICF Brief Core Sets were studied. A final list of 108 items was composed from guidelines and ICF-Core Sets, based on selection of assigned scores by the research team. For example: problems with vision were assigned to ICF-item b210 (seeing functions). In the end they were combined and consensus was achieved. An item was considered to be relevant when it was scored twice or more in the NHG-guidelines and if it was used in 3 or more of the Brief Core Sets used in Rehabilitation Medicine. Body structures, which describe anatomical properties of organs and limbs, were excluded (figure 1).

The item list was presented to the participating GPs. They received a short introduction to the ICF via a movie (in Dutch; scan QR-code on the below, or use url: http://youtu.be/9FkcHwaO0iY). They were asked to rate a question on a scale to have the item registered: never, sometimes or always. This was done by doing a semi-qualitative explorative online survey.

Table 1: Items always to have registered

What do General Practitioners (GPs) want to know about a patient in terms of functioning? There is no existing literature describing or exploring the desired content of such an item-set or core set, to be used in General Practice. Therefore a number of studies will be undertaken to assess the usability of ICF for General Practice. The first of these studies is focused on which ICF items are considered relevant by GPs’ to be registered, including the willingness to register them.

Research Q

Figure1: selection mechanism of relevant ICF items

224 GP’s were approached. In total 77 GP’s responded (34%) of which 56 responses were complete (25%). A percentage for each answer-category was calculated for each question. We sorted them in 3 different ways.

Results

Table 2: Items never to have registered

Acknowledgements

The authors express their gratitude to all participating GPs’. Table 3: Usefulness of registering functioning

For more information:Newsletter on the WHO-FIC, Volume 12, number 1, 2014

Introduction

The weaknesses of the mechanisms fordisability assessment in Cyprus had beenidentified for years by all stakeholdersinvolved (executive, legislature, judiciary,voluntary organizations, citizens). Theresult of this malfunction was that citizenswere harassed and frustrated, feeling thattheir needs were not met. On the otherhand, the state lacked the necessaryinformation to implement the rights ofpeople with disabilities more effectively andefficiently, across all available resources.Among the problems recorded were theneed for a person applying for variousbenefits to be examined by differentmedical councils, the considerable delaybetween application and final decision andmainly the lack of scientific protocols and ofa uniform generally accepted evaluationmethodology. Another disadvantage wasthe inadequate use of knowledge ofrehabilitation professionals(physiotherapists, occupational therapists,psychologists, etc.) for tracking thenecessary individualized interventions in theareas of training, employment, supportedliving and therapeutic rehabilitation. Finally,the state lacked aggregated data on peoplewith disabilities in Cyprus, because ofinadequate documentation and leading toinability to support targeted disabilitypolicies.

THE CYPRUS PROJECT

Abstract In Cyprus the mechanism for assessing disability was not functional. The Ministry of Labour, Welfare and Social Security designed andimplemented a new ICF based system. The new assessing mechanism was based on Focused Protocols (FP). Five FPs using ICF codes were designed forthe main types of disability (Psychiatric, Mental retardation, physical/motor disabilities, vision and hearing disorders and one for multiple disabilities). At theend of the assessment process, a holistic report is used to summarize the main findings: the final qualifier for each ICF component (body structures, bodyfunctions, activities and participation, environmental factors) and the dominant qualifier, derived from the final ones, that totally describes the functionalstate of the applicant using a disability matrix. The first Disability Assessment Center in Nicosia began operating in a pilot mode in December 2013. FromApril to June 2014, more than 100 people with disabilities were assessed.


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Marianna Papadopoulou, Artemis Drosou, Ioannis Michopoulos, Andreas Karistinos, George Filippou, Kostas Francis, Sophie Koukouvinou, Maria Ioannou,

Christina Flourentzou, Venetsanos Mavreas, Stathis TriantafyllouDepartment for Social Inclusion of Persons with Disabilities, Cyprus

Methods & Materials

Through specially designed educationalprograms, 107 MDs and RPs weretrained on the use of the ICF and thenew assessment mechanism. Theeducational program was completed byan on-the-job-training before startingservice. Additionally, a specialeducational program for potentialtrainers was conducted and now a poolof 31 MDs and RPs is ready to providetraining on the new system for futureAssessors.

The first Disability AssessmentCenter in Nicosia began operating in apilot mode in December 2013. FromApril until June 2014 more than 100people with disabilities were assessed.The results confirmed the functionalityof the assessment mechanism, while atthe same time suggested areas ofpotential improvement.

Results

Recognizing all the weaknesses of thecurrent situation and the necessity of usingthe ICF as a major reform, the Ministry ofLabour, Welfare and Social Securityconsidered it necessary to devise andimplement, on the basis of ICF, a newsystem through which citizens andGovernment agencies will take a credible,scientific and reliable report on the situationof disability and the functioning of theindividual. In Cyprus was decided toimplement the new system primarily forpurposes of social benefits provision, socialservices, training and employment, with thepossibility of extending the use of theservices to other ministries in the future. Afeasibility study was conducted in 2007.After consultation with other ministries andCyprus Federation of DisabilityOrganisations (KYSOA) the project waspromoted for co-financing through theEuropean Social Fund (ESF)and was approved by the Cabinet inDecember 2007 along with theestablishment of the new Department ofsocial inclusion of persons withdisabilities.

Conclusions

The assessment mechanism is designedso as to achieve the most objectivepossible assessment of the disabledperson without time-consumingprocesses, and with minimal expense.The assessment includes information fromevery possible source along with physicalexamination of the person.The assesment mechanism is summarizedin three main stages: (a) preparation ofthe assessment dossier, (b) conductingthe assessment of disability andfunctioning, and (c) completion of theassessment process-issuing a disabilitycard.

The new assessing mechanism was basedon Focused Protocols (FP). Five FPsusing ICF codes were designed for themain types of disability (Psychiatric,Mental retardation, physical/motordisabilities, vision and hearing disordersand one for multiple disabilities). Specialforms for collecting, recording andpresenting the data were designed. At theend of the assessment process, aHolistic report is used to summarize themain findings: the final qualifier foreach ICF component (body structures,body functions, activities andparticipation, environmental factors) andthe dominant qualifier, derived fromthe final ones, that totally describes thefunctional state of the applying personusing a disability matrix. Guides werewritten and addressed to the Assessors(medical doctors (MD), RehabilitationProfessionals (RP)) and State officials forthe implementation of the new system.

Methods & Materials

• AFTER ICF IMPLEMENTATIONBEFORE ICF

IMPLEMENTATION

• One assessment for different facilities and services

Discomfort from different reviews for different facilities and services

• Increase frequency of assessments and reduce waiting time

Long time waiting for assessment

• Knowledge of technological devices, accessibility, care services, therapeutic services, training opportunities, employment

Poor knowledge about possibilities for improving

quality of life

• Assessment by multidisciplinary teams of experts on the basis of personalized data

Missing or inadequate multidisciplinary assessment and

individualized approach

• Hollistic report and Disability Card certified by the StateLack of Disability Card

Benefits for citizens with disabilities

Benefits for the State

• AFTER ICF IMPLEMENTATION

BEFORE ICF IMPLEMENTATION

• Modernisation and upgrading scientific basis for assessing

No use of protocols and ICF

• Safeguards for objectivity, integrity, reliability

Contestation of assessment results

• Gradual creation of a National Disability RegisterLack of aggregate knowledge for disability

• Support and strengthening of government agencies with scientific information for targeting resources

Insufficient coordination and targeting of public services for the

disabled persons

• Increased cooperation and sharing scientific knowledge on disability in CyprusInsufficient cooperation of

public and private sector for disability

Acknowledgements

We would like to thank all the colleagues from the

Department for Social Inclusion of Persons with Disabilities in Cyprus and European Profiles

S.A. who implemented this project to the benefit of persons with disabilities.

Introduction

The ICF provides a functioning descriptivemodel useful to describe the interactionsbetween an individual with a healthcondition and his/her contextual factors. Agreat novelty is its Environmental Factors(EF) component. Unfortunately, the poorgranularity of the EF component of ICFcompared to other standard terminologiesmay discourage its use by those who lookfor more accuracy or, on the contrary, mayfacilitate its use by those who need lessaccuracy. However, standard terminologiesdo not cover all factors classified by the ICF.Aims: (1) to build expanded ICF-EF terms;(2) to study the distribution of expandedICF-EF terms in a selected outpatientsample; (3) to suggest the use of expandedICF-EF terms in epidemiological studies.

To kill two birds with one stone: how to automatically combine standard terminologies and nomenclatures with ICF Environmental Factors in

epidemiological studies

Abstract


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Castelpietra G., Bassi G., Frattura L.Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC

Methods & Materials

Expanded ICF-EF terms related tooutpatients sample were almost 200compared to 17 ICF-EF items.Twenty-nine ICF-uncoded family members,health and social professionals, trustees,friends and colleagues were found(corresponding to 8 ICF items in e3)[Table1]. Fifty-six ICF-ISO-9999 codes were found(corresponding to 7 ICF-EF e1 categories)[Table 2].Twenty-five different ICF-ELHC terms werefound (corresponding to ICF code e580)[Table 3]. Eighty ICF-Italian Social CareServices terms were found (correspondingto ICF code e575)[Table 4].

Results

Specific standard terms concerning care andliving environment were collected usinginternational and national nomenclaturesand standards (ISO-9999, Italian EssentialLevels of Health Care (ELHC), Italian SocialCare Services nomenclature) andautomatically mapped to ICF. Then,expanded ICF-EF terms were obtained thathad the ICF code in first coding position andthe standard nomenclature term in secondcoding position. The expanded ICF-EF termswere then used to collect data on a sampleof 213 outpatients selected according tothe main healthcare service involved (Childand Adolescent Neuropsychiatry Services,No. = 53; Mental Health Departments, No.= 51; and Healthcare Districts, No. = 109).

Conclusions

The expanded granularity of ICF-EF itemswill allow a more detailed description of theEF underlying an individual functioningprofile. The fact that almost 200 expandedICF-EF codes, out of only 17 ICF-EF items,were used, shows the usefulness to expandthe ICF.The different distribution of expanded ICF-EF terms in the three groups suggests adifferent pattern of the “functioning/disability balance” in these groups.Expanded ICF-EF terms may be useful forepidemiological and statistical purposes.

Table 3: Distribution of Essential Levels of Health Care (ELHC) termsand ICF fitted items, in different groups (G), according to the electronicICF-based individual record. Data are presented as number of itemscoded and percentages (%) on the total number of ICF e580 code.

Table 2: Distribution ISO-9999 codes and ICF fitted items, in differentgroups (G), according to the electronic ICF-based individual record.Data are presented as number of items coded and percentages (%) onthe total number of ICF codes.

Table 1: Distribution of the main uncoded Environmental Factors (EF)defining subjects that provide support, assistance and relationships tothe patients, in different groups (G), according to the electronic ICF-based individual record. Data are presented as number of items codedand percentages (%) on the total number of ICF items.



References

1. Reinhardt JD, Miller J, Stucki G, Sykes C, GrayDB. Measuring impact of environmental factorson human functioning and disability: a reviewof various scientific approaches. Disabil Rehabil.2011;33(23-24):2151-65.

2. Jelsma J. Use of the International Classificationof Functioning, Disability and Health: aliterature survey. J Rehabil Med. 2009Jan;41(1):1-12.

3. Frattura L, Simoncello A, Bassi G, Soranzio A,Terreni S, Sbroiavacca F. The FBE developmentproject: toward flexible electronic standards-based bio-psycho-social individual records. StudHealth Technol Inform. 2012;180:651-5.

4. Bougie T, Heerkens Y. ISO 9999 with ICF.Working Document, A combined action of NEN(Dutch Normalisation Institute) and the DutchWHO-FIC Collaborating center. 2009 Dec

Uncoded “Support and Relationships” EF Expanded ICF-EF ICF codes G1 G2 G3 Tot G1 G2 G3 Tot

Spouse 0 2 9 11e310 Spouse

e310Immediate family

11735.6

6919.2

17348.2

359100

% 0.6 2.5 3.1

Partner 0 4 2 6e310 Partner

% 1.1 0.6 1.7

Father and/or mother 92 33 102 227e310 Father and/or mother

% 25.6 9.2 28.4 63.2

Sibling 5 25 35 65e310 Sibling

% 1.4 7.0 9.7 18.1

Children 0 4 15 19e310 Children

% 1.1 4.2 5.3

Foster/adoptive parent 7 1 5 13 e310 Foster/adoptiveparent% 1.9 0.3 1.4 3.6

Grandparent 13 0 5 18e310 Grandparent

% 3.6 1.4 5.0

Medical Doctor 0 7 0 7e355 Medical Doctor

e355Health professionals

26.4

2890.3

13.2

31100

% 22.6 22.6

Psychoterapist 0 3 0 3e355 Psychoterapist

% 9.7 9.7

Speech therapist 1 0 0 1e355 Speech therapist

% 3.2 3.2

Occupational therapist 1 5 0 6 e355 Occupationaltherapist% 3.2 16.1 19.4

Nurse 0 13 1 14e355 Nurse

% 41.9 3.2 45.2Lawyer 0 0 2 2

e360 Lawyer

e360Other professionals

0 1672.7

627.3

22100

% 9.1 9.1Social worker 0 16 4 20

e360 Social worker% 72.7 18.2 90.9

Trustee 0 8 10 18e330 Trustee

e330People in position of authorithy 0

1139.3

1760.7

28100

% 28.6 35.7 64.3Employer 0 0 6 6

e330 Employer% 21.4 21.4Supervisor 0 3 1 4

e330 Supervisor% 10.7 3.6 14.3

Personal care provider 0 0 4 4 e340 Personal care provider

e340Personal care providers and

personal assistants0

1155.0

945.0

20100

% 20.0 20.0Personal assitant 0 11 5 16

e340 Personal assitant% 55.0 25.0 80.0

Ex spouse 0 1 0 1e315 Ex spouse

e315Extended family 0

1052.6

947.4

19100

% 5.3 5.3Cousin 0 4 0 4

e315 Cousin% 21.1 21.1Nephew/niece 0 1 2 3

e315 Nephew/niece% 5.3 10.5 15.8Brother in law 0 1 3 4

e315 Brother in law% 5.3 15.8 21.1Aunt/uncle 0 3 4 7

e315 Aunt/uncle% 15.8 21.1 36.8Friend 0 8 4 12

e320 Friende320

Friends0

866.7

433.3

12100% 66.7 33.3 100

Acquaintance 1 1 1 3e325 Acquaintance

e325Acquaintances, peers,

colleagues, neighbours and community members

116.7

466.6

116.7

6100

% 16.7 16.7 16.7 50.0Colleague 0 1 0 1

e325 Colleague% 16.7 16.7Neighbour 0 1 0 1

e325 Neighbour% 16.7 16.7Community member 0 1 0 1

e325 Community member% 16.7 16.7

Total120

24.1

157

31.6

220

44.3

497

100

χ² test for the difference in the distribution of ICF codes = 133.4 P < 0.001

ISO-9999 codes Expanded ICF-EF ICF codes

Codes Description G1 G2 G3 Tot G1 G2 G3 Tot

03 03 Assistive products for respiratory therapy 5 0 4 9 e115 03 03

e115Products and technology for personal use in daily living

7831.2

62.4

16666.4

250100

03 18 Assistive products for administering medicines 2 2 0 4 e115 03 18

03 24Physical, physiological and biochemical test equipment and materials

0 0 1 1 e115 03 24

03 33Assistive products for pressure-sore prevention (antidecubitus)

2 0 28 30 e115 03 33

03 39 Assistive products for visual training 1 0 0 1 e115 03 39

03 48Equipment for movement, strength and balance training

7 0 7 14 e115 03 48

06 03 Spinal orthoses 3 1 2 6 e115 06 0306 12 Lower limb orthotic systems 15 0 10 25 e115 06 1206 24 Lower limb prosthetic systems 0 0 1 1 e115 06 2406 30 Prostheses other than limb prostheses 1 2 1 4 e115 06 3006 33 Orthopaedic footwear 10 0 18 28 e115 06 3309 03 Clothes and shoes 1 0 1 2 e115 09 03

09 06Assistive products for protecting the body (body-worn)

0 0 6 6 e115 09 06

09 12 Assistive products for toileting 0 0 8 8 e115 09 1209 15 Assistive products for tracheostomy care 1 0 0 1 e115 09 1509 18 Assistive products for ostomy care 1 0 2 3 e115 09 1809 21 Products for skin protection and skin cleaning 0 1 1 2 e115 09 2109 24 Urine diverters 0 0 4 4 e115 09 2409 27 Urine collectors 0 0 3 3 e115 09 27

09 30Assistive products for absorbing urine and faeces

8 0 20 28 e115 09 30

09 33Assistive products for washing, bathing and showering

1 0 12 13 e115 09 33

15 03 Assistive products for preparing food and drink 1 0 0 1 e115 15 0315 09 Assistive products for eating and drinking 1 0 4 5 e115 15 0918 03 Tables 2 0 1 3 e115 18 0318 09 Sitting furniture 12 0 8 20 e115 18 0918 36 Furniture for storage 0 0 1 1 e115 18 36

24 09Assistive products for operating and/or controlling devices

0 0 2 2 e115 24 09

24 27 Assistive products for fixation 0 0 1 1 e115 24 2727 06 Measuring instruments 1 0 0 1 e115 27 0630 06 Games 1 0 0 1 e115 30 06

12 03Assistive products for walking, manipulated by one arm

1 1 5 7 e120 12 03

e120Products and technology for personal indoor and outdoor mobility and transportation

4232.5

10.8

8666.6

129100

12 06Assistive products for walking, manipulated by both arms

10 0 8 18 e120 12 06

12 07 Accessories for assistive products for walking 0 0 2 2 e120 120712 12 Car adaptations 3 2 0 5 e120 12 1212 18 Cycles 2 0 1 3 e120 12 1812 21 Wheelchairs 17 0 42 59 e120 12 2112 24 Wheelchair accessories 1 0 6 7 e120 12 2412 27 Vehicles 3 0 1 4 e120 12 2712 30 Assistive products for transfer and turning 0 0 7 7 e120 12 3012 36 Assistive products for lifting 2 0 12 14 e120 12 3618 18 Support devices 1 0 2 3 e120 18 1821 03 Assistive products for seeing 10 4 24 38 e125 21 03

e125Products and technology for

communication15

25.95

8.638

65.558

100

21 09Input and output devices for computer, typewriters and calculators

1 0 3 4 e125 21 09

21 12 Computers 0 0 7 7 e125 21 1221 15 Typewriters and word processing software 0 0 1 1 e125 21 1521 18 Assistive products for calculation 0 0 1 1 e125 21 1821 24 Assistive products for drawing and writing 0 0 1 1 e125 21 2421 36 Assistive products for telephoning 0 1 0 1 e125 21 36

21 42Assistive products for face-to-face communication

2 0 0 2 e125 21 42

21 45 Assistive products for hearing 2 0 1 3 e125 21 45

03 43Assistive products for training in alternative and augmentative communication

0 0 3 3 e130 03 43e130

Products and technology for education

0 03

1003

100

27 09 Work furniture 0 0 1 1 e135 27 09e135

Products and technology for employment

0 01

1001

100

30 09 Assistive products for exercise and sports 0 0 1 1 e140 30 09 e140 Products and technology for culture, recreation and sport

133.3

02

66.73

100

30 12 Musical instruments 1 0 0 1 e140 30 12

30 15 Assistive products for producing photos 0 0 1 1 e140 30 15

18 30 Assistive products for vertical accessibility 1 0 4 5 e150 18 30

e150 Design, construction and building products and technology of building for

public use

120.0

04

80.05

100

Total13730.6

122.7

29966.7

448100

χ² test for the difference in the distribution of ICF codes = 12.6 P = 0.39

ELHC terms Expanded ICF-EF ICF code

Codes* Description G1 G2 G3 Tot G1 G2 G3 Tot

1.A-1.FServices targeted to the population at large and the working community 5 3 3 11

e580 1.

e580Health

services, systems and

policies

17325.9

20931.3

28642.8

668100

% 0.7 0.4 0.4 1.6

2. District health care services

2.A Basic health care services 24 28 51 103 e580 2.A

% 3.6 4.2 7.6 15.4

2.B Local emergency response 3 2 2 7 e580 2.B

% 0.4 0.3 0.3 1.0

2.CPharmaceutical services provided through licensed local pharmacies 13 21 45 79

e580 2.C

% 1.9 3.1 6.7 11.8

2.D Supplementary health care support 4 1 6 11 e580 2.D

% 0.6 0.1 0.9 1.6

2.E Specialist day-hospital services 36 24 35 95 e580 2.E

% 5.4 3.6 5.2 14.2

2.F Provision of prostheses 17 0 23 40 e580 2.F

% 2.5 3.4 6.0

2.G Local day-hospital and home-based services 36 63 58 157 e580 2.G

% 5.4 9.4 8.7 23.5

2.HLocal health care services provided in residential and semi-residential support facilities 12 56 52 120

e580 2.H

% 1.8 8.4 7.8 18.0

3.A-3.I Hospital services 21 7 8 36 e580 3.

% 3.1 1.0 1.2 5.4

4.Services targeted to care and rehabilitation of non self-sufficient persons 2 4 3 9

e580 4.

%0.3 0.6 0.4 1.3

*Code 2.I (Spa water services) was excluded, due to the lack of codes in this categoryχ² test for the difference in the distribution of ELHC codes = 24.43 P < 0.001

Regional Social Services Information System codes Expanded ICF-EF ICF code

Description G1 G2 G3 Tot G1 G2 G3 Tot

Interventions for access to Social Service a

%

7 0 2 9e575 Interventions for access to Social Service

e575General social support

services, system and policies

4236.8

3026.3

4236.8

114100

6.1 1.8 7.9

Social work b

%

10 4 9 23 e575 Social work

8.8 3.5 7.9 20.2

Economical support interventions c

%

8 16 11 35 e575 Economical support interventions

7.0 14.0 9.6 30.7

Residential services d

%

11 6 7 24 e575 Residential services

9.6 5.3 6.1 21.1

Semi-residential and social skill interventions e

%

5 3 12 20e575 Semi-residential and social skill interventions

4.4 2.6 10.5 17.5

Family care and institutional care f

%

1 1 1 3 e575 Family care and institutional care

0.9 0.9 0.9 2.6

*Housing services and activities supporting the access to employment were excluded, due to the lack of codes in this category

a Interventions addressed to the user that are adopted immediately after contact with social services b Services provided by social services professionals c Interventions providing economical support to single users and/or families, based on national and/or regional regulations, and/or absence of or insufficient income, and of evident social difficulties and/or risk of social marginalizationd Interventions aimed at ensuring home care, meant as a basic individual right and, more extensively, as a meaningful space. The concept refers to the user’s home - place of memory and of material and immaterial objects linked to user and user’s family personal history and to his/her routine. This concept may be expanded to social relationships, nature, landscape, culture, community history. e Integrated services provided to families that need specialist support. These interventions provide daily stay in residential facilities (24h care) for elderly, immigrants, disabled people, persons underage, etc. ; daily care centers; and temporary residential facilities providing accommodation, health care, recreational services, etc.f Replacement services addressed to families unable or inadequate to perform, permanently or temporarily, their duties. Interventions providing permanent stay in 24h care facilities, such as residential facilities for self-sufficient persons with social difficulties that cannot be dealt with at home, and community and housing facilities providing social and health care.

χ² test for the difference in the distribution of Regional Social Services Information System codes = 20.8 P < 0.001

The distribution of expanded ICF-EF codeswas statistically different among groups (χ2

test for the difference in the distribution ofICF codes, ELHC codes and Regional SocialServices Information System codesP<0.001), except in Table 2 (χ2 test for thedifference in the distribution of ICF codesP=0.39). Outpatients in G2, however,represented only the 2.7% of the total ICFcodes in Table 2.

Table 4: Table 7: Distribution of Regional Social Services InformationSystem terms and ICF fitted items, in different groups (G), accordingto the electronic ICF-based individual record. Data are presented asnumber of items coded and percentages (%) on the total number oftimes ICF e575 code is used.

The distribution of expanded ICF-EF terms was analyzed in a sample of 213 outpatients from Region Friuli Venezia Giulia, Italy.Outpatients were selected according to the main healthcare service involved. Almost 200 expanded ICF-EF terms were found(corresponding to 17 ICF-EF items). The distribution of expanded ICF-EF terms in the three groups was different, suggesting a differentpattern of the “functioning/disability balance” in these groups. Expanded ICF-EF terms may be useful for epidemiological and statisticalpurposes.

Introduction

There are currently no collaborative studies inside the WHO-FIC network on biopsychosocial determinants of outcomes at community level to facilitate decision-making, continuity of care, and welfare planning. The aims of this three-country collaboration are to develop, test and launcha first release of an international version of the web assessment systema namedVilmaFABER (1) in a multicenter“naturalistic outcome” study inside the WHO-FIC network.

How to automatically expand ICF-EF in order to better describe care and living environment factors at country level: steps toward a multicenter project on the biopsychosocial determinants of outcomes

Abstract To launch a cooperation to carry out a WHO-FIC based multicenter naturalistic outcomes study using an international version of VilmaFABER (Friendly Alimenting Biopsychosocial Electronic Record), a web application developed by the Italian WHO-FIC collaborating center. Three countries took part in this preliminary study: Finland, South Africa, and Italy. The WFABER (Worldwide Friendly Alimenting Biopsychosocial Electronic Record) project is open to all other interested WHO-FIC network countries.


C525


Frattura L.1, Anttila P.2, Nurmi-Koikkalainen P.2, Snyman S.3, Green S.(4), Bassi G.1, Simoncello A.1, Terreni S.5, Soranzio A.51Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC, Italy; 2Service System Department, National Institute for Health and Welfare (THL), Finland; 3Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; 4 Department of Social Work, Stellenbosch University; 5Insiel, Trieste, Italy

Methods & Materials

The FABER information model was enriched with two new country-specific terminologies regarding health and social services and systems, in order to create new expanded ICF-EF terms that can be used in Finland and South Africa. The first part of the collection information form was completed. A prototype of the international FABER was developed. A preliminary draft of the worldwide FABER (WFABER) project was made.

Results

Three countries took part in this preliminary study: Finland, South Africa and Italy. The FABER application was used. FABER integrates WHO classifications with national terminologies and standards into an individual electronic record. FABER uses the ICF environmental factors (EFs) as “superstandard” terminology. It automatically creates new terms made by an ICF code in the first position and other standard terms (where existing) in second position. This expanded ICF-EF list of terms is used to explore the role (as facilitator or barrier) of the EFs when assessing individual functioning/disability. As there is currently no common international classification of health and social services, great progress was made by the three participating countries to list the country-specific terminologies relating to services in order to provide country-specific expansion of ICF-EF categories e575 (General social support services, systems and policies) and e580 (Health Services, systems and policies).

Conclusions

The expanded ICF-EF terms may be considered in the development of ICHI, for ICF-EF ontology and update purposes, and for the mICF development. The WFABER (Worldwide Friendly Alimenting Biopsychosocial Electronic Record) project is open to all other interested WHO-FIC network countries.



Discussion

There are huge differences how the services in the participating countries are named and described in the national contexts. The current ICF-EF terms are not sufficient to describe such diversity, but the new expanded ICF-EF terms are. This preliminary work revealed that it is possible to expand the ICF EF component in order to better describe different health and social systems. The launch of a multicenter outcome study is currently being considered.

Figure 1 - WFABER cooperation project: step 1

Figure 3- VilmaFABER assessment systemfunctions like a concrete mixer

Figure 2- WFABER cooperation project: step 2

STE

P 1

Table 1 - WFABER cooperation project: some examples about the e580 ICF expansion (a new Big Bang?)Italy * Finland ** South Africa ***

Italian Health System

Italian expanded ICF-EF

Finnish Health System

Finnish expanded ICF-EF

South African Health System

South African expanded ICF-EF

2.A Assistenzasanitaria di base

e580 LEA:2.A -Assistenza sanitaria di base

E Perusterveydenhuollonpalvelut

e580 E Perusterveydenhuollonpalvelut

2.1.1.1 Primary Healthcare services: Community-based services (CBS)

e580 2.1.1.1 Primary Healthcare services: Community-based services (CBS)

2.B Attività di emergenza sanitaria territoriale

e580 LEA:2.B - Attività di emergenza sanitaria territoriale

A Hätä-, ensiapu- ja päivystyspalvelut

e580 A Hätä-, ensiapu-ja päivystyspalvelut

2.3.5.1 Specialisedservices: Emergency medical services

e580 2.3.5.1 Specialised services: Emergency medical services

2.C Assistenza farmaceutica erogata attraverso le farmacie territoriali

e580 LEA:2.C -Assistenza farmaceutica erogata attraverso le farmacie territoriali

SI Apteekkipalvelu e580 SI Apteekkipalvelu

1.8 Essential Drugs Programme (EDP)

e580 1.8 Essential Drugs Programme (EDP)

2.F Assistenzaprotesica

e580 LEA:2.F -Assistenza protesica

HGA Apuvälinepalvelu e580 HGA Apuvälinepalvelu

2.3.2.3 Provision of assistive devices

e580 2.3.2.3 Provision of assistive devices

2.G Assistenza territoriale ambulatoriale e domiciliare

e580 LEA:2.G -Assistenza territoriale ambulatoriale e domiciliare

O Kotihoito, kotipalvelut ja omaishoidon tukipalvelut

e580 O Kotihoito, kotipalvelut ja omaishoidon tukipalvelut

2.1.1.1 Home and community-based care

e580 2.1.1.1 Home and community-based care

2.G.3 Attività sanitaria e sociosanitaria rivolta alle persone con problemi psichiatrici e alle loro famiglie

e580 LEA:2.G.3 -Attività sanitaria e sociosanitaria rivolta alle persone con problemi psichiatrici e alle loro famiglie

J Päihde- jamielenterveyspalvelut

e580 J Päihde- jamielenterveyspalvelut

2.3.1.1 Mental health & psychiatric service: Community-based service

e580 2.3.1.1 Mental health & psychiatric service: Community-based service

3.A Pronto soccorso e580 LEA:3.A - Pronto soccorso

AA Hätäkeskuspalvelu e580 AA Hätäkeskuspalvelu

2.3.5.1 Emergency medical services

e580 2.3.5.1 Emergency medical services

3.B Degenza ordinaria e580 LEA:3.B -Degenza ordinaria

F Erikoissairaanhoidonpalvelut

e580 F Erikoissairaanhoidonpalvelut

2.2.1 District hospitals services

e580 2.2.1 District hospitals services

*Source: D.P.C.M. del 29 novembre 2001, “Definizione dei livelli essenziali di assistenza”, in GU 8 febbraio 2002, n. 3.**Source: Finnish Social and Health Service Classification (in development).Available: http://www.terminaattori.fi/THL/index.php?=TESTI1&ID=XU4HOlVKCcMfhM***Source: Western Cape Government. 2013. Healthcare 2030 [Online]. Available: http://www.capegateway.gov.za/health; Republic of South Africa. 2014. Annual Performance Plan 2014/15 – 2016/17. Pretoria: Department of Health; Brand south Africa. 2014. Healthcare in South Africa [Online]. Available: http://www.southafrica.info/about/health/health.htm#.U-fPYOOSz4Z.4K

Table 2 - WFABER cooperation project: some examples about the e575 ICF expansion (a new Big Bang?)Italy * Finland ** South Africa ***

Italian Social CareSystem

Italian expanded ICF-EF

Finnish Social CareSystem

Finnish expanded ICF-EF

South African Social Care System

South African expanded ICF-EF

Attività di Servizio sociale professionale

e575 Attività di Servizio sociale professionale

B Neuvonta - jaohjauspalvelut

e575 B Neuvonta - jaohjauspalvelut

Social work with children and families

e575 Social work with children and families

Interventi volti a favorire la domiciliarità

e575 Interventi volti a favorire la domiciliarità

M Asumiseen liittyvätpalvelut

e575 M Asumiseenliittyvät palvelut

Home-based care for: Aged; Disabled; Terminally ill people

e575 Home-based care for: Aged; Disabled; Terminally ill people

Trasferimenti in denaro per il pagamento di interventi e servizi

e575 Trasferimenti in denaro per il pagamento di interventi e servizi

I Työllistymisen ja taloudellisen tuen palvelut

e575 I Työllistymisen ja taloudellisen tuen palvelut

Social security e575 Social security

individualized intervention plan written in expanded ICF-EF language

STE

P 2

*Source: Conferenza delle Regioni e delle Province autonome, "Nomenclatore interregionale degli interventi e dei servizi sociali", Documento n. 09/093/CR/C8, 29 ottobre 2009, Roma. **Source: see Table 1 ***Source: see Table 1

Introduction

In 2013, a new national programme was launched on the evaluation of functioning/disability of persons with disability in order to support their inclusion in the labour market by Italia Lavoro, the governmental body responsible for the programme on behalf of the Italian Ministry of Labour. On the basis of a specific agreement, the WHOFIC Italian CC supported Italia Lavoro in the review and development of specific ICF-based assessment tools (Figure 1, blue-written labels). During this cooperation, a first version of a “Workplace assessment schedule” was developed, taking into account ICF and its limits regarding the Environmental Factors component.

How to describe the workplace using and expanding the Environmental Factors

component of the ICF: the first version of the “Workplace assessment schedule”


C526


Bassi G.1, Frattura L.1, Simoncello A.1, Paolone D.2, Gorini G.21Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC; 2Italia Lavoro, Ministry of Labour, Rome

Methods & Materials

The possibility to use other standard terminologies to expand the ICF categories used was also considered. It was found that only categories from domain e1 could be expanded using a more specific standard terminology. The standard used was ISO9999. The expansion of the other ICF-EF categories was done using the general terminology already present in the assessment tool.

Results

The starting point was a previous version of the assessment schedule and the areas it assessed (1, 2). The characteristics of the workplace to describe are shown in Figure 2.

Conclusions

It is possible to expand ICF to describe a workplace. The list of expanded ICF-EF terms can be used to describe a worker functioning profile in a workplace described using the new tool. This new tool will be used jointly to a



References1. Frattura L., Conclave M., Gorini, G. ICF implementation in targeted employment of

persons with disabilities: the Italian work in progress. WHO-FIC Network Annual Meeting Cape Town 2011

2. Conclave M, et al. The ICF and Labour Policies Project: the first Italian nationwide experience of ICF implementation in the labour sector, D&R, 2009; 31 (S1): S16-S21

Itemsto map

No.ICF EF Chapters

ICF categories

used to mapworkplace

items3 e1 Products and

technologye120

19 e13521 e1503 e2 Natural environment

and human-made changes to environment

e22503 e2401 e2501 e3 Support and

relationshipse325

1 e3301 e3351 e3454 e5 Services, systems and

policiese540

31 e59089 Total

Table 2 – Number of items mapped to ICF EF Chapters

Workplace accessibility

Work spaces

Task and workstation characteristics

Technologies and tools for the workplace

Personal protective equipment at the workplace

Persons related to the workplace

Figure 1 – New ICF based tools for labour system

The tool foresaw the assessment of 89 items, in the 6 aspects mentioned above. The 89 items were mapped using 12 ICF categories (Tables 1 e 2) from the following domains: – 3 categories from e1: e120, e135, e150– 3 categories from e2: e225, e240, e250– 4 categories from e3: e325, e330, e340,

e345 – 2 categories from e5: e540, e590.

Figure 2 – What to describe in the workplace

The information foreseen by the assessment tool was mapped to ICF using a semantic and/or conceptual similarity method.

“Questionnaire on the employer’s expectations 1.0”, which was also defined. This other questionnaire, through the exploration of 8 AP chapters and 54 items, will be useful to match the professional functioning profile requested by the employer with the functioning profile of the candidate. Field trials were planned to verify their feasibility.

Abstract On the basis of a specific agreement, the WHOFIC Italian CC supported Italia Lavoro in the review and development of specific ICF-based assessment tools. During this cooperation, a first version of a “Workplace assessment schedule” was developed, taking into account ICF and its limits regarding the Environmental Factors component.

Table 1 – Structure of the Assessmentschedule and count of items

Introduction

Title

It is difficult to collect information about performance while explicitly taking into account the Environmental Factors (EF) role, for each activity considered, whatever the subset of categories considered. Moreover, it results particularly difficult to collect information about barriers. Available tools have not been developed to take into account the different kinds of environmental aspects. On the other hand, ICF as a language, which classifies Environmental Factors, may result difficult to use. Aim: to define a web questionnaire to facilitate the description of ICF performance, facilitators and barriers for any selection of ICF AP categories, without using ICF sentences and definition to question someone about his or her life in the past 30 days.

How to ask questions about performance while considering facilitators and barriers: the first web

version of the “Web Activity and Participation Performance Inventory” (WAPP.In).


C527


Frattura L., Bassi G., Simoncello A.Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC

Methods & Materials

A new questionnaire was developed, temporarily named WAPP.In. It considered 63 items from the 9 Activity and Participation chapters, and explored the EF role, starting from the list of expanded ICF-EF terms which VilmaFABER releases at the end of the first step of the individual functioning assessment, available in a drop-down menu. WAPP.In collects information on facilitators, barriers and performance in natural language and uses a unique question structure. The answers were collected using a five-level Likert scale to explore the level of difficulty in doing activities and the level of facilitator and/or barrier effects. Each level of the Likert scale corresponds to an ICF qualifier value (0 to 4). An automated ICF coding was developed and an instruction manual was written to administer WAPP.In. A special attention was given to self-determination, in order to distinguish activities which cannot be performed because of barriers from activities that are not performed because of the individual’s will. A version for children was studied.

Results

The starting point was a previous VilmaFABER selection of AP categories and the way they were analysed jointly with EF. At the current stage of development, VilmaFABER may be considered as a system for coding information on functioning that supposes a method to collect biopsychosocial information. To overcome some methodological and practical issues on how the biopsychosocial information has to be collected, WHODAS 2.0 and other tools that had dealt with the problem of performance description were analysed.

Conclusions

It is possible to explicitly collect information on performance, facilitators and barriers using the WAPP.In. It is also possible to ask questions using natural language, stressing the necessity to collect good information on the EF role to explain difficulties in doing an activity. Coding in ICF may be a subsequent, automatic step in the process of standardization of the information collected using natural language. A first field test is ongoing to test the questionnaire in selected samples.



References

Domain 3 Self-care

I am now going to ask you about difficulties in taking care of yourself.

Show flashcards #1 and #2

In the past 30 days, how much difficulty did you have in:

None Mild Moderate Severe Extreme or cannot

do D3.1 Washing your whole body? 1 2 3 4 5

D3.2 Getting dressed? 1 2 3 4 5

D3.3 Eating? 1 2 3 4 5

D3.4 Staying by yourself for a few days? 1 2 3 4 5

I am now going to ask you some questions about:

d510 Washing oneself: Washing and drying one's whole body, or body parts, such as bathing, showering

In the past 30 days did you do this activity? Yes (Go to 1) No (Go to A)

A) Did you not do the activity because you were hindered by someone?

(Ongoing intervention project: Professionals in charge of the patient and people close to the patient)

1) Did any of the professionals in charge of your health or any of the people close to you hinder you in doing this activity? Yes (Go to 2‐2a) No (Go to 3)

3) Did any of the professionals in charge of your health or any of the people

close to you help you do this activity? Yes (Go to 2‐2b) No (Go to 4)

Yes (Go to 2‐2a) 2) Could you tell me who? 2a) How much did he/she hinder you? 2b) How much did he/she help you?

No (Go to B) N L M S C N L M S C

N L M S C N L M S C

(Go to 3) (Go to 4)

B) Did you not do the activity because you were hindered by something?

(Ongoing intervention project: Products and technologies used)

4) Did any product or technology you are using hinder you in doing this activity? Yes (Go to 5‐5a) No (Go to 6)

6) Did any product or technology you are using help you do this activity? Yes (Go to 5‐5b) No (Go to 7)

Yes (Go to 5‐5a) 5) Could you tell me what? 5a) How much did it hinder you? 5b) How much did it help you?

No (Go to C) N L M S C N L M S C

N L M S C N L M S C

(Go to 6) (Go to 7)

C) Did you not do the activity because health services hindered you ?

(Ongoing intervention project: health interventions/policies)

7) Did the health interventions you received hinder you in doing this activity?

Yes (Go to 8‐8a) No (Go to 9)

9) Did the health interventions you received help you do this activity? Yes (Go to 8‐8b) No (Go to 10)

Yes (Go to 8‐8a) 8) Could you tell me which services?

8a) How much did they hinder you? 8b) How much did they help you?

No (Go to D) N L M S C N L M S C

N L M S C N L M S C

(Go to 9) (Go to 10)

D) Did you not do the activity because other services/organizations hindered you?

(Ongoing intervention project: social, welfare, education, labour interventions/policies)

10) Did the interventions you received

hinder you in doing this activity? Yes (Go to 11‐11a) No (Go to 12)

12) Did the interventions you received help you do this activity?

Yes (Go to 11‐11b) No (Go to 13)

Yes (Go to 11‐11a) 11) Could you tell me which services/organizations?

11a) How much did they hinder you? 11b) How much did they help you?

No (Go to E) N L M S C N L M S C

N L M S C N L M S C

(Go to 12) (Go to 13)

E) Did you decide not to do the activity? 13) In the past 30 days (considering everything that helped and/or hindered you) how much

difficulty did you have in doing this activity?

Yes (Go to next activity) None Mild Moderate Severe Extreme

No (Go to 1)

Figure 2 – How WAPP.In asks about doing activities: an example

Figure 3 – A WHODAS 2.0 question example

World Health Organization. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0) / edited by TB Üstün, N Kostanjsek, S Chatterji, J Rehm. Geneva, WHO, 2010.

Abstract WAPP.In was developed to be a web questionnaire to facilitate the description of ICF performance, facilitators and barriers for any selection of ICF AP categories. It does not use ICF sentences and definitions to question someone about his or her life in the past 30 days, but its contents fit completely with ICF constructs. A field test is ongoing in a clinical setting.

Figure 1 – Comparison between WHODAS 2.0 and WAPP.In flashcards

The aim was to allow to collect information in natural language and to allow VilmaFABER to code them in ICF language.

Introduction

As ISO-9999 classification is a related member of the WHO-FIC since 2003 [1] and it was suggested as a more specific and a more detailed classification in addition to the Environmental Factors (EF) listed in ICF, it seems reasonable to combine the two classifications in order to ensure a more precise description of the care and living environment [2]. The aim was to develop some expanded ICF-EF e1 categories by combining ICF categories with ISO-9999 terms, useful to implement web tools in order to better describe patients [3] and suggest ICF updates too.

How to expand ICF Environmental Factors (EF) starting from ISO-9999 Classification: toward

a “hybrid” standard terminology?

Abstract VilmaFABER assessment system uses a ICF-ISO9999 “hybrid” standard terminology, developed by the Italian WHO-FIC CC to overcome the poor descriptive power of ICF Environmental Factors component. It was used to describe care and living environment in different samples of Italian outpatients. It has shown a positive answer from professionals and persons evaluated. A validation is kindly suggested in the context of the WHO-FIC network. It should be useful to consider new candidates for updating the ICF EF list of categories.


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Bassi G., Simoncello A., Castelpietra G., Frattura L.Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC

Methods & Materials

Eight hundred forty-one ISO-9999 (ISO) classes were found to fit with 8 ICF categories. The distribution of ISO classes within the ICF categories was the following:• 500 ISO classes fitted with ICF - e115, • 98 ISO classes fitted with ICF - e120, • 125 ISO classes fitted with ICF - e125, • 64 ISO classes fitted with ICF - e130, • 13 ISO classes fitted with ICF - e135, • 21 ISO classes fitted with ICF - e140, • 20 ISO classes fitted with both ICF - e150

and ICF - e155.A total of 841 expanded ICF-EF terms out of 8 ICF-EF categories was thus obtained.

Acknowledgements

Results

ISO-9999 classes [4-7] were mapped to three digit categories of ICF-EF, Chapter 1, and compared with the semantic content of the titles and definitions (including inclusions and exclusions) of the ICF categories. If an ISO-9999 class was mapped to more than one ICF category, its subclasses were considered. Combined terms were created (Expanded ICF-EF terms), with the ICF code in first coding position and the ISO-9999 code in second coding position, for example: "e120 Wheelchairs (ISO 12 21)" or "e115 Aspirators (ISO 03 03 21)". This expansion was tested in a sample of outpatients (N=213) from Friuli Venezia Giulia Region. Detailed information on the field trial sampling procedure and results are shown elsewhere [8].

Conclusions

Our findings highlight the importance of expanding the granularity of ICF-EF categories in order to describe more accurately the EF involved in the individuals’ functioning and disability.The expanded ICF-e1 terms may be considered a new hybrid standard terminology and may be a useful solution instead of updating all e1 categories. The reliability of this methodology was further supported by the evidences obtained from the field trial. Furthermore, the mapping has to be revised using the ISO-9999 updated version. A validation of our mapping is kindly suggested in the context of the WHO-FIC network. This, may enrich the debate on the actualization of the WHO health classifications, particularly concerning the ICHI development. It should be also useful to consider new candidates to update ICF EF list of categories.



References

…18 3318 3018 2718 24

…ISO 18

ICF e150

ICF e155…

18 3318 3018 2718 24

…ISO 18

ICF e150

ICF e155

12 3912 3612 33

…12 0712 0612 03

ISO 12

12 3912 3612 33

…12 0712 0612 03

ISO 12 ICF e120 ISO 03

03 7803 75

…03 6003 5703 5403 5103 4803 4503 4303 4203 3903 36

…03 0603 03

ISO 03

03 7803 75

…03 6003 5703 5403 5103 4803 4503 4303 4203 3903 36

…03 0603 03

ICF e115

ICF e130

Case 2Case 1

Case 3

ICF category ISO 9999 classesNumber (%) of

overall ISO codes

e115 03, 06, 09, 15, 18, 21, 24, 27, 30 500 (59,5)

e120 12, 18 98 (11,7)e125 21 125 (14,9)e130 03 64 (7,6)e135 24, 27 13 (1,5)e140 30 21 (2,5)

e150 e155 18 20 (2,4)

Total N=8 Total N=17 841 (100)

Table 3 – Results of mapping ISO9999 to ICF in the firstVilmaFABER field trial

e115 Assistive products for administering medicines (ISO 03 18)e120 Wheelchairs (ISO 12 21)e125 Assistive products for seeing (ISO 21 03)e130 Assistive products for training in the arts (ISO 03 69)e135 Industrial transportation vehicles (ISO 24 39)e140 Musical instruments (ISO 30 12)e150 Assistive products for vertical accessibility (ISO 18 30)e155 Construction elements in the home and other premises (ISO 18 24)

Table 2 – Examples of the VilmaFABER expanded ICF-EF categories

1. Bougie T, Heerkens Y. ISO 9999 with ICF. Working Document, A combined action of NEN (Dutch Normalisation Institute) and the Dutch WHO-FIC Collaborating center. 2009 Dec

2. Bassi G., Simoncello A., Frattura L. Mapping ISO9999 to ICF in health information systems.The FABER way. Who-FIC Network Annual Meeting, Brasilia 2012

3. Frattura L, Simoncello A, Bassi G, Soranzio A, Terreni S, Sbroiavacca F. The FBE development project: toward flexible electronic standards-based bio-psycho-social individual records. Stud Health Technol Inform. 2012;180:651-5.

4. ISO. 2011. ISO 9999 Assistive products for persons with disability – Classification and terminology. Geneva: International Organization for Standardization

5. ISO, ISO 9999 Ausili tecnici per persone disabili –Classificazione. Geneva, 1998

6. GMDN, GMDN User Guide, 20107. Ministero della Salute, Decreto Ministeriale 22 settembre

2005 e s.m.ei., Classificazione Nazionale dei Dispositivimedici (CND)

8. Castelpietra G., Bassi G., Frattura L. To kill two birds with one stone: how to automatically combine standard terminologies and nomenclature with ICF Environmental Factors in epidemiological studies. Who-FIC Network Annual Meeting, Barcelona 2014

Figure 1 – Examples of mapping of ISO codes to ICF categories

The distribution of ISO classes within the ICF categories, when applied to the fieldtrial sample, was the following:• 30 ISO classes fitted with ICF – e115• 11 ISO classes fitted with ICF – e120• 9 ISO classes fitted with ICF – e125• 1 ISO classes fitted with ICF – e130• 1 ISO classes fitted with ICF – e135• 3 ISO classes fitted with ICF – e140• 1 ISO classes fitted with ICF – e150 A total of 56 expanded ICF-EF terms out of 7 ICF-EF categories was thus obtained at population level [8].

Table 1 – Results of mapping ISO9999 to ICF EF chapter 1

ICF category ISO 9999 classesNumber (%) of

overall ISO codes

e115 03, 06, 09, 15, 18, 24, 27, 30 30 (53,6)

e120 12, 18 11 (19,6)e125 21 9 (16,1)e130 03 1 (1,8)e135 24, 27 1(1,8)e140 30 3 (5,3)e150 18 1 (1,8)

Total N=7 Total N=16 56 (100)

IntroductionPersonal factors are very important in everyday general practice. Demographic variables, socio-economic factors, biographic data, lifestyle factors, life events and personal work related factors are the main personal factors which form the background of the actual contact between patient and the health care professional. Personal factors can have an influence on the policy of a treatment and therefore contribute to patient centred care.

General practitioners (GPs) know most of their patients well and are aware of the personal factors and circumstances of the patient. Sometimes, these personal factors are not documented, but are only remembered by the GP. Only a few personal factors are consistently registered in the EMR, others are stored in patient episodes or in free text.

Registration of personal factors of patients in the general practice: which are important to register according to general practitioners? A Delphi study

Abstract


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Niek Stoop¹, Kees van Boven¹, Huib Ten Napel¹ ², Annemarie Uijen¹

¹Department of Primary and Community Care, Radboud university medical centre, Nijmegen, ²Dutch WHO-FIC Collaborating Centre, Bilthoven, all in The Netherlands

Method

Why

More and more doctors work part time. The exchange and sharing of personal factor related information is necessary for patient centred care. Therefore the use of a classified set for registration of patient factors becomes important. Up to now, no study was conducted to propose a list of personal factors, which can be used in the daily practice of the GP. Furthermore, not only the GP can register personal factors. Patients, as primary custodians of this information, could help collect and register these factors too. Our aim is to create this list of personal factors in this study.

We limited our research to develop a list of factors in 5 categories: General personal data, social context, lifestyle factors, life events and work related personal factors. These categories are derived from a proposal, developed by members of the ICF-team of the Dutch Collaborating Centre and presented at the WHO-FIC Network Meeting in Brazil, 20121. This proposal was based on an exploration of International articles concerning this subject. Also, a literature study was conducted to propose a first draft of a list of personal factors for initial use in our study. Geyh et al. published a systematic review in 20112, which provides an overview of the literature regarding personal factors used in the ICF. Also the article by Heerkens in the WHO-FIC newsletter which proposed a concept list of personal factors was used3. Eventually, after confrontation and discussions on relevance for the general practice within our team, 60 items were selected for our study.

Delphi methodUsing the Delphi method, a group of 26 GPs completed three succeeding rounds in which personal factors were included or excluded. In each round GPs were asked to evaluate each factor and if this factor should be registered for each adult patient.

Personal factors, one’s personal background, are sometimes registered in general practice (GP), but not consistently, systematically and with standardized terms. These factors can be used as background knowledge during a patient-GP encounter and can have an influence on the policy of a treatment.This research is one of a series of researches for the implementation of ICF in Primary Care/General Practice

Figure1: Red boxes describe activities performed by the study group, yellow boxes describe activities performed by GPs.

Results

Recommendations

The authors express their gratitude to all participating GPs’.

Table 1: Final list of the included 20 personal factors

Eventually, 20 items were included during the three Delphi- rounds. These are listed in table 1. Consensus was not achieved for 9 items, which are listed in table 2 of the article about this research in the Dutch WHO-FIC Newsletter, Volume 12, number 1. 2014

Acknowledgements

The research group will explore solutions to integrate the final list of personal factors in the TransHis EMR system. This EMR system is used in several GP practices in the Netherlands. To implement this list of personal factors, other aspects should be explored. It is interesting to explore which factors are valued important by patients to register in General Practice.

Introduction

There are no automated tools to describe functioning and disability in children that take into account the need to collect information on impairments, limitations and restrictions, and consider explicitly the Environmental Factors (EF) role.Aim: to define a web tool to facilitate the description of the individual functioning/disability balance in children, which combines BF and AP categories according to specific assessment criteria, and takes into account the EF role.

Grouping Body Functions (BF) and Activity and Participation (AP) categories in

children functioning assessment: a new core set or some ontologic suggestions?

Abstract Results are shown on the contents of a web tool to facilitate the description of the individual functioning/disability balance in children. BF and AP categories were combined according to specific assessment criteria, taking into account the EF role.


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Frattura L.1, Bassi G.1, Simoncello A.1, Terreni S.2, Veos C.21Central Health Directorate, Classification Area, Friuli Venezia Giulia Region, IT WHO-FIC CC; 2Insiel, Trieste

Methods & Materials

The VilmaFABER system was updated with this new core set. An automated output was designed in order to release a specific valid document, written in both natural and ICF language. This new document describes the individual functioning/disability balance, according to the threshold between functioning and disability which VilmaFABERsystem was using (2). Field trials were planned to test the core set in selected samples in order to reduce the number of the chosen dimensions to assess and to verify how the information on the EF role for each category changes the meaning of the sentences written in natural language. The combination of BF and A&P categories describing 9 assessment areas may be helpful on the ICF ontological revision.

Results

The starting points were the Italian administrative rules for school inclusion of children with disabilities and specific educational needs (1). These rules suggest to assess children in 9 areas: cognitive, relational, communication, linguistic, sensorial, movement, neuropsychological, social and personal autonomy, and learning.



References

Figure 1 – 5 W for exploring children functioning

A web children and youth core set was created as a part of the Vilma-FABER system, which foresaw the assessment of 101 categories, 24 from BF Chapters 1-3 and 77 from all 9 AP Chapters (Table 2). After grouping the items in the 9 suggested assessment areas, taking into account the professionals’ suggestions, and after three rounds of consultations, a final combination of categories was approved.

Table 2 – The CALM after the storm

Area What to explore?1 Cognitive Explore the levels of cognitive

development achieved; the strategies used to solve tasks or problems; cognitive style; the ability to use different skills in an integrated way.

2 Relational Explore the level of self-esteem; the relationships with other people; the motivations of the relationships.

3 Communication Explore the interaction modality; the main contents of communication; the preferred tools.

4 Linguistic Explore the ability to understand oral language; the verbal production and the communicative use of verbal language; the use of alternative or additional languages.

5 Sensorial Explore the visual, auditory, tactile functionalities.

6 Movement Explore the fine and gross movements.

7 Neuro pshycological

Explore the mnestic and attention abilities; the intellectual ability; the spatio-temporal organization.

8 Social and personal autonomy

Explore the personal and social autonomy.

9 Learning Explore the acquisition of the skills expected for the age.

Thirty professionals were selected among those who had taken part in the VilmaFABERfield trial during 2013 and who had a specific background on neurological and psychiatric problems of children. Formal assessment documents prepared by the professionals were collected and information on functioning, written in natural language, was backcoded to ICF. A list of BF and AP ICF categories was thus created, moving from a semantic storm (Figure 2). The professionals were then asked to group the information mapped to these categories into the 9 suggested assessment areas, avoiding to put a category in more than one assessment area.

1. Presidenza del Consiglio dei Ministri, Conferenza Unificata, “Intesa tra il Governo, le Regioni, le Provincie autonome di Trento e Bolzano, le Provincie, i Comuni e le Comunità montane in merito alle modalità e ai criteri per l’accoglienza scolastica e la presa in carico dell’alunno con disabilità”, 20 marzo 2008

2. www.vilmafaber.eu

Figure 1 – The semantic STORM in children assessment

Table 1 – What to explore, according to the administrative rules?

AssessmentAreas

BF (N) BF categories A&P

(N) A&P categories

Cognitive 5 b117; b160; b163; b164; b167 5 d131; d132; d137; d155; d175

Relational 6 b110; b122; b125; b126; b152; b180 11 d240; d250; d660; d710; d720; d730; d740;

d750; d760; d880; d920

Communication - - 7 d134; d315; d335; d345; d350; d355; d360

Linguistic 3 b310; b320; b330 6 d133; d310; d320; d325; d330; d340

Sensorial 3 b210; b230; b265 - -

Movement 2 b147; b176 11 d410; d415; d420; d435; d440; d445; d446; d450; d455; d460; d465

Neuro pshycological 4 b114; b140; b144; b156 5 d110; d115; d135; d160; d161

Social and personal autonomy

- - 21d210; d220; d230; d470; d475; d510; d520;

d530; d540; d550; d560; d570; d571; d620; d630; d640; d650; d835; d840;

d860; d870

Learning 1 b172 11 d130; d140; d145; d150; d166; d170; d172; d815; d820; d825; d830

Introduction

During the first years of life, childrenwith special needs and their familiesturn to health and education specialiststo establish diagnoses and interventionplans, generating a great amount ofinformation with dissimilar conceptsbetween the professionals and theparents, slowing down opportuneattention during this age of highdevelopmental potential (Image 1).Having a central program based oncase management and a transversalICF-based instrument which permitsthe use of common language in thecontinual back-and-forth of health andeducation can facilitate the continuityand coordination of the interventions.Experts were consulted with theobjective of evaluating the validity andreliability of the instrument,considering that it will be used in fourlarge areas: a) General information formedical specialists, b)process andresults indicators for the coordinatorc)information for parents to commit tocertain support and d)profile offunctioning for rehabilitationprofessionals and early childhoodeducation centers that also includespecial needs children (Image 2).

Coordination Program in the Education-Health Interface for Early Childhood with Special Needs

(ICF Validation Instrument)

Abstract Early Childhood with special needs requires a strong coordination between health and education professionals. Considering the potential development of this group and the benefits of early intersecting attention, a coordination program is proposed based on case management that uses common language to avoid the fragmentation of interventions, establishing the profiles of functioning and support from a health and education perspective. The central focus of the coordination program is anICF-based instrument which, through methodology corroborated by experts, demonstrated validity and reliability.


C531


Authors: Daniel Cid*; Erika Jiménez ; Germán Rojas *Physical Therapist, Master of Health Management, Centro de Innovación y Desarrollo en Ámbitos de Salud (cIDEAS), Chile

Methods & Materials

Of the 21 professionals that were sentthe instrument, only 14 responded tothe requirements (66,7%). Half ofthese respondents work in clinicalfunctions, while half work inmanagerial functions. For validity, thedescriptive data of the mean score, aswell as the standard deviation for eachof the dimensions indicate an adequaterelevance of the instrument (1.23).There is no significant differencebetween the scores assigned by theevaluators (F=3.4; p=0.78). Thecorrelation indicators (r=0.69,p=0.001) indicate a positive relationamong the different evaluators. For theinternal consistency of the 28 items, aCronbach coefficient was used, whichgave values of 0.89 for healthprofessional and 0.85 for educationprofessionals.


Results

To determine the convergent anddivergent dimensions, the Pearsoncorrelation coefficient betweenevaluators was calculated. In this way,the scale-item correlation was alsoassessed using the Pearson correlationcoefficient.The reliability was analyzed throughthe internal consistency of thedimensions, which was evaluated usingthe Cronbach coefficient on the scoresof the evaluators.

Conclusions

We would like to thank those that collaborated on the development of the instrument. Construction and design: Teresa Nuñez, MaríaPomez, Paulina Alid, Mauricio Zepeda; Revision and proofreading: Helia Molina, Carlos Quinteros, Patricia Soliz, Armando Vázquez, Carolina Toro, Marisol Moreno, Yonatan Encina, Elizabeth Fonseca, Guadalupe Morales, Fernanda Jara, Mariela Amaro, Mónica Donoso, Andrés Ehrmmantraut, Magaly Jaimes, Jaime Collazos, Elizabeth Fernández; Tech support: Horst Rojas; Images: Ricardo Lara, Kurt Castro; Translation: Chelsea Dietsche

Significant efforts by professionals arebeing made to strengthen the continuity,coordination, monitoring, and follow-up ofactions in early childhood.

The model in its pilot phase has obtainedsignificant results in all of its indicators.

According to the assessment specialists,the instrument is valid and reliable,permitting the implementation of thefollowing steps: complete field tests,create a prototype of software design andvalidation in order to make an onlinedigitalized monitoring system that permitsusers to access an information platformfrom any geographic point that hasInternet connection.

Image 1: Problem-Sequence for a child with special needs, where the parents, health, education, and social services professionals don’t use common language (Squares 1-4). A transversal ICF-based instrument which is used as a common framework is validated (Square 5).

Image 2: The instrument generates information for central coordination with indicators of: management, basic actions for parental commitments to collaborate in interventions, a basic profile of the case for medical specialists, and the education-health team’s support plans.

Dimension Health EducationSupportrequirements 1.143 1.286

Adaptive conduct 1.143 1.357

Intellectual abilities 1.214 1.214Psychomotorabilities 1.071 1.210Environmentacting as barrier orfacilitator

1.143 1.286

Table 1: Average scores upon evaluating whether or not the dimension of the instrument is adequate. (1= VeryAdequate; 3= Inadequate)

The sample consisted of 21 health andeducation professionals. A self-administered tool with 28 items and 5dimensions was sent. An additive scaleof evaluation was used. The maximumscore is 126 points, while the minimumis 28. The data were normalized to arange of values from 0 to 100, where 0represents the best state of evaluationand 100 represents the worst possiblestate of evaluation.To evaluate the validity, the differencesin the mean scores between thedifferent groups of evaluators wasanalyzed with a unidirectional analysis ofthe variance.

Further information: Daniel Cid P.T. [email protected]

MANAGEMENTEducation

Access/HealthServices/Follow-up

FAMILYCommitments/

Information

HEALTH/EDUCATION PROFESSIONALS

Planning

MEDICAL SPECIALISTCheck-upsMorbidity

Medical Specialist uses Technical Language Misunderstood Medical Documents in the School More Education, Health, Social Service Paperwork Family Confusion with Health and .EducationICF-based Instrument applied in Health and Education Assesment

Context

Title

Abstract The Australian Institute of Health and Welfare (AIHW) has developed and tested a new disability ‘Flag’ that identifies records of people with a disability within a data collection. The Flag derives from a standard set of questions that assesses a person’s level of functioning and need for support in everyday activities. The set is based on the International Classification of Functioning, Disability and Health, and is broadly consistent with the short disability questions that the Australian Bureau of Statistics (ABS) uses in a number of its social surveys.The module has been designed for implementation in collections covering a wide range of sectors, which will enable nationally consistent collection of information about the disability status of people encountering mainstream services.This poster describes the conceptual development of the Flag, the consultation and testing processes, and the preparation of metadata specifications under the ISO/IEC 11179 Metadata Registry standard and data collection guides.

Commitment of all Australian governments in promoting the rights of individuals with disability has been at the forefront of the recent disability policy environment, and is articulated in a number of key policy documents and strategies.A major theme running through these documents is the need to ensure that all mainstream services and programs across the country address the needs of people with disability. (Mainstream services are those services that people encounter in everyday life—such as healthcare, education, housing, transport, community services.)A critical first step to improve the capacity of mainstream services is to achieve accurate and comparable identification of people with disability. Accurate identification is important to monitor the gap in health and social outcomes between people with disability and other Australians. Information collected will also provide a broader sense of the service needs of, and services provided to, people with disability.

A Standardised Disability Flag for Australia


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Mark Cooper-Stanbury, Jenny HargreavesAustralian Institute of Health and Welfare, Canberra, Australia

Title

Development process

The following principles were employed in the development of the Flag:• data should be readily collectable by

all mainstream services• the Flag should be consistent with

the concepts underpinning the International Classification of Functioning, Disability and Health (ICF)

• data should be comparable—similar experiences should be coded similarly across a service sector and between sectors

• data should be meaningful: sufficiently sensitive, sufficiently broad, and sufficiently specific

• the Flag should be aligned with disability data items in population surveys and censuses

• the Flag should use existing national data standards, wherever possible.

Development principles

Acknowledgements

The consultation and testing phases of the project were managed by Graz Hamilton of the AIHW.The AIHW acknowledges the generous input from the diverse stakeholders who reviewed drafts, and the organisations that pilot-tested the module.

Figure 1: Representation of the Standardised Disability Flag

The AIHW developed the module with reference to, and following critical review of:• the concepts underpinning the ICF• the range of ABS instruments used to

measure disability (including survey and census-based instruments)

• international developments in disability measurement, such as the WHODAS 2.0 and the ‘Washington Group’ set of questions for population assessment of activity limitations.

During the conceptual development phase the AIHW consulted with experts in disability concepts and measurement. Draft versions of the module were then tested and refined through a series of focus groups, cognitive interviews and pilot testing. Each of these development components including input from people with lived experience of disability.

Outputs

The Flag enables the following outputs at an individual level (which can also be aggregated to report at a collection level, or for client sub-groups):• Extent of activity limitation• Activity limitation flag (a summary of

Extent of activity limitation)• Extent of core activity limitation• Education participation restriction flag• Employment participation restriction

flag.Relevant metadata have been produced in ISO/IEC 11179 format on METeOR, Australia’s online metadata register for health, housing and community services data—go to <meteor.aihw.gov.au> and search for ‘Standardised disability flag’.

Next steps

Australia’s National Disability Strategy signals the intention for a disability identifier to be implemented in data collections for mainstream services such as healthcare, education, housing, transport and community services.The Flag has been piloted with the Specialist Homelessness Services collection, and is in the process of being implemented within other housing collections.

The authorsacknowledge the continuous feedback fromMelissa Selb, ICF Research BranchCoordinator.

Background

Title

Toward the system-wide implementation of the ICF in clinical and rehabilitation practice to describe

functioning along the continuum of care

Abstract Functioning, as described in the International Classification of Functioning, Disability and Health (ICF), is a primary healthoutcome in health and rehabilitation practice. It complements disease-specific information with information about biological aspects ofhealth and how health plays out in everyday life. The ICF serves as a standard for describing functioning and disability across all levels ofthe health system. This paper outlines the steps toward the development and implementation of a minimum set of domains most relevantalong the continuum of care to facilitate a standardized documentation of functioning in routine clinical and rehabilitation practice.


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Prodinger B1,2,3, Bickenbach J1,2,3, Stucki G1,2,3, Cieza A1,3,4,51Swiss Paraplegic Research, Switzerland; 2Department of Health Sciences & Health Policy, University of Lucerne, Switzerland

3ICF Research Branch in cooperation with the WHO-FIC CC in Germany (at DIMDI), Switzerland; 4Faculty of Health and Social Sciences, University of Southampton, UK; 5Institute for Public Health and Health Care Research, Ludwig-Maximilians University, Germany.

Title

Table 1: ICF Categories contained in ICF Generic and Disability Set

Next steps toward system wide implementation

1 Selb et al. A guide on how to develop an International Classification of Functioning, Disability and Health core set. Eur J Phys Rehabil Med 2014, Early online.

2 Cieza et al. : Towards a Minimal Generic Set of Domains of Functioning and Health. BMC Public Health. 2014, 14:218.3 Grill et al. ICF Core Sets for early post-acute rehabilitation facilities. J Rehabil Med. 2011 43(2)131-8.4 Grill et al. Brief ICF Core Sets for acute hospital. J Rehabil Med. 2011 43(2)123-30.

ICF Code Title b130 Energy and drive functions (G)b134 Sleep functions (G)b152 Emotional functionsb280 Sensation of pain (G)b455 Exercise tolerance functionsb620 Urination functions b640 Sexual functions b710 Mobility of joint functionsb730 Muscle power functions d230 Carrying out daily routine (G)d240 Handling stress and other psychological demands d410 Changing basic body positiond415 Maintaining a body positiond420 Transferring oneselfd450 Walking (G)d455 Moving around (G)d465 Moving around using equipmentd470 Using transportation d510 Washing oneself d520 Caring for body partsd530 Toiletingd540 Dressing d550 Eatingd570 Looking after one’s health d640 Doing houseworkd660 Assisting others d710 Basic interpersonal interactions d770 Intimate relationships d850 Remunerative employment (G)d920 Recreation and leisure

The comprehensiveness of the ICF is its strength and yet, a challenge for itsimplementation as a standard in routine clinical and rehabilitation practice.One of the biggest challenges with respect to functioning information is tospecify which domains to be assessed in routine clinical and rehabilitationpractice irrespective of the health condition of a person or the clinical setting(e.g. acute, long-term, community rehabilitation) to ensure that on one hand,all aspects relevant for a particular patient are captured and on the otherhand, that functioning information gets collected in a standardized manner sothat it can be compared across patients, settings, locally, regionally,internationally. Thus, it would be useful to have a parsimonious set of domainswhich can serve as the foundation for ICF-based tools and is tailored to theneeds of users while ensuring a standard for functioning information.

Over the last decade, more than 25 ICF Core Sets have been developed basedon a multi-phase international consensus process. ICF Core Sets constituteshort lists of ICF Categories most relevant for patients with a particular healthcondition.1 These sets served as a foundation for an empirical study includingpeople over 18 years with the respective health conditions to examine whichICF categories explain functioning in the general population and acrosspatients with varying health conditions. Seven ICF categories have beenidentified (Table 1). An additional 15 categories were shown to describefunctioning best particularly in the clinical population.2 Hence, these 22 ICFcategories serve as a minimum set of domains most relevant to describefunctioning across clinical populations. As the empirical study focused mainlyon adults in long-term, out-patient or community settings, we reviewedexisting ICF Core Sets for acute, early-post acute, and geriatric settings.3,4

Eight ICF Categories that were relevant across people with musculoskeletal,neurological or cardiopulmonary health conditions in those settings wereadded to the existing domain set. Based on this comprehensive process, thereis now a minimum set of 7 ICF Categories available that is most relevant todescribe functioning across the general and clinical population – ICF GenericSet – and a selection of another 23 ICF categories most relevant across clinicalpopulations along the continuum of care – ICF Disability Set (Table 1). The ICFGeneric Set is included in the ICF Disability Set and the ICF Core Sets asillustrated in Figure 1.

ICF Generic and ICF Disability Set

ICF

contains more than 1450 ICF categories organized in a mono-hierarchical structure.

ICF Core Setsare short lists of ICF categories most relevant in a particular health condition based on multi-phase international consensus process.1

Available ICF Core Sets: Acute inflammatory arthritis; Ankylosing spondylitis; Low back pain; Obstructive pulmonary diseases; Osteoarthritis; Osteoporosis; Rheumatoid arthritis; Chronic widespread

pain; Breast cancer; Head and neck cancer; Depression; Bipolar disorders; Chronic ischemic heart disease; Diabetes; Obesity; Stroke; Hand conditions; Multiple sclerosis; Traumatic brain injury;

Spinal cord injury in post-acute and long-term care; Sleep disorders; Inflammatory bowel diseases; Hearing Loss; Vertigo; Children/youth with Cerebral Palsy; Cardiopulmonary, muskuloskeletal and

neurological conditions in acute and post-acute setting including for geriatrics; Vocational rehabilitation

ICF Core Sets in development: Lower limb amputees, Autism spectrum, Attention Deficit Hyperactivity Disorder (ADHD), Schizophrenia

ICF Generic Set

consists of ICF categories most predictive of health across general population and people with various health conditions based on all ICF categories contained in existing ICF Core Sets.2

Figure 1: The ICF categories of the ICF Generic Set constitute a minimum set of categories contained in all ICF Core Sets.

References

The ICF Generic Set serves as the minimum standard for reporting functioning in clinical and rehabilitation practice. The set of 7 ICF categories can beaugmented with any ICF category of the ICF Disability Set, as well as with ICF categories from existing ICF Core Sets and the whole ICF depending on thepurpose of use. For the system-wide implementation of this minimum standard for reporting functioning, relevant information on these domains needs torecorded for each patient. It is only once this information is available in a structured manner in all health records that functioning information cansystematically be used for health service planning and health resource allocation, as well as policy development and evaluation.

System-wide, standardized documentation of functioning

Acknowledgments

Introduction

Title

Typhoon Yolanda struck the Philippines on November 8, 2013 with strong winds of over 300 km/h. It was one of the strongest tropical cyclones ever recorded. The death toll has reached 6.300 and many provinces were affected, as showed in the figure 1.In response to this massive devastation, the WHO Regional Office for the Western Pacific, in consultation with the UN Humanitarian Inter-Cluster Coordination Group decided to conduct a survey on post-typhoon disability and health profiles of people affected. The main aim of this survey is to provide detailed information on affected populations’ ongoing health and disability problems as well as to provide a broader base for humanitarian support to people affected.

Measuring Disability and Health in Emergencies: implementing a disability survey using WHODAS 2.0 in the Typhoon Yolanda affected areas of the Philippines

Abstract Typhoon Yolanda was one of the strongest tropical cyclones ever recorded that struck the Philippines on November 8, 2013. A survey on the populations’ disability and health profiles was conducted after this disaster using a protocol composed of socio-demographic schedule, household questionnaire and WHODAS 2.0 Disability Assessment Schedule. This survey will allow us to report the affected populations’ health and disability problems and to validate the WHODAS 2.0 in an emergency situation so that for future emergency health and disability evaluation could be performed with WHODAS 2.0 as part of the general emergency situation.


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Leonardi M.��, Kostanjsek N.F.�, Chatterji S.³, Naidoo N. ³, Raggi A.�², Schiavolin S.��, Zayas J.�, Tarroja C.�, Regadio C.J.�, Pindog M.�, Talampas R.�, Paiella G.6, Zagaria N.6

1 Neurology, Public Health and Disability Unit - Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy2 WHO Collaborating Centre Research Branch3 WHO Head Quarter, Geneva, Switzerland4 Social Development Research Center (SDRC) of De La Salle University, Manila, Philippines5 Inclusive Development and Empowerment Agenda (IDEA), Philippines6 WHO, Philippines

Title

Methods & Materials

A sample of 2000 adult people has been interviewed by researchers of the Social Development Research Center (SDRC) of De La Salle University and the Inclusive Development and Empowerment Agenda (IDEA). The interviewers were 40, men and woman from Tacloban area, Leyte island, and some had previous experiences on surveys. There were teachers, social workers, phychologists, nurses and community workers among the field staff. People interviewed came from 12 different Barangays.Data will be analysed by Besta Institute, WHO of Geneve and WHO of Manila and they will be available soon.


Results

Conclusions

It was the first time ever that – within the context of an UN lead humanitarian response effort - disability was officially recognized as key outcome indicator and WHO committed to do a disability survey in the areas affected by Yolanda.This innovative approach that considers functioning and disability profiles together with tailored socio demographic information, allows better public health planning and improvement in policies and interventions.At the end of data analysis we will be able to report the health of people affected. Furthermore this survey will allow us to validate the WHODAS 2.0 in an emergency situation so that for future emergency health and disability evaluation could be performed with WHODAS 2.0 as part of the general emergency situation.

The Survey Protocol includes socio-demographic questionnaire, household questionnaire and WHODAS 2.0 Disability Assessment Schedule. Whodas 2.0 was provided by WHO HQ, and modified for field application by WHO Regional Office, the Social Development Research Center (SDRC) of De La Salle University, Inclusive Development and Empowerment Agenda (IDEA) and Neurological Institute Besta of Milan. A field training was prepared by Besta Insitute and performed by a WHO expert in the area of disability studies and by researchers of SDRC and IDEA.Data collection was conducted from May 25 to June 30, 2014 and July 17-18, 2014 after a pilot study on 100 cases. A further survery will be repeated 9 months to one year later.Figure 2 shows the specific questions on typhoon of the Household questionnaire as an example.

Figure 1:Affected provinces in red

Conclusions

Photo: Typhoon Yolanda

Figure 2: Questions on typhoon of the Household questionnaire

Authors thank all the interviewers that participated to data collection.

Introduction

Title

CBR is a valued community development approach but lacks evidence about its efficacy1,2. To build evidence about CBR in a way that is consistent with the philosophy of CBR, the starting point should be to encourage locally controlled and owned monitoring. Quality information generated through monitoring can empower stakeholders, and support the planning and review of CBR programs.

Monitoring Manual and Menu for community-based rehabilitation (CBR)

Abstract CBR is a valued community development approach but there is a criticism on the lack of evidence about its efficacy. Locally controlled monitoring is an essential first step in building evidence on and understanding of CBR. We outline a collaborative project to develop a CBR Monitoring Manual and accompanying Menu of information items.


C535


Ros Madden, Sue Lukersmith, Charlotte Scarf, Michael Millington, Sally Hartley, Nicola Fortune, Alex Gargett, Gwynnyth Llewellyn

University of Sydney, Australia*

Title

Methods & Materials

Collaborative, participatory research involved workshops: in 2011, with CBR managers and stakeholders from Asia (Vietnam, Lao PDR and the Philippines); and in 2013 with Pacific region partners from PNG, Fiji, Solomon Islands and Timor Leste. The workshops focussed on training on CBR and the ICF and identifying what information is important to stakeholders. The workshop format provided the template for the information design methods outlined in the Manual. Participants described their information needs and worked though the types of questions and exercises now set out in the Manual, (in Step 2 ‘Design information’). Other outcomes of the workshops were organised lists of information items of importance to participants, and these helped frame and populate the Menu.

Synthesis, consultation & review:- Combining the Menu items and framework from the workshops with the items from the analysis of literature. Mapping items to relevant frameworks (e.g., CBR Matrix) and data standards (ICHI, ICF and others) helped refine the structure and content of the Menu, as did thematic analysis and an international survey of experts.- Collaborators provided case studies, for inclusion in the Manual. - Several iterations of review and refinement drew on the expertise of collaborators, an Advisory Group and a wider group of reviewers (NGOs, DPOs, CBR practitioners, academics).

Acknowledgements & Notes

Three components of research were conducted (2011-14) to develop the Monitoring Manual and Menu (MM&M): review and analysis of literature; collaborative, participatory research; and synthesis, consultation and review of draft elements and products.

Review of the literature involved two analyses of 36 articles. The first analysis looked at methods for CBR monitoring and evaluation. It found that a variety of tools and methods were used, but with a lack of detail and consistency, thus making systematic measurement of CBR program outcomes difficult. More rigorous and consistent monitoring and evaluation practices were needed3. A consistent approach in monitoring activities would enable data to be combined across programs and time, to build stronger evidence about CBR efficacy and effectiveness.

The second analysis explored the potential of the ICF to support CBR and its monitoring. From each article ‘information items’ were extracted and coded to ICF domains and categories4. Around one third of information items (32% of 2,495) related to functioning, disability or environment, and could be coded to the ICF. Most related to Activities and Participation (49%) or Environmental Factors (42%).

Conclusions

*Regional collaborators: Sainimili Tawake, Mariaia Matakibau, Bounlanh Phayboun, Sengthong Soukhathammavong, Khamko Chomlath, Bounpheng Phetsouvanh, Ben Theodore, Peter Sindu, Susan Goikavi, Goretti Pala, Casper Fa’asala, Elsie Ningalo Taloafiri, Penafrancia Ching, Joaquim Soares, Francisco de Deus Soares, Phuong Anh Tran Thi, Phuong Tran Thi, Nhan Ha Chan, Cam Tu Huynh Thi. Research was resourced by the University of Sydney, DFAT and CBM International. 1. WHO & World Bank 2011. World Disability Report. WHO Geneva2. WHO 2014. Global Disability Action Plan3. 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, Vol. 35, No. 23 , Pages 1941-19534. 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 2014, Vol. 36, No. 10 , Pages 826-837 5. Madden RH, Fortune N, Cheeseman D, Mpofu E, Bundy A 2013. Fundamental questions before recording or measuring functioning and disability. Disability & Rehabilitation, 2013; 35(13): 1092–1096

Menu of information items: Headings

P1 Person—Personal profile & history P2 Person—Functioning and disability

P2.1 Body functions P2.2 Activities and Participation

P3 Person – Environmental factors P4 Person – OutcomesO1 Organisation – Purpose, structure, strategyO2 Organisation – Resources O3 Organisation – Environment O4 Organisation – OutcomesA1 Activities – What is done A2 Activities – Outcomes W1 Workforce – Personal profile of staffW2 Workforce – Knowledge and skills W3 Workforce – Responsibilities and tasksW4 Workforce – Training undertaken W5 Workforce – Quality of performance

This work produced a Menu of data items and information items for use in monitoring and a Manual containing advice on monitoring design and use of the Menu. CBR managers and other stakeholders can work together locally to create a monitoring system to suit the needs and circumstances of different programs and communities.The Manual and Menu are published and freely available for testing or use, from: sydney.edu.au/health-sciences/cdrp/cbr-monitoring/

It was concluded that the ICF is a useful framework and classification, providing building blocks for the systematic recording of information on functioning and disability for CBR monitoring and evaluation.

8%1%

49%

42%

Body Functions

Body Structures

Activities & Participation

Environmental Factors

Steps explained in the ManualBefore you begin

1 Prepare for collaboration2 Design information

Exercise 1: Why is information needed? How will it be used?Exercise 2: What items of information are needed?Exercise 3: How will we collect and record the information?Exercise 4: When and where will information be collected, who will collect it, and how will it be stored?Exercise 5: Who will use the information and how?

3 Develop the monitoring plan4 Undertake monitoring activities5 Analyse and use information6 Review monitoring activities & the monitoring plan

Results & Conclusion

GATE

TitleToday only 5-15% of the population in need has access to assistive products and this gap will be magnified in future by the immense projected increase in the number of older people worldwide. Increasing access to high-quality and affordable Assistive Health Products (AHP) is a priority of the World Health Organization (WHO).


C536


Theo Bougie1, Yvonne F. Heerkens2, Jerome E. Bickenbach3, Chapal Khasnabis4, Takenobu Inoue5

1) BRT-advies / The Netherlands; 2) Dutch Institute of Allied Health Professions / The Netherlands; 3) Swiss Paraplegic Centre / Switzerland; 4) WHO / Switzerland; 5) Research Institute of the National Rehabilitation Center for Persons with

Disabilities / Japan

Title

Suggested new definition of Assistive (Health) Productor Assistive Product for Functioning and Health (APF/APH)

The Global cooperation on Assistive Health Technology (GATE) is a WHO initiative. GATE has the goal of moving the global Assistive Health Technology (AHT) agenda forward in order to meet current and future challenges.More than 80 professionals representing all stakeholders from all over the world attended the first meeting of GATE in July 2014 in Geneva. House opined that the present definition used in the ISO 9999 ‘Assistive products for persons with disability – Classification and terminology’ needs conceptual expansion. Considering the ultimate purpose of assistive product and to have a better clarity, it was suggested that AT should be referred as AHT or Assistive Technology for functioning and Health (ATF or ATH) and AP as AHP or Assistive Product for Functioning and Health (APF or APH). In collaboration with ISO, WHO would soon create a taskforce to finalize the terminology and definition.

Conclusions

This adapted definition will be discussed by Subcommittee 2 of ISO/TC173 in October 2014 and WHO GATE Terminology taskforce. When approved it will be included in the DIS version of ISO 9999 version 2016 to be published in November 2014.

Adaptation of the definition of ‘assistive product’

from a ‘health’ perspective

Any external product (including devices, equipment, instruments and software) especially designed and produced or generally available,

whose primary purposes are* to maintain or improve individual’s functioning and independence

* to facilitate participation* to enhance overall well-being

but which can also be used* to protect, support, train, measure or substitute for body functions,

structures and activities* to prevent avoidable impairments, activity limitations and

participation restrictions.

Background

Follow-up

ISO 9999

Every four or five years a new version of the ISO 9999 is published. In the 2011 version an adapted definition of assistive products was included based on discussions related to the harmonization of terminology with ICF. Now Working group 12 is working on the 2016 version of ISO 9999.

Working on this new version the definition was again changed a bit; the present Committee Draft contains the following definition of assistive products: Any product (including devices, equipment, instruments and software) especially produced or generally available, used by or for persons with disability- for participation- to protect, support, train, measure or substitute for body functions/

structures and activities- to prevent impairments, activity limitations and participation restrictions

However during the GATE meeting, the following terminology/definition was proposed.

Abstract, BackgroundDuring a meeting of GATE (Global cooperation on Assistive Health Technology) suggestions were formulated to update the present definition of ‘assistive products’ as presented in the Committee Draft of ISO 9999, Assistive products for persons with disability - Classification and terminology.

Goal of the poster To stimulate discussion about the proposed definition of assistive (health) products and about the use of assistive (health) products in promoting health.

Title

Classifying disability services activities and workforce in the 21st Century:

applying ICF to ISIC and ISCO

Abstract Much effort has gone into ensuring that WHO-FIC classifications support the rights of people with disabilities, as enshrined in the UN Convention on the Rights of People with Disabilities (CRPD). There are, however, other relevant international classifications where change is needed to support the CRPD.

There is a role for the WHO and the WHO-FIC Network in encouraging change where a need is identified, in order to promote the consistency of international classifications, and thus the quality and comparability of data collected using those classifications.Two classifications stand out as in need of reform to align with the CRPD: the International Standard Industrial Classification of All Economic Activities (ISIC), published by the UN’s own Statistics Division, and the International Standard Classification of Occupations (ISCO), published by the International Labour Organization. These classifications are widely used in reporting data on workforce and economic activity at an international level, and they are used by countries as a basis for developing national classifications.


C537


Richard Madden & Nicola Fortune National Centre for Classification in Health, University of Sydney

Title

Classes in ISIC and ISCO relevant to the identification of economic activity and workforce in the disability sector are

listed in Table 1. The classes in ISIC have several shortcomings: Inappropriate language, notably ‘mental retardation’ (872) Separating intellectual disability (872) from other disabilities (873)Combining ‘elderly’ and ‘disabled’ (873 and 881)Use of the term ‘social work activities’ (881) rather than a more

appropriate description.

ISCO’s classes provide only partial coverage of disability workers. Minor Group 532 covers personal care workers in health services who ‘provide personal care and assistance…in health care and residential settings’; other community settings are not covered. ‘Home-based personal care workers’ (5322) are described as providing personal care and assistance with activities of daily living—self care, mobility and communication are mentioned, but not assistance for broader community participation.This brief analysis shows that ISIC and ISCO do not allow comprehensive identification of the disability sector (activity or workforce) separately from other sectors. The ISCO classes need reform to cover provision of assistance for the full range of ICF Activity and Participation domains, and in all settings. The ISIC categories need reform to allow separate identification of activities in the aged and disability sectors. For both classifications the language used needs to be updated in line with the CRPD and ICF. The current situation is a severe impediment to the collection and analysis of data to support the development and monitoring of policies and programs in the disability sector.The revision of ISIC and ISCO should be accomplished with the active involvement of the United Nations Statistics Division, ILO, WHO, WHO-FIC Network collaborating centres, and relevant national statistical agencies. It should be informed by the ICF, as the international standard framework for disability. Following this, national classifications should be revised in line with the international standards.

Article 31 of the UN CRPD states:

States Parties undertake to collect appropriate information, including statistical and research data, to enable them to formulate and implement policies to give effect to the present Convention. The process of collecting and maintaining this information shall … comply with internationally accepted norms to protect human rights and fundamental freedoms and ethical principles in the collection and use of statistics.

The International Classification of Functioning, Disability and Health (ICF) provides a common language for communication among all concerned with disability, and an infrastructure for the collection of data related to disability. The ICF conceptualises functioning as comprising body functions and structures, activities and participation, with all these dimensions being affected by environmental and personal factors. Within this framework, disability is an umbrella term for impairments of body function or structure, activity limitations or participation restrictions.

Here we examine ISIC and ISCO in order to identify classes relevant to the disability workforce. In doing this we ask: Can the classifications support the

collection of data on workforce and economic activity in the disability sector, separately from other sectors (e.g., aged care)?

Is the language used in describing the relevant classes consistent with that used in the ICF, and with the principles of the CRPD?

Introduction

Abstract

Table 1: ISIC and ISCO classes relevant to economic activity and workforce in the disability sector

Results and discussion

ISIC unstats.un.org/unsd/cr/registry/isic-4.aspISCO www.ilo.org/public/english/bureau/stat/isco/isco08/

ISIC ISCO

872 Residential care activities for mental retardation, mental health and substance abuse

873 Residential care activities for the elderly and disabled

881 Social work activities without accommodation for the elderly and disabled

No class names include ‘disability’ or ‘disabled’. Disability is mentioned in the definition of:

2635 Social work and counsellingprofessionals

5322 Home‐based personal care workers

2269 Health professionals not elsewhere classified

Methods

Development

Title

Clinical Practice Guideline for the Assessment of Function in

Head and Neck Cancer

Abstract

Background: Functional outcome following head and neck cancer (HNC) is not regularly assessed in a standardized way in clinical practice. Clinical trials assessing functional outcome apply many different instruments. Therefore, results are not always comparable and have limited clinical implications. Aim of this study was the identification, interdisciplinary evaluation, and recommendation of functional outcome instruments for use in clinical practice and clinical trials in patients with HNC. All work was based on the functional aspects defined in the ICF Core Sets for head and neck cancer (ICF-HNC).

Material: Preparatory studies came up with a shortlist of outcome instruments on the basis of previously determined criteria. An interdisciplinary expert group evaluated these instruments and decided on which ones can be recommended for use in 3 application areas: screening, therapy evaluation/planning, and clinical trials. Decision making health professionals included physicians (ENT and maxillofacial surgeons, radiotherapists, oncologists), medical psychologists, speech and language therapists, physiotherapists, and social workers.

Results: 98 instruments were presented at the consensus conference. Altogether 21 participants recommended for each of the 3 application areas a basic set of measures for the evaluation of impairment in 6 functional domains: follow-up therapy monitoring, pain, ingestion, voice/speaking, other organic problems, and psychosocial problems.

Conclusion: A multi-professional expert’s pool discussed and adopted recommendations for the use of functional outcome instruments in clinical praxis and/or in research. The recommended instruments are now available for use in clinical routine.


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M. Stier-Jarmer1, A. Cieza2,3, U. Tschiesner4, C. Sabariego1, M. Kirschneck1, S. Becker,4 U. Harréus4,5

Title

Conclusion and next steps

Pilot-Implementation

•Identification of functional aspects, relevant for patients with HNC What to measure?Project 1: Development of ICF Core Sets for Headand Neck Cancer (2006 – 2008)

•Identification of instruments and related cut off values to assess thefunctional aspects

How to measure?Project 2: Development of an ICF-based Clinical Practice Guideline for the Assessment of Function in Head and Neck Cancer (2009 – 2013)

1. Preparatory Studies

2. Consensus Conference

3. Implementation

Instruments for measuring functioning in 3 application areas were recommended:

ScreeningTherapy

evaluation/planning

Clinical trials

1Chair for Public Health and Health Care Research, Ludwig-Maximilians-University, Munich, Germany, 2World Health Organisation, Geneva, Switzerland, 3Faculty of Health and Social Sciences, University of Southampton, UK, 4Department of Otorhinolaryngology, Ludwig-Maximilians-University, Munich, Germany, 5Department of Otolaryngology and Head and Neck Surgery, Evangelisches Krankenhaus Düsseldorf, Germany

The authors are grateful to all those involved, particularly among the participants of the Consensus Conference: K. Bikowski, H. Danker, A. Dietz, R. Fietkau, J. Heine, Ch. Hey, A. Hofmayer, M. Kapsreiter, M. Knödler, K. Lüders, G. Mast, M. Patz, H. Scheithauer, O. Seitz, S. Singer, S. Stanschus, S. Strieth, I. Weis, C. Winkelmann, and B. Wollenberg. The study was funded by: Deutsche Krebshilfe e.V.

Consensus Conference(interdisciplinary)

CLINICAL PRACTICE GUIDELINE

Implementation of the recommended screening instruments in clinical practice, e.g., systematic and standardized assessment of functional problems over 2 years within the cancer follow-up using a web-based data collection system - smartSurvey

• Comprehensive, systematic collection and standardized assessment of functioning from the patient's perspective

• Use of the screening tool for evaluating short-, medium-, and long-term functional effects of different therapies in patients with HNC is planned in the scope of a multicenter cohort study

Title

Encephalitis is a rare entitycompared to stroke or traumaticbrain injury in a rehabilitationsetting. Neurological impairments interms of motor functions, cognitiveskills and behavioral disorders canlead to very severe disability.Most of the literature related toinfections to the central nervoussystem is referred to the acuteepisode, to the diagnosis and to theacute management but there is scantinformation addressing functioning.Up to now there is no universaloutcome measure to determine thecurrent status of functioning ofpeople that suffer from thesesqueals.

The aim of the present study isto determine within an ICF languagewhich are the relevant aspects offunctioning in patients survivingencephalitis. A secondary aim is todescribe the functioning profile aftera rehabilitation programme.


C539


Authors: Sara Laxe, Montserrat Bernabeu, Josep M TormosGuttmann Institut Hospital for Neurorehabilitation

Title

Methods & Materials

Results

Clinical records of patientsaccepted in a neurorehabilitationhospital were retrospectivelyreviewed. Data related tosociodemographics, time since injuryuntil the begginning of arehabilitation program and durationof the rehabilitation programmewere extracted. Any medicalcomplication during therehabilitation program was recordedas well.Admission and discharge evaluationmade by the multidisciplinary teamin the brain injury unit with goalsetting and goal achieved werecarefully reviewed in order to assessthe functional outcomes, and themeaningful concepts were linked tothe best ICF category and theassessment of punctuation followedthe recommendations showed ingraphic 1.

Graphic 1: Identification of concepts of the clinical records and linking to ICF categories

22 patients were admitted over the lastfive years but only 16 were engaged in arehabilitation programme.

Characteristics of patients

N=16

Age 38,75 years

Gender 62,5 (10) female

Time of admission atthe RHB unit sinceonset of thesymptoms

3,9 months

Medical complications at rehabilitation

Epilepsy 50%Paroxysmal SympatheticOveractivity 6.25%Bladder stones 6,25%

Length of stay 5 months

Discharge destination 81,25% home1 deceased

Rehab cycle Identified concept ICF linkage ICF code

Changes in personality Temperament and personality functions B126 Attention Attention B140 Memory Memory functions B144 Psychomotor retardation or excitement

Psychomotor control B1470

Affection Emotional functions B152 Problem solving Problem solving B1646 Dysarthria/anarthria Articulation functions B320 Dysphagia Swallowing B5105 Fecal incontinence Faecal continence B5253 Urinary continence Urinary continence B6202 Understanding spoken language Communication with spoken mesages D310 Understanding gestures, symbols or figures Comunnication with non verbal messages D315 Speaking Speaking D330 Communication with symbols Producing non verbal messages D335 Standing or sitting Changing and maintaining body possitions D410 Moving from one posstion to the other Transferreing oneself D420 Walking Walking D450 Using wheelchair Moving around using equipment D465 Bathing and showering Washing oneself D510 Care for body parts Caring for body parts D520 Use of toilet Toiletting D530 Dressing Dressing D540 Eating Eating D550 Interacting with people Basic Interactions D710

ICF category Description Admission Discharge Differenceb126 Temperament and personality functions* 62,5 50 0.026b140 Attention* 75 68,75 0,023b144 Memory functions* 75 68,75 0,023b1470 Psychomotor control 43,75 37,5 0,180b152 Emotional functions 31,25 25 0,102b1646 Problem solving* 87,5 75 0,014b320 Articulation functions 81,25 75 0.1b5105 Swallowing* 62,5 50 0,041b5253 Faecal continence 62,5 43,75 0,066b6202 Urinary functions 75 50 0,078d310 Communication with spoken messages 43,75 37,5 0,066d315 Communication with non verbal messages* 68,75 43,75 0,023d330 Speaking* 62,5 62,5 0,038d335 Producing non verbal messages 75 62,5 0,010d410 Changing and maintaining body position* 87,5 68,75 0,009d420 Transferring oneself* 87,5 75 0,008d450 Walking* 100 100 0,004d465 Moving around using equipment* 81,25 68,75 0,028d510 Washing oneself* 93,75 93,75 0,014d520 Caring for body parts* 93,75 81,25 0,038d530 Toiletting 81,25 75 0.1d540 Dressing* 93,75 81,25 0,010 d550 Eating* 87,5 75 0,026d710 Basic interactions* 100 93,75 0,005

The study showed that thegoals for rehabilitation werefocused in the areas of mental,digestive and genitourinaryfunctions as well as learning andapplying knowledge,communication, mobility andself care.

The most impaired areaswere those regarding mobility,activities of daily life, voice,memory, attention and problemsolving which were present inmore than 75% of the patients.Concerning to motoracquisitions, the best resultswere obtained in changing thebody position, transfers andmoving around usingequipment. All patientsremained with impossibility tohave an independent gait.Regarding self care, patientsexperienced an improvementcooperating with theircaregivers in dressing, eatingand caring for body parts.Urinary and faecal incontinencewere also improved.Mental functions improved inevery case; nevertheless theoverall results were poor andremained the main cause ofdependency on another person.None of the goals described inthe medical records mentionedenvironmental factors. Theseare external features that canhave an impact on theindividual´s performance actingas barriers or facilitators andrepresent the impact of thedisability in the individual.

FUNCTIONING AFTER INFECTIOUS ENCEPHALITIS IN THE LIGHT OF ICF

24 ICF categories were identifiedfrom the clinical records as seen in thefollowing table.

Functioning problems were describeat admission and at discharge.Statistically significative differences areshown with an asterisk (*).

DiscussionIntroduction

Methods & Materials

Discussion

This study showed that ICFcan be of help in describing thefunctional profile of patientsdespite the etiology. Aditionally,even though ICF is not a scale,can identify improvement areasafter a rehabilitationprogramme.

Introduction

Title

A diagnosis can not be considered as a single reason for disability assessment. Definition of measures of assistance for persons with disabilities is even more complicated process. In state assistance a common system is used to identify needs of persons with disabilities in measures of assistance, develop habilitation or rehabilitation programmes and evaluate results.The research aims at a practical approach to develop individual rehabilitation programme (IRP) based on the biopsychosocial model.

METHODOLODY OF DATA PROVIDING ON THE OPTIONS OF ICF-BASED REHABILITATION

ASSISTANCE

Abstract The research aims at a practical approach to develop individual rehabilitation programmes based on the ICF biopsychosocial model. Given approach allows to objectify condition of a person with disability from the perspectives of impairments of body functions, body structures, and activities and participation, to evaluate the potential needs in rehabilitation, define primary types of assistance and give recommendations to a specialist.


C540


Alexander Shoshmin, Natalia Lebedeva, Vladimir Shestakov, Yanina BesstrashnovaSt. Petersburg Scientific and Practical Center of Medical-Social Expertise, Prosthetics and

Rehabilitation of the Disabled named after G.A. Albrecht, St. Petersburg, Russia

Title

Methods & Materials

Now we have a dictionary that allows to view options of rehabilitation services and technical aids depending on body functions disorders and not tied to either nosologic units or a disabled person.After objectification of personal health conditions the suggested approach helps a specialist to get the appropriate rehabilitation services and technical aids and use the obtained list in the further work.This is the first version of the dictionary. It requires more content and refinement. Developing a directory of rehabilitation techniques, binding services to the national legislation, describing relationships between body functions and barriers and another research may be continued on its base.

Acknowledgements and Notes

Results

Various alternatives how to implement the ICF have been analyzed. We assume that while dealing with disabled persons we can affect elements of activities and participation. The following algorithm has been was developed as changes in body functions and structures are rare.A body function corresponds to a body structure leading to its change. We define elements of activities and participation that suffer from changes in this function and this structure. Then we can change severity of the elements of activities and participation by choosing special measures of assistance.Thus, there is a logical chain consisting of a body function, a body structure, an element of activities and participation and measures of assistance. The latter are divided into rehabilitation services and technical aids.The set of such chains imposed on the individual profile of a person with disabilities allows to develop an IRP.A specialized software product was created to input, accumulate and view chains. A group of experts from doctors and professionals on medical-social rehabilitation entered data. Initially the experts chose rehabilitation services and technical aids that affected a body nonspecifically and different elements of activities and participation as a whole. Then each element of activities and participation was associated with rehabilitation services and technical aids.

The main part of the research was performed in accordance with the terms of the contract with the Ministry of Health and Social Development of the Russian Federation within the framework of the state program "Accessible Environment" for 2011-2015. We thank the Company "SP.ARM" (St. Petersburg, Russia) for the implementation of our ideas in the form of software and to simplify the work of experts on entering and correcting data as well.

Their combination allows to define the best kinds of assistance for citizens in practice. Given approach permits state and objectify the severity of disability on the basis of the impairment of body functions and structures, describe typical kinds of assistance and define the needed amount of rehabilitation services and technical aids for rehabilitation when making the IRP. Further on, upon evaluation the results of the IRP implementation, relying on comparison of severity of impaired functions and structures, activities and participation of a person with disability before and after carrying out the rehabilitation measures and in dynamics one can evaluate the efficiency of rehabilitation of a person.Thus, the condition of a disabled person can be objectified both from the perspective of impairments of body functions and structures and from the perspective of activities and participation in life situations. Given approach allows to define primary types of assistance to integrate the person into environment. Codes obtained as a result of formalizing the condition of a disabled person can be used to record measures on a social card of a citizen electronically, to control the implementation of rehabilitation measures, to analyze the needs in various kinds of assistance and accordingly to plan a budget for different levels, development of rehabilitation industry etc.

Chart 1: Structure to define needs in rehabilitation measures and services.

Conclusions

The suggested methodology that exists in the form of the Codifier can be widely applied. Independent but logically connected classifiers contains urgent knowledge and approaches contain.

Introduction

Title

PERSON WITH DISABILITY CARD (CPD, ACRONYM IN SPANISH),0 – 17 YEAR AND 18 YEARS AND OVER

DEVELOPMENT OF ADMINISTRATIVE REGISTRATION IN MEXICO


C541

WHO – Family of International Classifications – Annual Meeting 2014

Avendaño-Badillo D., Galicia-Amor S., Lopez R. V., Valerio V. N., Velázquez L. R., et al. Mexican WHO FIC Collaborative Center, Mexico (CEMECE)

Title

Methodology and materials

Material and methods Development of test

SUMMARY Mexico does not count with a systematic registration of persons with disabilities, nor with a standardized data collectioninstrument for such purpose. Therefore an interdisciplinary group gathered and designed a Person with Disability Card in two versions: one foradults (2011) and another for persons aged 0 to 17 years (2014). Both instruments are based on the International Classification ofFunctioning, Disability and Health —Children and Youth version (ICF-CY, 2011). Adults’ instrument has been proved at a tertiary care level andchildren and adolescents’ version is to be evaluated later. At the instruments, the following sections are included: medical unit, identification ofdisabled person and respondent data, and the sociodemographic section consist of the health, education and work subjects. On the other hand,sections directly involved with the ICF are body functions and structures and activities, as well as participations and environmental factors.Instruments conclude with a diagnosis section and medical data. They also have their filling instructions and recommend that the applicationmust be by trained medical personnel in ICF.

In Mexico, the Law of the National System ofStatistical and Geographical Information(LSNIEG, acronym in Spanish) establishes theidentification of information needs where thetopic of disability is one of them. As part ofthe Law, the Technical Specialized SectorialCommittee in Health (CTESS, acronym inSpanish) is the body in charge of developingactions to strengthen the National System ofInformation in Health. A working group ondisability formed within the CTESS, preparedan instrument based on the ICF for disabilityregistry, which is known as the Person withDisability Card (CPD, acronym in Spanish).

On having proved the instrument at thetertiary level of attention, it was considerednot sensitive for population between 0 to 17years. Therefore, the following step was todesign a specific instrument for this group ofage, based on the International Classificationof Functioning, Disability and Health —Children and Youth version (ICF-CY). Thechildren and youth version instrument has notbeen proved yet, but both have been designedto create an administrative record ofpopulation for the Health Sector, that will allowobtaining information to address problems ofattention and prevention of disablingconditions for this sector as well as others onthe subject of disability.

Development of the Person with Disability Card for Children and Youth

The Person with Disability Card for Children and Youth, has four large sections and eleven parts:

1. Identification dataMedical unitIdentification of disabled personRespondent data

2. Sociodemographic informationHealth Education Work

3. ICF componentsFunctions and body structures Activities and participation Environmental factors

4. Medical diagnosis Diagnosis (ICD 10, start and origin) Information from doctor

The Person with Disability Card (CPD,acronym in Spanish) is a usefulinstrument offering a wide set ofinformation about conditions andcharacteristics of persons coming tohealth institutions due to certain illness,problem or injury that could causereduction in their functioning andrestriction in his/her participation.

Mexico still presents lags in this topicand moreover in the integration ofqualifier groups to certify disabilities.Nevertheless these data collectioninstruments (cards) prepared by theinterdisciplinary group, agree with therecommendations to obtain informationof persons with disability, from a moreintegral perspective and not onlymedical. By achieving itsimplementation in the whole HealthSector, the first administrative record ofpopulation evaluated from the ICF-CYwould be obtained, in addition of havingthe information to be used for thedefinition of policies and public actionsin any area, taking advantage of therecommendations from the Conventionon the Rights of Persons with Disability.

For the Health Sector it turns into arecord that will serve to guide researchand to conduct public policies in favor ofhealth needs of persons with disabilities.

Data collection instruments werechecked by PHO/WHO regional adviserswho made comments to the instrumentswhich were included in this version.

Body functions

Body structures

d315

d410

d415

d530

d550

d880

Activity/Participation (added)

Environmental factors

Conclusions

1. Conceptual developmentInstruments (cards) Manuals

2. Application of Test Doctors and institutions (applicators)Unit of observation (children and adolescents in focal groups)TrainingApplicationTreatment of informationReport of evaluation

3. Modifications to the CPD (acronym in Spanish) for 0 to 17 years

Final version of instrument and manuals

Focal groups

The purpose of application in focalgroups, is to obtain quality and detailedinformation of each population group (0to 2; 3 to 5; 6 to 11 and 12 to 17 years)by type of impairment (walking, seeing,moving, learning, hearing, self-care,speaking and mental), which will allowto assess the sensitivity of theinstrument and the quality of theinformation for every target group. Thisis considered a fundamental aspect toguide policies and strategies for theprevention and integral attention ofdisability in the child and adolescentpopulation.

Card testing phase

Changes in relation to adults’ Card:

In the part of Education, a section relative to Child-care facility, day care section, was added for population from 0 to 6 years.

In the part of Work, the section Cause for he/she works is included, for persons from 5 to 17 years.

C601-610

ICHI


C601 A Content Model for Health Interventions: Integrating ICHI Alpha and CPT

Tu; Csongor; Tierney; Syed

C602 Development of ICHI Alpha2-Updated Zaiss; Hanser; Cumerlato; B

C603 Using the National Classification of Interventions for Social care in Sweden

Almborg; Bratt; Hammerin

C604 Public health interventions in WHO’s International Classification of Health Interventions

Fortune; Bond; Riley; Madd

C605 The development of Functioning Interventions–“updated” ICHI Alpha2

Almborg; Salvador-Carulla;

C606 Nursing-relevant content in WHO’s International Classification of Health Interventions

Fortune; Hardiker; Jansen;

C607 Mapping a preliminary taxonomy on case management of brain injury to ICHI

Lukersmith; Fernandez; Mi

C608 ICHI UNUCBG International Casemix Grouper feasibility test on Casemix Data in National University of Malaysia Hospital

Aljunid; Rodrigues; Best; A

C609 USE OF THE INTERNATIONAL CLASSIFICATION DESDE-LTC FOR MONITORING THE SOCIAL CARE SYSTEM IN ANDALUCIA (SPAIN)

Alonso-Trujillo; Gutiérrez-C Carulla

C610 Implementation of an international taxonomy of care services: DESDE-LTC

Salvador-Carulla; Ruiz; Fern

Introduction

Title

A “Content Model” is part of the WHO architecture for developing and maintaining international classifications. It defines the types of entities specified in the classification (e.g., diseases, disorders, and injuries in ICD-11 and health interventions in ICHI), the parameters that describe different aspects of the main entities (e.g., definitions, inclusions, and exclusions for all classifications; severity for ICD-11 diseases; and actions for ICHI interventions), and value sets for the parameters (e.g., the severity scales in ICD-11 and the hierarchy of actions in ICHI). The Content Model defines rules for composing new entities from existing entities, the available parameters, and value sets.

In 2014, WHO, AMA, and the Stanford University WHO Collaborating Center began development of a new Content Model for health interventions that would integrate extant work on ICHI and AMA’s CPT. The model would be the basis for a collaborative authoring tool similar to the iCAT tool for ICD-11.

A Content Model for Health Interventions

Abstract For the ICD 11 revision, the World Health Organization (WHO) developed a methodology for creating classifications based on a “Content Model,” which defines the properties of an entity in a classification and drives the development of tools for editing or reviewing these classifications. The Stanford University Collaborating Center, in conjunction with the WHO and the American Medical Association (AMA), has led the development of a prototype Content Model for health interventions. This Content Model integrates and reformulates the Action–Means–Target axes of the proposed International Classification of Health Interventions (ICHI) and the code properties and characteristics of the AMA’sCurrent Procedural Terminology (CPT) into a coherent information model and ontological structure.


C601


S.W. Tu1, C. Nyulas1, M. Tierney1, A. Syed2, R. Musacchio2, T.B. Üstün3, M.A. Musen1

1Stanford University WHO Collaborating Center, Stanford, CA USA2American Medical Association, Chicago, IL USA

3World Health Organization, Geneva, Switzerland

Title

Methods & Materials

The prototype Content Model, represented as a Web Ontology Language (OWL) ontology, defines three types of parameters:

(1)WHO-FIC core parameters that are shared by all WHO-FIC classifications (such as titles, definitions, inclusions, and exclusions)

(2)Classification-specific descriptive parameters that are not inherited by more specialized categories (such as CPT descriptors)

(3)Structural parameters (such as action and approach) that can be used to perform queries along different axes and to post-coordinate new concepts.

The prototype Content Model disaggregated ICHI’s Means axis into specific parameters that may be used simultaneously to define a health intervention (e.g., “Manually assisted delivery” may have an “external” approach and a “manual” technique). The model specifies optional parameters, such as entities added, removed, or used in a health inter-vention, to clarify the roles that a device, substance, or tissue may play.

The prototype model contains 17 structural parameters (Figure 1), some of which have sub-parameters (e.g., hasTarget subsumes hasEntityTarget and hasFunctionBehaviorTarget) and 25 descriptive parameters imported from CPT.

Acknowledgments

Results

We used as source materials ICHI Alpha and AMA’s Developer Tool Kit (DTK) representation of CPT. We closely analysed properties and axes for procedures and interventions defined in ICHI Alpha and DTK to proposed a set of Content Model parameters that align those defined in the two sources and refactor them when appropriate.

We performed an initial validation of the prototype Content Model at a joint meeting of ICHI developers and AMA subject-matter experts, where we analyzed and represented in the format of the prototype Content Model a collection of exemplar interventions selected from both ICHI and CPT.

At Stanford, a physician modeled 79 interventions from the exemplar collection. The Stanford team reviewed and analyzed his work.

We would like to thank the collaboration of the ICHI Alpha developers (led by Richard Madden) and the AMA team that worked on this project. Special thanks to Dr.Jeffrey Ketchersid. We are grateful for the generous support of Ms. Marilyn Allen and the Council of Colleges of Acupuncture and Oriental Medicine.

The initial validation exercises helped us to refine and clarify the model and demonstrated that the distinctions made in the prototype model are fundamentally sound.

Analysis of the source materials and of the exemplars suggests that the Content Model for health interventions requires features that are not in the ICD-11 Content Model. For example, to generate CPT as a linearization of the ICHI Foundation Component requires that the Content Model specify parameters whose values should be part of the linearization. Logical conjunction, disjunction, and negation of parameter values are necessary to disambiguate multiple values for a parameter. Value sets to specify intervention parameter values, such as anatomic sites, need to be reconciled with similar value sets in ICD-11. It would be very desirable to be able to specify default values for the parameters and to infer some values from properties of other parameters (e.g., entities used in a procedure may be inferred from entities associated with a technique). These extensions will require considerable modification of the existing iCAT software.

Much remains to be done to make the prototype Content Model usable. The value sets of the parameters require further specification. Guidelines are needed to suggest the necessary granularities of interventions and parameter values. For different types of interventions, we need to describe the parameters that are mandatory, optional, or never used. Above all, we need to articulate use cases that help to constrain the scope of the project and to demonstrate the utility of this Content Model for health interventions.

Figure 1: The structural parameters of the Content Model for Health Interventions

Discussion

Introduction

Title

Development of ICHI Alpha2 - updated

Abstract

Since the 2013 Annual WHO-FIC Meeting, held in Beijing, work has continued to progress on finalising content for the International Classification of Health Interventions (ICHI). The Medical and Surgical and the Functioning Technical Working Groups (TWGs), together with other members working on the areas of public health and nursing-related interventions, have been progressively updating ICHI content and structure.

This work has continued to be facilitated by a number of face-to-face meetings and teleconferences.

This poster will highlight recent work on ICHI content development across medical and surgical, functioning and public health interventions, expansion and refinement of the axes, development of extension codes, and the continued work on coding and editorial rules.


C602


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

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

Title

Methods & Materials

First versions of the ICHI axes for targets, actions and means were published in 2008 and still constitute the base of the current axes system. During the further development of the classification, a growing number of items (values) for the three axes led to difficulties maintaining the axes and limited a use of the axis codes for ordering the interventions in the Tabular list of interventions. In addition, the discussion on the adequate presentation of the different types of interventions – acute care, mental health, physiotherapy, nursing etc. led to the decision not to split these diagnostic and therapeutic interventions artificially but to integrate the functioning targets to the respective body sites.

The values of all three axes have been reordered by assigning new codes which are appropriate for grouping and producing data subsets: Interventions on a body site e.g. (the ear, “C” targets), on a body part (e.g. inner ear, “CB” targets) or function (e.g. “CT” targets –hearing), actions of “taking out” something from the body: from drainage over excising to amputation, all action codes starting with “J”. The means subsets are approaches, techniques as radiation or heat, facilitators as animals, methods as “interview” and samples. Using the newly implemented target groups, the tabular list presents the interventions with an additional level of hierarchy: there are subchapters for body parts and for types of activity.

Much work was done on the revision of the textual descriptions (titles, definitions, in- and exclusions ), spelling and punctuation, a review of the exclusions and similar work for a unambiguous and consistent result.

Results

Conclusions

ICHI Alpha 2 updated is a still growing collection of Health interventions based on a system of now extensively stable axes contents in an improved ordering.Next steps of the work should include the implementation of a web tool for the maintenance of the terminological system as well as field tests to evaluate and improve the content by potential users.

Content development for the International Classification of Health Interventions (ICHI) has continued to progress during2013-2014. The current classification contains 5648 interventions across medical, surgical, functioning and otherenvironmental and health behaviour areas. This poster describes the refinements made to the ICHI axes and content.

ICHI Alpha 2 updated consists in tables for Targets (n=633), Actions (n=131) and Means (=59) and a Tabular List of Interventions in three sections1. Interventions on Body Systems and Functions (n=4346) in 12 Chapters2. Interventions on Activities and Participation Domains (n=707)3. Interventions to Improve the Environment and Health Behaviour (n=595)

Introduction

Title

In Swedish social care each municipality uses its local terms and descriptions of activities, which can lead to misunderstandings when infor-mation is to be shared between professions and operational areas. The lack of uniformity also limits the quality of the data used in evidence-based practices and in reporting to regional and national statistics.

The aim is to develop a national classification of interventions for social care that is based on the ICHI-structure with the three axes (targets, actions and means). The classification can be used by the social care and national authorities to take part of the benefits of a clear and uniform descrip-tion of social interventions used in the Swedish social care.

More clear and uniform descriptions of the activities used within social care will improve the quality and comparability of:• local documentation • transfer of information to local

operations• evaluation on local or regional levels• the basis for national statistics• the development of evidence-based

practices

The target group of the classification is professionals, representatives of the social care sector, business developers and people responsible for develop-ment and (national authorities) monitoring on a national level.

Development 2013-2014The first KSI Alpha version (2013) includes 443 supportive interventions. Then 367 investigative interventions were added to the next version.

About 200 professionals of social care have been involved in the development of KSI.

Social care in Sweden use investigative and supportive activities instead of diagnostic and therapeutic interventions.

Using the National Classification of Interventions for Social care in Sweden

Abstract The National Board of Health and Welfare in Sweden is developing a national classification of interventions in social care (KSI), commissioned by the Swedish government. The KSI is based on the ICHI-structure with the three axes (targets, actions and means). The result so far is a Beta2 version of KSI, including about 900 interventions. The next step in the development process is to secure the quality of the Beta2 version by workshops with professionals, experts and different case tests. The tests include using the activities in the various steps of the social care process, for example the planned and performed activities. Also which activities the social workers have made a formal decision on.


C603


Almborg A.H.1,2, Bratt M.1, Hammerin A.1, Berg L.21 National Board of Health and Welfare, Sweden2 Nordic WHO-FIC Collaborating Centre, Norway

Title

Results

Conclusions

Swedish social care professionals have expressed that they may get benefits in future use of KSI in their electronic documentation such as:

• Provide clarity

• Increase legal security

• Facilitate cooperation

• Possibility to evaluate at local and national level

• Make activities more concrete

They have also expressed that there is a learning challenge in incorporating KSI and electronic documentation in the work environment. One reason is that there is not a broad tradition in using classifications in the Swedish social care even if ICF is used to some extent.

The on-going step in the development process is to secure the quality of the KSI Beta2 version with workshops inviting professionals and experts and also different case and quality tests. The tests include using the activities in the various steps (see figure) in the social care process such as planned and performed activities, but also which activities the social workers have made a formal decision on.

Targets number

Activities & participation 68

Body functions 7

Environmental factors 26

Behaviours 16

Interventions number

A B

Interventions on activities & participation 269 347

Interventions on body functions 9 21

Interventions on environmental factors 79 66

Interventions on behaviours 55 49

InterventionsThe result so far (in the autumn of 2014) is a KSI Beta2 version, including 895 interventions, (412 investigative activities [A] and 483 supportive activities [B]) which are distributed as follows:

1. Investigate and assess - to plan and conduct investigative activities (KSI) in order to gather information and evaluate the person´s health, functioning (ICF), environment (ICF) or behaviours and assess the need for activities in relation to the goal (ICF). 2. Decide - to make a formal decision on the supportive activities (KSI)3. Plan for execution - form an assignment for clients on the suppor-tive activities (KSI) to be carried out.4. Perform assignment - to develop a social care plan, that includes supportive activities (KSI) 5. Follow-up –by using the investigate activities (KSI) to achieve results (ICF) and goal-achievement.6. Finish activities (KSI)

The axes The result so far is 117 targets and 17 actions for the KSI Beta2version 2014.

TargetsThe final count of targets is 117distributed as follows:

Quality of KSI Beta 2

The activities and participation, body functions and environmental factors can be used at different levels such as chapters, blocks and 2nd, 3rd and 4th

level of the ICF.

ActionsThe final count of actions is 17, distributed between six investigative (diagnostic), and eleven supportive (therapeutic) actions.

Title

Public health interventions in WHO’s International Classification

of Health Interventions

Abstract The WHO’s International Classification of Health Interventions (ICHI) spans all sectors of the healthsystem, including public health interventions delivered to populations. The classification of public healthinterventions in ICHI can be used at international level (e.g., comparing the public health systems of

different countries in terms of types of interventions delivered), national level (e.g., expenditure data—describing the outputs to which public health funding is allocated), and local/organisation level (e.g., recording and reporting interventions delivered; comparing practice between regions and over time). This poster provides an overview of the updated list of public health interventions in ICHI, and illustrates the use of ICHI in describing public health interventions delivered in Victoria, Australia.


C604


Nicola Fortune1, Lyndal Bond2, Therese Riley2, Richard Madden11National Centre for Classification in Health, University of Sydney, 2Centre of Excellence in Intervention and Prevention Science, Melbourne

Title

Public health interventions in ICHI are

interventions delivered to populations; they target health behaviours or environmental factors. The classification aims to provide an international standard for collecting, reporting and analysing data on population-level prevention and health promotion activities. Among other uses, it will provide a consistent basis for describing interventions delivered at population level as part of the WHO’s Universal Health Coverage initiative.

Public health practitioners andresearchers were

consulted to gather feedback on the comprehensiveness of the draft list of public health interventions in ICHI, and the Target, Action and Means categories used to describe them. The list was further expanded and refined in response to the comments received.A preliminary pilot test of the revised list was undertaken by using it to describe three public health interventions delivered in Victoria, Australia.

Introduction

Abstract

Table 1: Use of ICHI to describe public health interventions delivered in Victoria, Australia

Methods

The Infant Program www.infantprogram.orgHealthy by Design www.heartfoundation.org.au/driving-change/current-campaigns/local-campaignsHealthy food connect www.health.vic.gov.au/prevention/initiatives/healthy-food-connect.htm

There are 356 public health intervention codes in the2014 version of ICHI, an increase from 193 in the 2013version. Some of these codes may also be used forinterventions delivered to individuals—for example,

‘Assessment of tobacco use’ may be used to describe an intervention delivered to an individual or to a population. An extension code can be used to signify the intervention recipient (e.g., individual, community, population).

Changes to the list allow the classification to better describe the full breadth of contemporary public health practice, including:

Interventions focused on building community capacity (e.g., ‘Capacity building interventions targeting healthy eating’)

Interventions targeting aspects of the social environment (e.g., ‘Enactment of legislation or regulations targeting the social environment, Incl. Anti-discrimination legislation’)

Interventions targeting aspects of the built environment (e.g., ‘Public facilities/infrastructure development to improve aspects of the built environment including housing’)

Cross-sectoral public health work (e.g., ‘Advocacy concerning health-related issues directed towards services, systems and policies’).

The revised list performed well in describing ‘real life’ interventions (Table 1). The exercise raised some discussion points, including:How many ICHI intervention codes should be used to describe a public

health program? Because public health programs often comprise multiple components more than one ICHI code may be needed.

How might the Means axis be expanded to make important distinctions between different ways of delivering public health interventions?

These issues and others will be further explored through an expanded program of pilot testing, and coding guidance will be developed to ensure a consistent approach among users of the classification.

Results and discussion

Intervention Description ICHI intervention codes

The Infant Program A six session program delivered

to parents of young infants that

aims to promote healthy eating

and active play in parents and

their children

Education about diet by providing instructional materials

(Target = ‘Diet’)

Education about physical activity by providing instructional materials

(Target = ‘Physical activity’)

Healthy by Design An urban planning resource

intended to help planners design

environments that encourage

active living

Public facilities/infrastructure development to

promote physical activity

(Target = ‘Physical activity’)

Healthy Food Connect An initiative aimed at changing

local food systems—supply and

access

Public facilities/infrastructure development to

improve availability of or access to food

(Target = ‘Food safety and security’)

Introduction

Title

The International Classification of Health Interventions (ICHI) is the third WHO reference classification, and among its scope is to provide a frame-work systematically describing health interventions to allow comparison in provision of health interventions, assist in the development of health policies, contribute to evaluation of healtheffectiveness.

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 Alpha 2 version of ICHI functioning included 1490 interventions.

Development of functioninginterventions-ICHI Alpha2 Updated 2014

Abstract Since the Annual WHO-FIC meeting in Beijing 2013 the development of International Classification of Health Interventions (ICHI) functioning interventions has continued. The Functioning Technical Working Group (FTWG) sent out requests to review ICHI Alpha2 to members and collaborators of the Functioning and Disability Reference Group (FDRG) and other relevant stakeholders and potential users in the fourth quarter of 2013. In the first half of 2014 the FTWG has reviewed the comments, updated the content of the axes, expanded and rationalized the functioning interventions, developed extension codes and revised the coding and editorial rules.


C605


Almborg A.H.1,4, Cumerlato M.2, Salvador-Carulla L.2, Sykes C.3, Berg L.4, Madden R.2, Martinuzzi A.5.1 National Board of Health and Welfare, Sweden2 University of Sydney, Australia 3 World Confederation for Physical Therapy, United Kingdom4 Nordic WHO-FIC Collaborating Centre, Norway5 E. Medea Institute, Research Branch of the Italian CC, Italy

Title

Development 2013-2014

The results are 633 targets, 131 actions and 59 means for the whole ICHI Alpha2 Updated 2014.

TargetsFinal count of targets is 633 distributedas 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.

ActionsAction codes were enriched to approp-riately capture the peculiar nature of actions performed in the functioning field. Some of the definitions of the actions in ICHI Alpha 2 have been revised to receive a clearer distinction between the actions.

Final count of actions is 131. The actions are distributed as following:

MeansSome means have been added. Final count for means is 60 at approach, techniques, method and sample.

During a recent review and restructure of the axes the above figures may slightly change and are described in the Development of ICHI Alpha2 Updated 2014 poster.


Results

The Functioning Technical Working Group (FTWG) sent out requests to review ICHI Alpha2 to members and collaborators of the Functioning and Disability Reference Group (FDRG) and other relevant stakeholders and potential users in the fourth quarter of 2013. Comments received were discussed during a special meeting held in Freiburg, Germany in January 2014 and contributed in the further development of ICHI.

The FTWG has held a number of tele-conferences and face-to-face meetings to continue the content development for ICHI Alpha2 Updated 2014 according the Working plan.

The tasks have been prioritized to update the content of the axes, of extension codes. The list of interventions has expanded to cover the needs of interventions for diagnostic and therapeutic purposes.

Conclusions

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

The ICHI Alpha 2 Updated 2014 version of ICHI functioning originally included 1490 interventions and has now expanded to ≈1790 interventions. The project now is ready to move into a new phase of realization, with the WHO leadership and the participation of supporting stakeholders.

InterventionsThe ICHI Alpha2 Updated 2014 includes ≈1790 functioning interventions, which are distributed as follows:

Targets number

Anatomy 313

Body functions 109

Activities & participation 111

Environmental factors 77

Behaviours 23

Actions number

Diagnostic 16

Therapeutic 77

Managing 13

Preventing 25

Interventions number

Interventions on anatomical part ≈141

Interventions on body functions ≈347

Interventions on activities & participation 707

Interventions on environmental factors 288

Interventions on behaviours 307

The more the granularity and richness of the functioning interventions grows the more the connections with other classifications (such as nursing interventions) becomes apparent.

Similarly the overlap between functioning and medical & surgical interventions, especially in the area of assessment, facilitates the merging of the two sections and ordering the interventions according to body (target) systems.

Title

Nursing-relevant content in ICHI

Abstract It has been agreed from the outset that the WHO’s International Classification of Health Interventions(ICHI) will encompass all sectors of the health system. Nursing is a crucial component of health systems globally. Nursing interventions are provided in many different settings—hospitals, clinics,

physician practices, community health centres and people’s homes—and they are delivered in a broad range of health care contexts—acute care, rehabilitation, palliative care, primary care and public health.Members of the International Council of Nurses (ICN) and the ICHI development team have worked cooperatively to improve coverage of nursing-relevant interventions in ICHI. In this poster we use data for a region in the north of Portugal to show how ICHI may be used to describe commonly reported nursing interventions, and suggest how nursing-relevant interventions in ICHI could contribute to the development of indicators for monitoring the WHO’s Universal Health Coverage initiative.


C606


Nicola Fortune1, Nicholas R Hardiker2, Claudia C Bartz2, Kay Jansen2, Paulino de Sousa3, Richard Madden1

1National Centre for Classification in Health, University of Sydney, Australia, 2International Council of Nurses, 3Nursing College of Porto, Portugal

Title

67 new nursing-relevant interventions have beenincorporated into ICHI. In many instances two or more ICNP interventions map to a single ICHI intervention, indicating that ICNP tends to provide a more granular

description of nursing interventions than ICHI. New interventions include:Managing enteral feedingGenetic counsellingManaging painMeasuring fluid intake

Seven new ICHI Target categories have also been added:Functions related to fertilityFunctions related to pregnancyParent-child relationships Growth maintenance functionsUsing ICNP as a starting point to identify and expand nursing-relevant content in ICHI has been useful and productive. Box 1 shows how ICHI may be used to describe commonly reported nursing interventions, using ICNP-based data from hospitals in northern Portugal.

Nurses are central to the success of the WHO’s UHC initiative. A key use case for ICHI is to describe health interventions within the context of UHC. Box 2 provides examples of nursing-relevant interventions in ICHI that are applicable to the development of indicators for monitoring UHC, based on a proposed set of ‘tracer’ indicators published by WHO in May 2014.

Pilot testing in a range of contexts will help inform further refinement of nursing-relevant content in ICHI.

The ‘Alpha2’ versionof ICHI was released in October

2013. It included good coverage of medical and surgical interventions, interventions targeting body functions, and public health interventions. Independently, nursing interventions had been developed within the International Classification for Nursing Practice (ICNP), which became a WHO-FIC related classification in 2008. The ICN and the ICHI development team agreed to seek to align interventions in ICHI and ICNP. Mapping of ICNP interventions to ICHI has led to the addition of new interventions in ICHI.

ICNP interventions were mapped by identifying matching

interventions in ICHI. Members of the ICN provided advice as to whether ICNP interventions were conceptually equivalent or represented a subclass (more detailed concept) or superclass(broader concept) in relation to the ICHI intervention to which they were mapped. Each intervention in ICHI is described in terms of three axes—Target, Action and Means—with each axis comprising a list of descriptive categories. Where no matching ICHI intervention could be found for an ICNP intervention, relevant axis categories were identified, and new interventions were proposed for ICHI on this basis. In several instances no appropriate ICHI Target could be found, and so new Target categories were proposed for consideration by the ICHI development team.Subsequent work has involved testing nursing-relevant content in ICHI to describe ICNP-encoded clinical data, and exploring the potential use of nursing-relevant interventions in ICHI for monitoring the WHO’s Universal Health Coverage (UHC) initiative.

WHO and World Bank 2014. Monitoring progress towards universal health coverage at country and global levels. Framework, measures and targets.

Results and Discussion

Methods

Introduction

Education about medicationService planningPractical support with breastfeedingFertility counseling

Artificial body structure: Other stomaGenomeWhole person

Reference

Abstract

ICNP intervention ICHI intervention

Monitoring heart rate (4.0% of total) •Cardiac monitoring

Monitoring blood pressure (3.8%) •Blood pressure monitoring

Environmental safety management (3.7%) •Managing or adapting natural environment and human‐

made changes to environment

Assessing pain (3.7%) •Assessment of pain

Monitoring body temperature (3.6%) •Monitoring of body temparature

Motivating patient for self turning (3.5%) •Emotional support for changing body position

Monitoring blood oxygen saturation (2.6%) •Monitoring blood properties

Maintaining bed rail (2.4%) •Managing or adapting natural environment and human‐

made changes to environment

Positioning patient (2.4%) •Positioning of the body

Monitoring blood glucose (1.9%) •Monitoring blood properties

Box 1: Top 10 nursing interventions delivered in Hospitals, Matosinhos, Portugal, Sept 2012 – Aug 2013 (total = 6,838,355)

UHC indicator (WHO & World Bank 2014) ICHI intervention

Satisfaction of family planning needs Fertility management; Fertility advice; Fertility counselling

At least four antenatal care visits Antenatal or postnatal care

Measles vaccination in children Other immunisation, not elsewhere classified (+ ICD code)

Antiretroviral therapy Oral pharmacotherapy (+ ICD code)

Tuberculosis case detection Health screening, not elsewhere classified (+ ICD code)

Box 2: ICHI interventions relevant to monitoring Universal Health Coverage

Introduction

Title

Case management makes a unique contribution towards the improved functioning and participation of a person with a complex health condition such as brain injury. Community-based case management has multiple components and variations, depending on the context in which it occurs and the client population. The description of case management and the components in the literature is highly variable. The need for language and clarity about what is, and is not case management was the impetus for the development of a preliminary taxonomy on case management for persons with brain injury and spinal cord injury. A component of the feasibility analysis of the beta version of the taxonomy is mapping to ICHI

Mapping a preliminary taxonomy to ICHI


C607


Lukersmith, S.1,2, Fernandez, A1, Millington, M1.,Brain injury case management nominal group2, Salvador-Carulla, L1

1. University of Sydney, Australia 2. Lifetime Care & Support Authority, Australia

Title

Methods & Materials

Results

The brain injury case management preliminary taxonomy (BICM-PT) developed in four phases.

Phase 1A systematic search and review of the case management literature to extract information on the components, activities and descriptors of case management.

Phase 2A critical review of appropriate frameworks to inform the structure of the taxonomy.

Phase 3The iterative development and refinement of the draft taxonomy using consensus with a nominal group of experts in case management.

Phase 4 Mapping the actions, main actions and related actions of the draft taxonomy to ICHI to identify the alignment and gaps and submission of proposed inclusions to ICHI

Conclusions

The ‘in kind’ support provided by Lifetime Care & Support Authority is gratefully acknowledged.

It has not been possible to map all actions and components of case management to ICHI Alpha 2 (including the February amendments). There is alignment of the BICM-PT beta 2 version with ICHI for some actions, but there are differences in the grouping of actions as well as gaps in ICHI.

Proposed new actions Coordination ‘Navigating and facilitating the access, management and

cohesion of services and supports for the client’Planning ‘Support the client to develop their individualised plan

including setting client goals and priorities, actions, responsibilities to achieve the goals and identify the supports needed (services and resources)’. Includes: Managing risks - (taken by the client) weighing up the potential benefits and likelihood of something happening, the impact or harms, respecting and supporting client choice and recognising acceptable risk is part of everyday life, for the development of strategies to manage unacceptable risks

Inclusion to actions Emotional & motivational support

Inclusion: engaging and building a partnership between the client and service provider

Inclusions to titlesTraining Training and skill development Emotional support

Emotional and motivational support

Following Phase 1 and 2 the BICM-PT beta 1 was developed which involved 12 actions and more than 50 components. The nominal group1

formed to develop and refine the beta 1 version through iterative development and consensus. The group included multi-disciplinary expert case managers who work with children and adults in both urban and regional areas in different service contexts. The group refined the taxonomy which included 13 actions and 37 components.

Following the mapping to ICHI (Phase 4), the taxonomy was further refined (BICM-PT beta 2) as a derived classification from ICHI with 9 actions and 25 components (Table 1).

The proposed inclusions for ICHI outlined in Table 2 were forwarded in June 2014.

There was alignment with the revised ICHI action definitions2 and BICM-PT: • Preparation, Education and

Monitoring as separate actions • The revised definition of Training• Revised title from counselling to

Advising • Revised title from personal support

to Emotional support• The changes to Client support

action• Task performed by another and

practical support

Abstract Case management makes a unique contribution towards improved functioning and participation for persons with complex health conditions. The need for a common language and clarity about what is, and what is not case management was the impetus for the development of a preliminary taxonomy on case management in brain injury. The taxonomy was iteratively developed in four phases with mapping to ICHI in the final phase. There is alignment of the taxonomy with ICHI for some actions, but there are differences in the grouping of actions, as well as gaps in ICHI. Proposed inclusions to ICHI are identified.

1. Salvador-Carulla L, Walsh CO, Alonso F, Gómez R, de Teresa C, Cabo-Soler JR, Cano A, Ruiz M. eVITAL: a preliminary taxonomy and electronic toolkit of health-related habits and lifestyle. Scientific World Journal. 2012;2012:379752.

2. ICHI Alpha 3 revised definitions (31 March -22 April 2014; Nicola Fortune and Ann-Helene Almborg, Megan Cumerlato, Lindy Best

1. Engage with the client

2. Holistic assessment

3. Planning

4. Education 5. Training & skills development

6. Emotional & motivational support

7. Advising 8. Coordination 9. Monitoring

Table 1 The main actions in the BICM-PT taxonomy tree

References

Acknowledgments

Table 2 Proposed inclusions to ICHI

Abstract UNU-CBG International Casemix grouper uses ICD 10 for diagnosis coding and ICD-9-CM for procedure coding. As part of theongoing efforts by WHO to develop its own procedure classification system, the research team has come up with the revised version ofInternational Classification of Health Interventions (ICHI). In preparation to replace the ICD-9-CM in the UNU-CBG grouper, a coordinatedeffort was carried out to map all the ICD-9-CM procedure codes with the newly developed ICHI codes. This research presents the results ofthe grouping the data from the National University of Malaysia Hospital using UNU-CBG grouper with newly developed ICHI codes. 3,851ICD-9-CM codes were mapped with the newly developed ICHI codes. 91% of the cases (n=31,703) have the same CBG before and afterthe ICD 9 CM codes are changed with ICHI codes.

Introduction

Title

UNU-Case-based Group software is the firstinternational casemix system launched byUnited Nations University-InternationalInstitute for Global Health (UNU IIGH) andInternational Centre for Casemix and ClinicalCoding (ITCC) at National University ofMalaysia. The UNU-CBG casemix system hasbeen introduced in twenty developingcountries since its launch in 2007. TheCasemix grouper software is used to createcasemix groups for acute, sub-acute andchronic cases managed in inpatient oroutpatient care. In addition to this, thegrouper provides the option to create specialgroups for costly procedures, investigations,drugs and prosthesis. Originally the grouperuses ICD-10 for diagnoses and ICD-9-CM forprocedure codes. In preparation to replacethe ICD-9-CM in the UNU-CBG grouper, acoordinated effort was carried out to map allthe ICD-9-CM procedure codes with thenewly developed ICHI codes. There are atotal of 4,578 ICD-9-CM codes available inthe original UNU-CBG grouper. Out of theseavailable codes, 3,851 (84%) ICD-9CMcodes are used in the UNU-CBG grouper forassignment of casemix groups. These 3,851ICD-9-CM codes were mapped with thenewly developed ICHI codes.

ICHI UNU-CBG International Casemix Grouper feasibility test on Casemix Data in National University of Malaysia

Hospital


C608


Authors: Syed M. Aljunid1, Jean Marie Rodrigues2, Linda Best3, Zafar Ahmed1, Hasrul Reeza Mustaffa1 , Syed M. HamzahAljunid1 , Sukil Kim4.

1.International Centre for Casemix and Clinical Coding, National University of Malaysia 2.INSERM U 1142 LIMICS Upmc and University Jean Monnet, France

3.University Of Sydney, Australia4.Catholic University of Korea, Korea

Title

Methods & MaterialsThe comparison Output 1 and Output 2shows that out of total 34,978 patients levelrecord grouped 31,703 (91%) of thepatients has the same Case Base Group(CBG) assignment in both the output. Theremaining 3,275 (9%) of patients hasdifferent CBG assignment in Output 2 ascompare to Output 1. This is shown inFigure 2.

Acknowledgements

Results

Results

We acknowledge the Casemix Unit,Department of Health Informatics NationalUniversity of Malaysia Hospital for providingus with the patient level data to test thetwo different versions of UNU IIGH groupersoftware.

Figure 1: The percentage of ICD-9-CMcodes mapped to ICHI codes

Mapped99%

Unmapped1%

Figure 2: The percentage of same CBGbetween Output1 and Output2

Conclusion

Mapping of procedures codes currentlygrouped in ICD9-CM is required in futurewhen ICHI is used as the standard forprocedure classification. This studydemonstrated the success of developing apractical and robust mapping table betweenthe existing ICD-9CM procedure codes andnewly developed ICHI codes within theexisting interface of UNU-CBG groupersoftware.

Casemix Major Group (CMG) FREQUENCY

A - Infectious & parasitic diseases 0

B - Hepatobiliary & pancreatic system 1

C - Myeloproliferative system & neoplasms 0

D - Haemopoeitic & immune system 0

E - Endocrine system, nutrition & metabolism 9

F - Mental Health and Behavioral 0

G - Central nervous system 145

H - Eye and Adnexa 4

I - Cardiovascular system 231

J - Respiratory system 16

K - Digestive system 415

L - Skin, subcutaneous tissue & breast 4

M - Musculoskeletal system & connective tissue 176

N - Nephro-urinary system 136

O - Delivery 1716

P - Newborns & Neonates 0

S - Injuries, poisonings & toxic effects of drugs 0

T - Substance abuse & dependence 0

U - Ear, nose, mouth & throat 5

V - Male reproductive system 3

W - Female reproductive system 414

X - Errors CMGs 0Z - Factors influencing health status & other contacts with

health services 0

Table 1: The distribution of unmatchedcases by Casemix Main Groups (CMG) inICD-9CM to ICHI Mapping

The comparison of result between Output1and Output2 shows that 31,703 (91%) ofthe patient records have the same CBGassignment in both datasets. The remaining3,275 (9%) patient records have differentCBG assignment when they are groupedusing the UNU-CBG Grouper with ICHImapping table. We analyze these 3,275patient records according to their CMG. Theresult of this analysis is shown in Table 1. Itshows that the 1,716 (52.39 %) of thesecases belongs to CBG Delivery groupsfollowed by CMG Digestive System and CMGFemale Reproductive System. In total, 9 outof 23 CMGs were perfectly matched in thismapping.

ResultsMethods & Materials

Match No Match

Match, 91%

No Match,

9%

3,851 ICD-9-CM Codes

Mapping

ICHI Codes

Results

3,844 ICD-9-CM Code Mapped to ICHI Code (99%)

34,978 Discharges

Remain the original data

Database 1

(using ICD9CM)

Change procedures to ICHI codes

Database 2

(using ICHI)

Grouped using UNU-CBG Grouper

Output 1 Output 2

Output 2 results compared to Output 1 results

Introduction

Title

The DESDE-LTC is a standardized international classification of services that allows mapping of social and health care based on the European Service Mapping Schedule (ESMS) developed for mental health services. This system is based in coding the “minimum units of production of care” within services called Basic Inputs of Care (BSICs). These units are labeled using the most meaningful activity or “Main Type of Care” (MTC). DESDE-LTC has been extensively used in different sectors such as mental health, disability, elderly and long term care, performed in over 17 countries both in Europe and America. However this system requires extensive training and periodical update of the information gathered.

USE OF THE INTERNATIONAL CLASSIFICATION DESDE-LTC FOR MONITORING THE SOCIAL CARE SYSTEM IN ANDALUSIA (SPAIN)

Abstract The DESDE-LTC is a standardized international classification of services that allows mapping of social and healthcare based on the European Service Mapping Schedule (ESMS) developed for mental health services. The DESDE-ANDproject aims at 1) testing the usability of DESDE-LTC for the classification of social services, and 2) developing a computeralgorithm for automatic collection of data and coding, following an integrated care approach.


C609


F Alonso-Trujillo1, M Ruiz Gutiérrez-Colosía2, FJ Delgado3, CR García-Alonso2, I González4, S Pinzón5, M Rabadán4, MF Raposo3, JA Salinas-Pérez2, JD Soto3, L Salvador-Carulla6, for the eDESDE-LTC AND Group.1. Agencia de Servicios Sociales y Dependencia de Andalucía ASSDA. Sevilla (Spain) 2. Asociación Científica Psicost. Universidad Loyola Andalucía. Sevilla (Spain) 3. Consejería para la Igualdad Salud y Políticas Sociales de Andalucía. Sevilla(Spain) 4. Servicio Andaluz de Salud. Sevilla (Spain) 5. Escuela Andaluza de Salud Pública. Granada (Spain) 6. University of Sydney. Sydney (Australia). Contact: [email protected]

Title

Methods & Materials

The DESDE-LTC could be used for coding and mapping social services with very minor modifications. As expected, modifications had to be made in the coding of the target population which was extended to frailty groups, deprivation, homelessness, migrants and others. Similarly additional qualifiers were included to better describe the social services from the perspective of the official agency in Andalusia. This included qualifiers for ‘transport’ and ‘dining’.


Results

The DESDE-AND project aims at 1) testing the usability of DESDE-LTC for the classification of social services, and 2) developing a computer algorithm for automatic collection of data and coding, following an integrated care approach. First the usability of the DESDE-LTC taxonomy was assessed by a group of experts in social services. This included the revision of the functional definition of all social service types and its assignment within the management structure of social care. Second DESDE-LTC was used for coding prototypes of the whole class of social services listed at the official catalogue of social services in different Council of Andalusia Regional Government (Spain). Third, a pilot study was conducted in a catchment area of Seville comprising a wide variety of typologies of care. Finally a feasibility analysis was performed with key decision makers in the field.

Conclusions

Funding for this study was provided by Junta de Andalucía (Spain). Health Research projects of Andalusian Regional Government (BOJA 77-22/04/2013 Ref. PI-0075-2013). Other members of the eDESDE-LTC AND group are: C Romero, E Motrico, M Poole, I Fdez de Bobadilla, J Limón, I Carmona, C López, J Álvares, A Mora, P Recio, JA García-Morales, JA Galera, F Romero-Alfaro, J Almenara, MJ Abellán, A Rabadán, FJ Ortiz, D Jiménez-Calvo, A García-Lupato, R López-Medel, MC González-Montero and M Martínez-Domene.

The DESDE-LTC has proven its feasibility for the assessment of social services. This indicates the generalizability of this taxonomy for mapping integrated care.

Chart 4: Screen for the review and verification of the code obtained with the eDESDE-LTC AND software in the validation phase of the project

Chart 1: Relational diagram of the development process with the traceability analysis

Minor changes where required in the tree taxonomy of the “Main Types of Care” only for one final code R14 (other non-acute residential care).The feasibility questionnaire showed that DESDE-LTC is acceptable and applicable for coding and mapping social services. The use of the algorithm in the assessment highly improved the practicality of the instrument and reduced the need of training although expert knowledge is still needed.

Results

TIPO SECTOR ANDALUCÍAPiloto Sevilla

CapitalPiloto Provincia

Sevilla Piloto AndalucíaCENTROS DE ATENCIÓN A LA JUVENTUD AT. JUVENTUD 4 1CASA AT. MENOR 145 7CENTROS DE DÍA AT. MENOR 7 2RESIDENCIAS AT. MENOR 93 2CENTROS DE DESINTOXICACIÓN RESIDENCIAL DROG. Y ADICC. 2 1CENTROS DE DÍA DROG. Y ADICC. 28 5CENTROS DE ENCUENTRO Y ACOGIDA DROG. Y ADICC. 8 1CENTROS DE TRATAMIENTO AMBULATORIO DROG. Y ADICC. 113 7CENTROS DE TRATAMIENTO AMBULATORIO DE ATENCIÓN EXCLUSIVA AL JUEGO PATOLÓGICO DROG. Y ADICC. 12 1COMUNIDADES TERAPÉUTICAS DROG. Y ADICC. 30 1OTROS DROG. Y ADICC. 1 1VIVIENDAS DE APOYO A LA REINSERCIÓN DROG. Y ADICC. 19 1VIVIENDAS DE APOYO AL TRATAMIENTO DROG. Y ADICC. 17 2CENTROS DE ACOGIDA PARA MARGINADOS SIN HOGAR GRA. PROB. SOC. 24 2ALBERGUES DE TEMPOREROS MIGRACIONES 5 1CENTROS DE ATENCIÓN A HIJOS DE TRABAJADORES TEMPOREROS MIGRACIONES 114 1RESIDENCIAS DE ATENCIÓN A HIJOS DE TRABAJADORES TEMPOREROS MIGRACIONES 4 1OTROS OTROS 2 1CASAS-HOGAR PE. ENF. MENTAL 27 3CENTRO SOCIAL PE. ENF. MENTAL 23 1VIVIENDAS SUPERVISADAS PE. ENF. MENTAL 127 1OTROS PERS. DISCAPAC. 8 1RESIDENCIAS DE ADULTOS PERS. DISCAPAC. 87 1RESIDENCIAS PARA PERSONAS GRAVEMENTE AFECTADAS PERS. DISCAPAC. 116 6UNIDADES DE ESTANCIA DIURNA PERS. DISCAPAC. 144 10UNIDADES DE ESTANCIA DIURNA CON TERAPIA OCUPACIONAL PERS. DISCAPAC. 225 12VIVIENDAS TUTELADAS PERS. DISCAPAC. 52 6CENTRO DE NOCHE PERS. MAYORES 5 1CENTROS DE PARTICIPACIÓN ACTIVA PARA PERSONAS MAYORES PERS. MAYORES 747 18CENTROS RESIDENCIALES PERS. MAYORES 657 32UNIDADES DE ESTANCIA DIURNA PERS. MAYORES 469 41VIVIENDAS TUTELADAS PERS. MAYORES 59 13CENTROS DE SERVICIOS SOCIALES COMUNITARIOS SERV. SOC. COM. 139 1CENTROS SOCIALES POLIVALENTES SERV. SOC. COM. 43 1COMEDORES SERV. SOC. COM. 16 2OTROS SERV. SOC. COM. 1 1

3573 176 6 7

Chart 2: Typology of services authorized by Junta de Andalucía and services selected for the piloting in the city of Sevilla

• Johnson S, Kuhlmann R and the EPCAT Group. The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiat Scand 2000; 102 (Suppl. 405): 14-23.

• Salvador-Carulla L, Poole M, González-Caballero JL, Romero C, Salinas JA, Lagares-Franco CM, for RIRAG/PSICOST Group and DESDE Consensus Panel. Development and usefulness of an instrument for the standard description and comparison of services for disabilities (DESDE). Acta Psychiatr Scand. 2006; 114 (Supp.432): 19–28.

• Salvador-Carulla L, Poole M, Bendeck M, Romero C, Salinas JA. Coding long-term care services: eDESDE-LTC. Int J Integr Care. 2009 Apr–Jun; 9(Suppl): e64.

• Salvador-Carulla L, Dimitrov H, Romero C, Weber G, McDaid D, Venner B, Sprah L, Romero, C, Ruiz M, Tibaldi G, Johnson S, for the DESDE-LTC Group (eds.) DESDE-LTC: Evaluation and Classification of Services for Long term Care in Europe. (2011) Spain: Psicost and Catalunya Caixa.

• Salvador-Carulla L, Romero C, Weber G, Dimitrov H, Sprah L, Venner B and McDaid D, for the eDESDE-LTC Group. Classification, assessment and comparison of European LTC services: Development of an integrated system. Eurohealth 2011; 17 num. 2-3: 27-29

• Weber G, Brehmer B, Zeilinger E, Salvador-Carulla L. A European classification of services for long-term care: the EU-project eDESDE-LTC. Int J Integr Care. 2009 Oct–Dec; 9(Suppl): e174.

References

Introduction

Title

In order to fully understand the context of care, an international classification of health services is needed in addition to the classification of interventions (ICHI). SHA 2.0 or ICF chapter 5 (e580) do not provide coding systems that could be used effectively to compare healthcare availability and capacity in different jurisdictions and they are not ontology-based. DESDE-LTC is a standardized international classification of services developed jointly by PSICOST and the Catalan Department of Health and other health organisations (Salvador-Carulla et al., 2013; Fernandez et al., 2014). It identifies “minimum units of production of care” within services called Basic Inputs of Care (BSICs), which are labelled using the most meaningful activity or “Main Type of Care” (MTC). DESDE-LTC has been extensively used in different sectors such as mental health (MH), disability, elderly and long term care (LTC),performed in over 17 countries mainly in the mental health sector. This project aims at 1) describing the spreading of the system, and 2) performing and impact analysis in policy and practice

Implementation of an international taxonomy of care services: DESDE-LTC

Abstract In order to fully understand the context of care, an international classification of health services is needed in addition to the classification of interventions (ICHI). The DESDE-LTC classification system has been extensively used in different sectors such as mental health, disability, elderly and long term care over 17 countries and has produced tangible impact on policy and planning in at least two countries.


C610


Title

Methods & Materials

Since 2011 this classification has beenused in system research analysis forcoding and mapping MH services in thestudy areas of 8 European countries(Austria, England, Finland, France,Italy, Norway, Romania and Spain)within the Refinement project; alsofor developing the integrated Atlases inthree Autonomous Communities orregions in Spain (Catalonia, BasqueCountry and Madrid) and in Chile. Ithas also been adopted for the listing ofdisability services in the Spanishcatalogue of Disability Care and it hasbeen adopted by Andalusia to monitorits social service system using analgorithm for computer coding.

The table at the next column gathersthe level of implementation impactthat the DESDE-LTC classificationsystem obtained in the studies carriedout in Spain. It had a high impact inresource allocation and planning ofmental health services in Catalonia andthe provinces of Bizkaia and Gipuzkoain the Basque Country

References

Results

We describe the implementation of DESDE-LTC since it was published in 2011. We analyse the spreading and impact in targeted public planning agencies. Impact has been assessed using the Implementation Impact Tool. It confers different levels of recognition to three different axes: impact, target agencies and geographical level.

Conclusions

Salvador-Carulla L, Alvarez-Galvez J, Romero C, Gutiérrez-Colosía MR, Weber G, McDaid D, Dimitrov H, Sprah L, Kalseth B, Tibaldi G, Salinas-Perez JA, Lagares-Franco C, Romá-Ferri MT, Johnson S. Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study. BMC Health Serv Res. 2013 Jun 15;13:218. doi: 10.1186/1472-6963-13-218

Fernandez A, Salinas-Perez JA, Gutierrez-Colosia MR, Prat-Pubill B, Serrano-Blanco A, Molina C, Jorda E, Garcia-Alonso C, and Salvador-Carulla L, on behalf of the GEOSCAT-SM group. Use of an integrated atlas of mental health care for evidence informed policy in Catalonia (Spain). Epidemiology and Psychiatric Sciences (in press)

DESDE-LTC is an international taxonomy of services that has been used in different services, target groups, care fields, and in very different countries. It has shown a high usability for policy planning in different studies. However, the implementation impact analysis of the studies conducted in Spain, shows a high degree of variability across different jurisdictions.

Table 3: Description of the level of impact of the use of the DESDE-LTC classification system for mental health policy in nine Spanish regions

Chart 1: Description of axes and levels in research impact assessment

Luis Salvador-Carulla a, Mencia Ruiz b , Ana Fernandez a, Antoni Serrano c, Cristina Molina d and Jaume Canela-Soler e

aMental Health Policy Unit, Brain and Mind Research Institute and Centre for Disability Research and Policy, University of Sydney (Australia); bPSICOSTScientific Association and University of Loyola Seville (Spain); cParc Sanitari Sant Joan de Deu, Sant Boi, Barcelona (Spain); dMental Health Plan. Catalan Department of Health, Barcelona (Spain); eStatistics Unit. Public Health Department. University of Barcelona, Barcelona (Spain)

Chart 2: Implementation process of the DESDE-LTC classification system

Acknowledgments

This project has been funded through grants from the Mental Health Unit, Department of Health (Catalonia, Spain), Institut d’Assistència Sanitària (Girona, Spain), the Mental Health Departments of Bizkaia and Gipuzkoa (Basque Country, Spain), Cantabria, and Madrid, as well as the Refinement Project (European Commission 7th Framework Programme ([FP7/2007-2013: 261459). www.refinementproject.eu;


C701-722 Other

C701 Argentine Center for Diseases Classifications

Marconi; Orellano

C702 Family of International Classifications: an updated definition, foundation and structure

Ten Napel; Hargreaves; Macpherson

C703 Use of the Family of International Classifications to support performance reporting for Universal Health Coverage


C704 Shared ontologies for the Family of International Classifications

Hargreaves

C705 SNOMED CT is a useful tool for sharing crucial clinical information in allergies of the citizens across centers and countries

Paluzie; Matallana; Barrabes; Conill

C706 WHO-FIC Implementation Database ten Napel; van der Haring; van Gool; Robinson - Nicol; Boucher

C707 Reporting results of disseminating best practices in FIC developed through horizontal cooperation (Latin American and Caribbean Network to Strengthen Health Information Systems-RELACSIS

Giusti; Ruiz Luna

C708 Harmonising Healthcare Terminologies with the International Classification for Nursing Practice

Kim; Coenen; Hardiker; Jansen; Bartz

C709 Australian Consortium for Classification Development – Navigating the information highway!

Curry; Dimitropoulos

C710 How to use terminology servers from Clinical WorkStations

Rius-Soler; Graupera-Díaz; Pratdepàdua-Bufill; et al.

C711 Linking clinical data with multiple terminologies Lozano; Pastor; Conesa

C712 Strengthening Informatics Education for Health Information Management Professionals in the Era of Interoperable Standards-based Health Information Exchanges

Greenberg; Green; Orlova

C713 Atlas of Variations in Medical Practice of Catalonia

Tebe; Espallargues; Vela; Pons

C714 Definition and pilot testing of indicators for the benchmarking of outcomes of hip and knee arthroplasties in the Catalan Health System

Serra-Sutton; Martínez; Marinelli; Tebé; Prieto-Alhambra; et al.

C715 Quality of chronic healthcare in the Catalan national health system: a web-based tool for performance analysis and benchmarking of chronic care models

Espallargues; Tebé; Noemí; Colls; Serra-Sutton; Escarrabill

C716 More Value to the Health Information of Catalonia - VISC+ project

Argimon Pallas; Garcia Lopez; Roman Viñas; Garcia Altes; et al.


C717 Diagnosticat: a disease surveillance system derived from the electronic medical records system

Coma; Méndez; Camús; Medina

C718 Pre-commercial Procurement : a tool to promote of the adoption of international standards in fragmented sectors

Alessandrello; Mathieu; Lähteenmäki

C719 A Global Health Metadata Catalogue to Inform Population Health, Health System Performance, and Quality of Care

Fabreau; Minty; Rosenkrantz Woskie; Sarma; Yang; Jha; Ghali

C720 A systematic review of Twitter’s hashtags in public health: an example of a globally adopted standard

de San Pedro López; Canela-Soler; Pla-Consuegra; Griñán; Martínez Roldan; Garcia-Cuyàs

C721 Effect of Physician Alternative Payment Plans on the Validity of Administrative Health Data

Cunningham; Quan; Jette

C722 Fortalecimiento de los Sistemas de Información en Salud. Paraguay

Severo; Concepciòn; Elizabet

Structure Main Achievements

In 1985, the National Commission of Classificationof Diseases (CNCE in its Spanish acronyms) wascreated by resolution of the Ministry of Health ofArgentina. Currently named Argentine Center forDiseases (CACE in its Spanish acronyms)

CACE is the advisory body of the national HealthStatistics System (SES, in its Spanish acronyms)

The CACE coordination is under the authority ofthe National Information and Statistics Directorate(in Spanish: Dirección de Estadísticas eInformación de Salud, DEIS).

From its creation to the present, CACE periodicallypublishes a technical bulletin in cooperation withPAHO/WHO on recent and planned activities,articles of interest, coding recommendationsbased on consultations from the SES, amongmany other topics.

Argentine Center for DiseasesClassifications (CACE)

Marconi E., Orellano A.National Information and Statistics Directorate. Argentina


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Abstract With the aim to promote the correct use of the WHO Family of International Classifications (WHO-FIC) and to improve thequality of morbidity and mortality statistics, CACE has developed training activities for coders, physicians and health professionals, eitherface to face or for distance education. Derived classifications based on ICD-10 have been developed, as well as specific research projectswere carried out. Moreover, technical cooperation directly or through the Pan American Health Organization (PAHO) to adjacent countrieswas provided. CNCE is part of the Regional WHO-FIC Collaborating Center Network of the Americas.

CNCE Objectives

• Support the FIC implementation

• Collaborate with SES and jointly develop withthe National Information and StatisticsDirectorate (DEIS) the annual program for thepromoting the correct use of the classification.

• Train in the use of the classification, accordingto knowledge level, face to face or distanceeducation.

• Participate in strengthening morbidity andmortality statistics and contribute to improvedata quality.

Members are professionals with a vast

experience in morbidity and mortality as well as

in the application and interpretation of FIC.

CACE implemented ICD-10 coding of mortality

in 1997 and of morbidity in 1998.

CACE was key in the implementation of derived

classifications for morbidity at the first level of

health care and for health interventions.

Collaborates with DEIS and different

components of the SES in the programming and

execution of activities for coding of morbi-

mortality, correct registration of cause of death,

diagnosis and interventions of hospitalizations

and in outpatient health care settings.

Through international technical cooperation,

CACE trains coders in morbi-mortality in

adjacent countries (Chile, Bolivia, Paraguay and

Uruguay).

Functioning

• CACE, together with DEIS, has a active participation in the review process of the WHO-FIC,representing Argentina, in the preceding version of ICD-10 in 1995, in the current and in the futureeditions of ICD.

•The role of CACE in strengthening mortality information in Argentina is widely recognized. Currently, theCommission is developing a multidisciplinary project to address the quality of data.

•The participation of CACE in the ICD-10 review process is key, as well as being a member of theRegional WHO-FIC Collaborating Center Network of the Americas, providing cooperation to PAHO inimplementing WHO FIC in the Region.

CACE in coordination with DEIS and support fromPAHO/WHO :

Developed the classification tocode morbidity at the first level of care based onICD-10, titled ‘Statistical Classification of HealthProblems in Primary Health Care’ (ClasificaciónEstadística de Problemas de Salud en AtenciónPrimaria).

Collaborated with its implementation that started in2002.

Translated the International Classification of HealthInterventions (ICHI)- beta-version, into Spanish, asrecommended in the WHO-FIC Network Meeting inReykjavik, Island, October 2004, that serves asreference to countries for use and adaption to theirspecific needs.

CNCE trained all coders for ICHI implementation in2008.

Drafted the glossary to facilitate the use ofthe Classification of Health Interventions (in2011).

Development of many training materials:•Morbidity coding guide•Mortality coding guide (based on ICD-10) withparticipation of physicians in mortality statistics,participation of physicians in fetal mortalitystatistics, among others.•All training materials are based on face to face ordistance education tools.

Developed virtual training and follow-up tools thatprovide shared learning experience.This virtual environment is being used for follow-up of trained personnel through distanceeducation or blended learning (in person andvirtual).

During 2013 and 2014 developed in conjunction with CEMECE two virtual training courses in morbidity-mortality coding for Spanish speaking countries of the American Region.Also developed pilot test introducing in Argentine the System Coding Automated of Death Causes implemented by INEGI of Mexico.

Conclusions

Collaboration

Further information:[email protected]://www.deis.gov.ar/cace.htm

Introduction

Title

The World Health Organization Family of International Classifications: definition, scope and purpose defines the WHO-FIC and discusses the scope and purpose for which the Family was developed. The Family is described as including the three reference classifications ICD, ICF and ICHI, as well as related classifications ICPC, ATC, ICECI and ISO 9999, classifications derived from the ICD for oncology, mental and behavioural disorders, dentistry and stomatology, neurology, and the ICF version for children and youth.

This document, also known as the ‘Family paper’, was authored in 2007 by Richard Madden, Catherine Sykes and Bedirhan Ustun, with inputs from the Family Development Committee. It is available at www.who.int/classifications/en/FamilyDocument 2007.pdf

Since the 2010 WHO-FIC Network meeting, where it was agreed the FDC should revisit the paper for re-drafting, the FDC has discussed how the paper should be reworked to reflect current approaches to classification development and, in particular, the work on the ICD revision.

The FDC plans to produce a revised version of the paper for the Network and the general public, and may also prepare a more technical version for a technical/scientific audience, and other summary material for non-technical audiences.

Family of International Classifications:an updated definition, foundation and

structure

Abstract A key work area of the Family Development Committee is to develop the WHO-FIC as an integrated and comprehensive suite of classifications. A current focus of this work is a review of the 2007 World Health Organization Family of International Classifications: definition, scope and purpose paper (also known as the ‘Family paper’). This poster provides a summary of the revised paper that is to be submitted to the WHO-FIC Network Advisory Council for consideration at the Annual Meeting in October 2014.


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Huib Ten Napel (FDC Co-chair, Netherlands Collaborating Centre), Jenny Hargreaves (FDC Co-chair, Australian Collaborating Centre), Brooke Macpherson (FDC Secretary, Australian Collaborating Centre)

Acknowledgements

Reference

Draft content structure for the revised Family paper

1. The WHO-Family of International Classificationsa. Introductionb. Definition c. Scope d. Function e. Purpose f. Oversight g. Custodianship

2. Foundations of the Family of International Classificationsa. Unifying conceptual modelb. Shared ontologiesc. Foundation component(s)d. Linearizations and use casese. Supplementary materials: knowledgebase, reference guide, index

3. Structure of the Familya. Reference classifications b. Related and derived classificationsc. Harmonisation

4. Development and update cycles5. Processes and considerations for adding and deleting

classifications 6. Terminology links with the Family

The FDC co-chairs would like to thank all the FDC members for their valuable contributions to this work activity to date.

At the mid-year meeting of the FDC, the redrafting of the paper was discussed, with these points agreed for inclusion and focus:The multiple use cases that are possible (now and into the future) for the classificationsThe need for a common structure for the Family and a focus on trying to link the classifications together; and link to terminologiesThe need for the classifications to be harmonised through alignment of content models and development of shared ontologiesA distinction to be drawn between classifications and terminologies, and information provided on how they can be linkedConsideration of external classifications (such as other UN classifications) being ‘neighbours’ rather than ‘family’, and mechanisms for interaction with their custodiansConsideration of the need for alignment with UN classification principles and terminologies, but noting they are not as contemporary as the planned redrafted Family paper will beThe family could be scoped using the definition of health inherent in the ICFThe roles and characteristics of derived and related classifications:

derived classifications could be expanded or reduced views of reference classifications the importance of describing the relationships accuratelyan aim for classifications to move from related to derived (with increased harmonisation). E.g. this has effectively occurred with ICECI through harmonisation with the injury components of ICD-11some related classifications could instead be described as ‘neighbours’, e.g. if they did not share much structure with the reference classifications or more work was needed for harmonisation. Present status of related classifications can be reviewed and repositionedclassifications should not be included in the Family (and should be deleted from the Family if already there) unless they can be made freely available.

Discussions during 2014

Title

The Family Development Committee has been assessing how the WHO-FIC can support the WHO’s Universal Health Coverage initiative.

The WHO and World Bank Group have

Use of the Family of International Classifications to support performance reporting for Universal Health Coverage

Abstract Universal health coverage (UHC) is a global WHO initiative to ensure that everyone who needs health services is able to receive them, without experiencing financial hardship. Ideally, the WHO Family of Classifications should be able to support the measurement of progress towards UHC. The FDC has assessed the extent to which the WHO-FIC can be used to support indicators recently proposed for UHC by the WHO and the World Bank(1), comprising service coverage rates for six illustrative prevention interventions and six illustrative treatment interventions. This poster summarises the results ofthe assessment and highlights where gaps were found in the WHO-FIC and in the specifications for the proposed indicators.


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Authors: Jenny Hargreaves (FDC Co-Chair, Australian Collaborating Centre), Huib Ten Napel (FDC Co-Chair, Netherlands Collaborating Centre), and Brooke Macpherson (FDC Secretary, Australian Collaborating Centre)

Title

Methods & Materials

Acknowledgements

Results - Indicators

The FDC co-chairs would like to thank the FDC members who took part in this exercise.

Some of the indicators required further detailed finition in order to be accurately captured using the reference classifications. Conversely, some of the reference classification codes were found to be not specific enough, particularly ICF environmental factor codes.

Future steps include refining and finalising the coding, providing feedback to the WHO about needs for more detailed definitions for the indicators, and providing information on code gaps to relevant Network committees and the WHO to consider.

Indicators Codes Assigned (Examples) Examples of Gaps/Issues

ICD (2010) ICF (Online browser) ICHI (alpha2)

At least four antenatal care visits

• Z30-39 (Persons encountering health services in circumstances related to reproduction)

• Z34-Z35 (Supervision of normal/high-risk pregnancy)• Z35.3 (Supervision of pregnancy with history of

insufficient antenatal care)

• b6601 (Functions involved in becoming pregnant and being pregnant)

• e580 (Health services, systems and policies)

• FOC PA ZZ (Ante/post natal education)• FOC SZ BK (Ante/post natal support)

• ICHI & ICF codes were not sufficiently specific

• Definition missing for a ‘standard’ antenatal visit

Measles vaccination • B05 (Measles)• Z24.4 (Need for immunization against measles alone)

• d570 (Looking after one’s health) • KBB VB PJ (Population immunization vaccination + relevant ICD, ATC code)

• ATC codes potentially required in the absence of ICHI codes

Improved water source • Chapter I (Certain infectious and parasitic diseases)• Y97 (Environmental-pollution-related condition)• Z58.2 (Exposure to water pollution)• Z58.6 (Inadequate drinking-water supply)

• e2101 (Bodies of water) • e530 (Utilities services, systems and policies)

nil • ICHI codes not available • ICF codes not sufficiently specific• Definitions missing for measuring basic

standards for water quality

Adequate sanitation nil • e1158 (Products and technology for personal use in daily living, other specified),

• e530 (Utilities services, systems & policies)

• Section 6: Public Health Interventions > Interventions on the Environment - codes related to water, land, food and air quality, waste management

• Definition missing for measuring what ‘adequate’ is, and a basic standard for sanitation

Non-use of tobacco • F17 (Mental and behavioural disorders due to use of tobacco, particularly .1 (Harmful use) and .2 (Dependence))

• Z50.8 (Care involving use of other rehabilitation procedures – includes tobacco rehabilitation)

• Z71.6 (Tobacco abuse counselling)• Z72.0 (Tobacco use)

• e1108 (Products or substances for personal consumption, other specified)

• ATR HM AC (Oral pharmacotherapy)• MAQ AA/MK/PA/PB ZZ (Assessment of/Prescription for/

Education about/Counselling about Tobacco use)

• Difficult to measure ‘non-use’. Easier to measure ‘use’?

• ICF code not sufficiently specific

Skilled birth attendance nil • b6602 (Functions related to childbirth) • Codes related to medical and surgical interventions (by caesarean, instrument, or manual assistance)

• AJP AI AH (Monitoring of spontaneous delivery) • FOC SY BK (Personal assistance during delivery)

• ‘Skilled’ could not be coded• What constitutes ‘skilled’?

Anti-retroviral therapy • B20-B24 (HIV disease)• Y41.5 (Antiviral drugs)• Z21 (Asymptomatic HIV infection status)

• e1101 (Drugs)• e5800 (Health services)

• ATR HM AC (Oral pharmacotherapy) • ICHI codes not specific enough• Unclear if measuring service or individual

aspect

Tuberculosis (TB) case detection

• A15-19 (Tuberculosis)• O98.0 (TB complicating pregnancy, childbirth and the

puerperium)• P37.0 (Congenital tuberculosis)• U80 (Agent resistant to penicillin and related antibiotics)• Z03.0 (Observation for suspected TB)• Z11.1 (Special screening examination for respiratory

tuberculosis)• Z20.1 (Contact with and exposure to TB)

Not applicable ? • AGI BA B1 (X-ray of lung) • Most of the codes relate to TB diagnosis or suspected diagnosis

• ICHI does not capture TB diagnostic tests on skin, blood and/or sputum not captured

Tuberculosis treatmentsuccess

• A15-19 (Tuberculosis) nil • ATR HM AC (Oral pharmacotherapy), then repeat diagnostic test • A code for directly observed therapy could be required

Hypertension treatment • I10-I15 (Hypertensive diseases) • b420 (Blood pressure functions) • ATR HM AC (Oral pharmacotherapy)• FHG AI AF (Blood pressure monitoring)• MAC PA PF/PH/PJ (Education concerning diet)• FHX MG ZZ (Exercise targeting cardiovascular system)• FHX PA ZZ, FHX PB ZZ, FHX PC ZZ (Education/counselling/

training in cardiovascular functions) • MAI MQ PM (Community development interventions to promote

medication compliance)

• Further detail would be required on the aspects of treatment to consider

Diabetes treatment • E10-E14 (Diabetes Mellitus) • b540 (General metabolic functions)• b555 (Endocrine gland functions)

• ATR HM AC (Oral pharmacotherapy)• MAC PA PF/PH/PJ (Education concerning diet)• FMX (Functions related to metabolism & endocrine system)• MAI MQ PM (Community development interventions to promote

medication compliance)

• Interventions are often focused on management (for already diagnosed patients) or prevention (for those at risk) rather than treatment

• Further detail would be required on the aspects of treatment to consider

Family planning needs satisfied

• Z30-Z32 (Contraceptive management / Procreative management / Pregnancy examination and test)

• b640 (Sexual functions) • b660 (Procreation functions) • d570 (Looking after one’s health)• e1101 (Drugs)• e585 (Education services, systems and policies)

• AJP HM AE (Termination of pregnancy by injection)• AJP HE/EC AC (Insertion/replacement of internal device of

uterus)• AJI ZZ AA (Male sterilization procedure)• FOZ (Interventions relating to genitourinary and reproductive

functions) • ATR HM AC (Oral pharmacotherapy)• MAN AA/PA/PB ZZ (Assessment of/Education about/Counselling

about Sexual behaviours)

• The concept of ‘satisfaction’ is not readily covered by the WHO-FIC

• There are overlaps between the classifications in this area

Introduction

Codes were assigned by FDC members from the 3 reference classifications to the 6 indicators related to treatment interventions and the 6 indicators related to prevention interventions, referenced from the WHO and World Bank publication.

Groups spent an hour focusing on the following questions for each indicator:• What codes would be used from each reference classification to measure this?

• Are there any gaps?

ICD (2010), the ICF online browser and ICHI alpha2 were used for this analysis.

ConclusionsPrevention Interventions Treatment Interventions

Non-use of tobacco Skilled birth attendance

Adequate sanitation Antiretroviral therapy

Measles vaccination Tuberculosis case detection

At least four antenatal visits Tuberculosis treatment success

Improved water source Hypertension treatment

Family planning needs satisfied Diabetes treatment

Reference

1. World Health Organisation and The World Bank (2014). Monitoring Progress towards Universal Health Coverage at Country and Global Levels: Framework, Measures and Targets. Available at: http://apps.who.int/iris/bitstream/10665/112824/1/WHO_HIS_HIA_14.1_eng.pdf?ua=1

recently published a framework for tracking country and global progress towards UHC. It provides a basis for assessment of aggregate and equitable coverage of essential health services and financial protection.

The health services tracking aims to cover all essential health interventions – promotion, prevention, treatment, rehabilitation and palliation. Twelve illustrative indicators were proposed.

Title

One of the items on the Strategic Work Plan of the Family Development Committee (FDC) is ‘Integration of the Family’. The main work currently being undertaken towards this goal is the redevelopment of the 2007 paper ‘Family of International Classifications: definitions, scope and purpose.’

The redevelopment of the paper by the FDC has involved some consideration of how current and future development of the reference classifications (ICD, ICF, ICHI) is being based on structured content models and ontologies, and how content models and ontologies shared among the classifications could help with integration of the Family and use of the classifications together, in applications such as casemix, and in comprehensive and integrated descriptions of the health of people, and of the health services provided to them.

This poster builds on posters presented at the Annual Network Meeting in Beijing ‘Integration of the Family: a unified conceptual framework’ (Poster C605) and ‘ICD-11 and the Factors influencing health status and contact with health services: a test of integration for the Family of International Classifications’ (Poster C301) by illustrating the range of concepts that currently exist in more than one of the three reference classifications.

As development work proceeds on the classifications, and in particular on ICHI and an ontology for ICF, it would be useful to consider these overlaps between the reference classifications.

• Some overlaps could be removed where, for example, it is decided that a concept should not be included in more than one classification. That approach would align with the approach being taking in ICHI development which is excluding information on diagnoses.

• Some overlaps could be retained, but work done to ensure that they were appropriately aligned, and classified in the same way in each of the classifications in which they exist. This could be the approach, for example, to including information structured according to anatomy in both ICD and ICF.

A similar approach could be taken to work to harmonise classifications, such as work to harmonise between reference classifications and related and derived classifications in the Family. It could also underpin considerations of classifications to be added to or deleted from the Family – if requirements for membership were to include conceptual alignment and shared ontologies with the reference classifications.

Shared ontologies for the Family of International Classifications

Abstract The Family of International Classifications is being transformed through the development of content models and ontologies for ICD-11, ICHI and ICF. This work offers the opportunity to work towards a truly integrated family of classifications that is based on a common conceptual foundation, that is designed to be used as one (rather than as separate classifications), concepts and terms that are re-usable among the classifications, easier integration of the classifications within electronic health record systems, and health statistics based on the classifications that are easily relatable and can be used to paint cohesive pictures of the health of people and the health services provided to them. This poster reports on initial work of the FDC towards these goals, and towards raising awareness of this approach within the Network and beyond it.


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Jenny Hargreaves, Co-Chair, Family Development CommitteeAustralian Collaborating Centre, Australian Institute of Health and Welfare

Acknowledgements

Thanks to Huib Ten Napel, my FDC co-chair, for his related earlier work for FDC, and to FDC members for comments and discussion about raising awareness of this aspect of the Family.

ICD conceptual content

Disease/injuryAnatomy/body structures as axesFunctioning properties in ICD-11

content modelManifestation properties in ICD-11

Causes of poisoningCauses of mental health conditions

Activity while injured Some chapter 21 codes e.g. ‘problems

relating to medical facilities’Various codes in chapter 21 e.g. family

and person historyCausal properties in ICD-11 content

modelCauses of complications of medical and

surgical careScreening/rule out codes

ICD-11 content model: treatment properties – interventions relevant to

define an ICD entry

ICHI conceptual content

Anatomy as a targetActivity/participation as a target

Environmental factors as target and as means (e.g. services, systems)

Behaviours as a targetInterventions

ICF conceptual content

Body functionBody structure

Activity/participationEnvironmental factors

Selected underlying conceptsDisease/injuryBody functionBody structure

Activity/participationSymptoms and signsDrugs, medicamentsEnvironmental factors

Risk factors/determinants of healthInterventions

Devices/assistive productsHealth services (providers, organisations, systems)

More information

This poster presents selected information from a preliminary analysis of the conceptual overlaps between the classifications. More information is available on request.

Introduction

Classifications/concepts embedded in the reference classifications

Introduction

Title

The increasingly frequent use ofterminology SNOMED CT helps ensuresemantic interoperability betweendifferent systems of healthinformation. The EpSOS projectmaintains that ontology as the masterdatabase for the exchange of healthinformation across European borders.In this line TicSalut Foundation(Department of Health, AutonomousGovernment of Catalonia, Spain) hasdeveloped the Clinical DictionaryProject to standardize vocabularywithin the health system in the publicnetwork of Catalonia whose base isSNOMED CT. Using a standardmethodology have been defined aclinical subset of allergies, that answerthe requirements of healthprofessionals and the data model forthe shared health history at Europeanlevel. Our institution is a health careprovider to give Primary Care, AcuteCare and Long-Term Care in a area of200,000 inhabitants to the North ofBarcelona.

SNOMED CT is a useful tool for sharing crucialclinical information in allergies of the citizensacross centers and countries

Abstract The SNOMED CT subset of allergies (2,139 concept Id) defined in the Clinical Dictionary Project of Catalonia hasbeen implemented in our institution. Doctors can incorporate allergies to a patient medical record from all care levels:primary care, acute care, hospitalized, long-term care. In seven weeks, 7,496 patients have been registered the allergies,1,186 (15.8%) with presence of any allergy (in 26% cases penicillin). The registration of allergies will improve patientsafety at all levels of our organization and to be through a common language, will share this information at higher levels asShared Clinical History of Catalonia, the National Health System and the EpSOS project.


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Paluzie G, Matallana A, Barrabes D, Conill XCorporació de Salut del Maresme i La Selva. Calella. España

Title

Methods & Materials

Results

The SNOMED CT subset of allergiesdefined by the multidisciplinary groupcontains 2,139 concept Id, includingdisorders (allergy to penicillin) ormanifestations (allergic rhinitis due topollen) and also allergic alerts(anaphylaxis). The table, that identifiesdrugs, foods and others allergies, hasbeen incorporated to our institutionalhealth information system (HIS) andcan be accessed through with aspecific tool to register and consultallergies. Doctors can incorporateallergies to a patient from all carelevels: primary care, acute care,hospitalized, long-term care. Theinformation appears with special andcolored icons and alarms in strategicplaces of the electronic clinical record.Always that doctors have to sign newmedical orders in hospitalized patientsthe allergy tool is opened to confirmallergy absence or to fill new allergy.Once allergies are registered locallythe next step will be to share thisinformation at higher levels as theClinical Shared History of Catalonia, atthe National Health System (Spain)and in the European project EpSOS.

Conclusions

Chart 1: A sample of the SNOMED CT subset of allergies with description in Spanish

Registration allergies will improve patient safety at all levels of our organizationand to be through a common language, will share this information at higherlevels as Shared Clinical History of Catalonia, the National Health System andthe EpSOS project.

Allergy to n %

Penicillin 307 25,9%

Aspirine 86 7,3%

Diclofenac 43 3,6%

Dipirona (Metamizole) 38 3,2%

Ibuprofen 34 2,9%

Personal history of allergy to sulfamide 27 2,3%

Iodine 24 2,0%

Codeine 23 1,9%

Chart 4: Ranking of more frequent declared allergies and registered inSNOMED CT after seven weeks of the implementation of the tool

Chart 2: Screen toincorporate a newallergy. A searchengine helps theprofessional to findthe allergy, in thiscase penicillin

Chart 3: Screens of thepatient electronic medicalrecord that show thealarms with theincorporated allergies

At present the following information rubrics have been included in the database to be populated:

o Introductory Questions (contact

details, year the data refer to, etc.)

o General Questions

o ICD Implementation

-Mortality Statistics

-Morbidity Statistics

-Cancer Statistics

-Surveillance

o ICF Implementation

-Health and Disability Statistics

-ICF in Legislation

-Disability Prevalence Rate and

Metadata Information

Under WHO coordination, the database is now being populated and updated regularly by identified focal points from the WHO-FIC Collaborating Centers as well as key informants from relevant countries, as indicated by the regional WHO offices.

The information in the database informs, guides and facilitates the exchange of information on where and how WHO-FIC Classifications are used on a general level. Information in the Implementation database can both be accessed or viewed and extracted, both through the Implementation Database itself (figure 1) and through WHO's Global Health Observatory (figure 2).

Introduction

The WHO-FIC Implementation database is a web-based application for the collection and dissemination of general information on the implementation of the WHO Family of International Classifications (WHO-FIC), including the International Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF), the International Classification of Traditional Medicine (ICTM), and others in WHO Member States. WHO-FIC implementation refers to the use and application of the WHO classifications, and their related instruments. Data on these uses and implementations can be stored in the WHO-FIC Implementation Database to inform the global community.

WHO-FIC Implementation Database

Abstract The WHO Family of International Classifications (WHO-FIC) Implementation database is a web-based platform for collection and dissemination of general information on the implementation of the WHO-FIC Classifications (ICD, ICF, and others) in WHO Member States. The information in the database informs, guides and facilitates the exchange of information on where and how WHO-FIC Classifications are used on a general level.


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H. ten Napel1, E.J. van der Haring2, C.H. van Gool1, P.J.-P. Boucher3, M.M. Robinson-Nicol3, 1 WHO-FIC Collaborating Centre in the Netherlands,

National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 2 eggbird Software Development and Knowledge Engineering, Leeuwarden, The Netherlands;

3 WHO Headquarters, Geneva, Switzerland

Specifications

Address correspondence to: [email protected]

Acknowledgements

Information Rubrics

Specifications for such a database were discussed in WHO-FIC committee meetings, as well as with WHO HQ, well before 2011. These included –amongst others:

o specifying user and role management (editor, administrator, etc.)

o user-definable additional languages for questionnaires

o user-definable information rubrics for the classifications ICF and ICD, and others.

o storage of answers in a databaseo statistical views (database retrieval)o functionality to export data to the WHO GHO (Global Health Observatory).

o keeping track of changes made in the database and capturing which user performed which change and when

o application software architecture supports hosting of the tool on the WHO website.

Once made final by WHO, the actual software development started late 2011. After several rounds of iterations and testing, the database is now in a stage that it can be populated further. The database has been set up in a modular way with different administrative roles (editor, administrator) and different topic areas, so called information rubrics.

Work ahead

Work on the WHO-FIC Implementation Database is funded through the Dutch Ministry of Health and WHO Partnership Programme 2010-2011. The kind cooperation of several country representatives, as well as of WHO-FIC collaborating centres around the world and of EIC and FDRG members is gratefully acknowledged.

It is foreseen that by the end of 2014 the Implementation Database (web-based application and underlying database) will move to the WHO domain. Until then a mechanism to enter or update country information regarding WHO-FIC implementations will be developed and implemented.

Figure 2: Screenshot of WHO-FIC implementation database data displayed through WHO’s Global Health Observatory, http://apps.who.int/gho/data/node.whofic.

Figure 1: Screenshot of WHO-FIC implementation database data input.

The purpose of the Latin American and Caribbean Network to Strengthen Health Information Systems(RELACSIS) is to develop a mechanism to coordinate regional efforts and promote horizontal cooperationaimed at contributing to the ongoing improvement of HIS in countries included in the Network.

Title

Officially launched in Lima, Peru inApril 2010. RELACSIS implementedtwo BWP: 2011-12 and 2012-2013.Supporting by PAHO, USAID, CIDA-Canada, MEASURE-EvaluationInternational, ECLAC, CC-IFC andNRCs and promoting horizontalcooperation between countries of theAmericas. The overall objective is tocontribute to HIS strengthening,dissemination, and use of informationby focused on: proposing standards togenerate higher-quality, more reliable,and more timely information;developing and sharing practices,lessons learned, and knowledge;promoting the dissemination and useof generated information andknowledge; promoting monitoring andevaluation of the performance ofnational HIS; strengthening humanand financial resources and developing

DISSEMINATING BEST PRACTICES IN IFC THROUGH HORIZONTAL

COOPERATION


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GIUSTI, Alejandro; RUIZ, PatriciaAMRO, Uruguay- AMRO, WDC

Three practices are disseminating andimplementing:

1. Strengthening of coding with ICD-10 virtual courses. Mexico andArgentina follow a road map for thedesigning, testing, implementation andM&E of the virtual course offered bytutors to Ecuador, Paraguay,Guatemala, Nicaragua, DominicanRepublic and Uruguay. The 1st coursetrained 94 coders from 15 countries. Inthe 2nd course, tutors from countriestrained in the 1st course are tranninig300 hundred participants from locallevel.

2. Implementation of an electronicsystem to codify mortality. Mexicodefined a road map for disseminating,testing and implementing the MMDSsoftware to Argentina, Uruguay, Chile,Paraguay, Ecuador, Guatemala,Colombia, Dominican Republic,Panama and Peru.A WG with countries of the region andSpain will develop and pilot the IRISSpanish version.ECLAC and the WB are participating asimportant stakeholders.

3. Online course for awareness ofmedical doctors in the adequateregistration of the causes of death.Uruguay, Argentina and Mexico aredesigning an e-learning course toCosta Rica, Ecuador, Panama,Paraguay, Guatemala , Nicaragua,Dominican Republic, Bolivia, Colombia,El Salvador, Honduras, Peru andVenezuela.

2012-14 RELACSIS WP

Three main activities wereimplemented:

1. Mexico City, May 23-26, 2011. Ameeting of the WHO InternationalCollaborating Centers (Brazil,Venezuela, México) for theInternational Family of Classifications(IFC) and National Centers (Argentinaand Cuba). The AMRO RegionalNetwork for the CollaboratingCenters and National ReferenceCenters for the IFC was launched tofortify the joint collaboration amongthe Centers and the PAHO/WHO, todefine a Regional Plan for trainingpeople on the use of the WHO relatedhealth classifications.

2. Ecuador, June-July 2011. A Sub-regional Training of trainers coursein IFC. Focusing on ICD-10 and willinclude the launch of a national centerof reference. 25 participants fromEcuador, Bolivia, Peru and Paraguay.Courses for ICD-10 200 coders wereimplemented in Bolivia and Ecuador.

3. April to July 2012. Honduras,Nicaragua, El Salvador and Guatemala.ICD-10 training courses for 120coders led by two CEMECE instructors.ICD-10 training courses for coders ledby two CEMECE instructors.

Website. www.relacsis.orgImplement virtual forums todisseminate practices and discuss onmethods, procedures, techniques, etc.,to produce information of a higherquality, more reliable, and timely.

A succeed pilot were developed with150 medical doctors and the course isnow available for all countries throughthe virtual campus of PAHO.

3rd Meeting of the AMRO regionalnetwork of WHO CollaboratingCenters and National Centers ofReference for mortality and morbidityfor the IFC was held in México, 2014 todefine a work plan and outline thedifferent responsibilities. The Center ofBarcelona was incorporated to thenetwork that became theIberoamerican Network for the WHO-IFC.A Forum on Electronic HealthRecord (EHR) thorough theRELACSIS portal discuss the conflict inthe uses of the IFC in the EHR in theregion.

Based Document included in the on line course in ICD-10. RELACSIS WP

Background

2011-2012 RELACSIS WP

Further information

The authors acknowledge on-going support from the ICN in advancing terminology work for nursing through its eHealth Programmes (web pages accessible via the QR code below).

Introduction

Title

• ICNP® is a terminology that represents nursing diagnoses (patient, family and community problems and assets/ strengths), outcomes of nursing care, and nursing interventions.

• To assure that the electronic health records (EHR) is patient-centered, multiple stakeholders including various healthcare providers need to be able to share data and information.

• Harmonisation of healthcare terminologies is essential for interoperability of electronic health records (EHRs).

• The International Council of Nurses (ICN) has formal harmonisation agreements with multiple organizations.

Harmonising Healthcare Terminologies with the ICNP®

Abstract The purpose of this poster is to highlight the partnerships and resulting resources that are aimed at harmonising the International Classification for Nursing Practice (ICNP®) and other healthcare terminologies. Along with an overview of the methods used, the resources resulting from these efforts are summarized. ICNP continues to advance through partnerships with users.


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Tae Youn Kima, Amy Coenenb, Nicholas Hardikerc, Kay Jansenb, Claudia Bartzba University of California Davis, Sacramento, CA, USA

b University of Wisconsin-Milwaukee, Milwaukee, WI, USA; c University of Salford, Salford, UK

Title

Methods & Materials

The WHO Reference Classifications are:

• International Classification of Diseases (ICD),

• International Classification of Functioning, Disability and Health (ICF) [1], and

• International Classification of Health Interventions (ICHI) (Table 1).

2. ICN has formal harmonisation agreements with:

• International Health Terminology Standards Development Organisation (IHTSDO) and

• Sabacare.

Two concept equivalency tables have been developed for a) ICNP and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) and b) ICNP and Clinical Care Classification (CCC) (Table 2).

Results

In order to harmonise ICNP with a target terminology, we first created a concept equivalency table between the two terminologies. There are eight steps involved in the process as shown in Figure 1.

Conclusions

A number of reports about the harmonisation methods used for ICNP have been published [1-4].

Major benefits of coordinated harmonisation work across international terminologies and classifications include:• Improvement of both source and target terminology through the addition of new concepts, or the refinement or inactivation of existing concepts;

• Concept equivalency tables to enhancement of the interoperability of clinical data; (http://www.icn.ch/pillarsprograms/icnp-download/);

• Enhancement of the UMLS as a terminology resource used in the health informatics community.

Figure 1: Cross-Mapping Process

ICNP 2013 ICD ICF

10027739 Bowelcontinence (Focus)

None B5253 Faecalcontinence (BF)

10027718 Bowel incontinence (Diagnosis)

787.6 Incontinence of faeces

B5253 Faecalcontinence + qualifiers (mild to complete impairment)

Table 1: Examples of linkages from ICNP to WHO Reference Classifications

ICNP 2013 ICHI

Assessing balance Assessment of vestibular function

Teaching about ambulation technique

Education about walking

Target Terminology

ICNP Diagnosis/Outcome Statements (2013 Release)

SNOMED CT 2013-01-01

a.91.6% of ICNP concepts (n=218) were correctlymapped through the UMLS [2-3].

b.38.6% of ICNP concepts (n=565) were mapped manually by experts [2-3].

CCC Ver. 2.5

100% of CCC problems mapped to ICNP concepts. Additional ICNP concepts were mapped to CCC care components (categories of problems).

Table 2: Results of mapping between ICNP and SNOMED CT and between ICNP and CCC

Acknowledgements

[1] Kim, T. Y. & Coenen, A. (2011). Harmonizing WHO international classifications: A nursing perspective. Informatics for Health and Social Care, 36(1), 35–49.

[2] Kim, T. Y. (in press). Automating lexical cross-mapping of ICNP to SNOMED CT. Informatics for Health and Social Care.

[3] Kim, T. Y., Hardiker, N., & Coenen, A. (2014). Inter-terminology mapping of nursing problems. Journal of Biomedical Informatics, 49, 213-220.

[4] Hardiker, N., Kim, T. Y., Bartz, C. C., Coenen, A., Jansen, K., (2013). Collaborative development and maintenance of health terminologies. AMIA Proceedings, 572–577.

References

1. As a Related Classification within the WHO Family of International Classifications (WHO-FIC), ICNP has a commitment to harmonise with WHO Reference Classifications.

Title

Australian Consortium for Classification Development:

Navigating the information highway!

Abstract The Australian Consortium for Classification Development (ACCD) led by the National Centre forClassification in Health (NCCH) with partners, The University of Western Sydney (UWS) and KPMG havean overall task of developing and refining the Australian Refined Diagnosis Related Groups (AR-DRG)

Classification System in an ongoing capacity for at least the next two editions/versions of the International Classification ofDiseases and Related Health Problems, Tenth Revision, Australian Modification, the Australian Classification of HealthInterventions , the Australian Coding Standards (ICD-10-AM/ACHI/ACS) and the AR-DRG Classification System. Thispartnership embodies a unique blend of skills and knowledge that provide substantial opportunities to advance thedevelopment and ICT support for the ICD-10-AM/ACHI/ACS and the AR-DRG classification now and well into the future.


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Joanne Curry & Vera DimitropoulosNational Centre for Classification in Health, The University of Sydney, Australia

Electronic Data Extracts Electronic outputs include electronic code specifications and code lists, mapping tables, and electronic, print-ready versions of the manuals including the ACS. Data for the electronic extracts will be drawn from both the Change Management System and the Classification databases. These electronic outputs will be available for use by software companies, State health departments, researchers and printers.

Certification System (CS)The CS will provide a mechanism for software certification for vendors providing electronic coding lookup tools. The CS will support the certification workflow and allow storage of data associated with certification activities. The CS provides for external transparency of progress and status, and internal reporting and audit logging of individual software certifications.

The inclusion of the University of Western Sydney, an organisation with specific health informatics research &development expertise, provides the ACCD with a strong base on which to improve ICT support and future innovation of the ICD-10-AM/ACHI/ACS and the AR-DRG classification systems.

ACCD have a number of deliverable tasks toundertake for ICD-10-AM/ACHI/ACS Ninth Edition and AR-DRG V8.0, under contract to the Independent Hospital PricingAuthority (IHPA).The following information provides an update on the progressof the innovative ICT infrastructure that will support thedelivery of the classification, its derived products andeducation to our national and international stakeholdersmoving forward into the future.

Figure 1 and the following descriptive information provides the Consortium’s long term vision for the IT environment that is required to deliver a robust, transparent and auditable national classification system.

Query and Submission System (QSS)This system will provide/accommodate for:• The receipt of public submissions relating to each development cycle and coding queries concerning the ICD-10-AM/ACHI/ACS and AR-DRG classifications

• Online explanatory feedback on queries/submissions, including documentation of decisions and what if any further action is required

• Communication of the status and progress of queries/submissions

• Data for reporting (i.e. number and type of submissions received).

• Dissemination of information for technical committee review, feedback and action

Change Management System (CMS): The CMS will provide a record of all changes made to the classifications and provide analysis facilities and an audit trail for reporting purposes. The CMS will receive input from and provide input to the QSS. The CMS will facilitate the update process including supporting the formal change management workflow and version control.

Classification Database – ICD-10-AM/ACHI: The actual ICD-10-AM/ACHI codes and associated data will be electronically stored enabling secure and rapid access to coding information as required.

Classification Database – MDC/PARTITION/ADRG/AR-DRG: AR-DRG codes and associated data will also be electronically stored enabling secure and rapid access to coding information. The AR-DRG classification data will be stored in separate physical tables with implicit links to associated ICD-10-AM tables. The AR-DRG database will also store related MDC/Partition/ADRG data.Both classification databases will provide data to the CMS for analysis and reporting. The database ‘front-end’ will be used for actual physical changes to the classification databases.

Introduction

Abstract

Figure 1: Classifications ICT Support Framework

Conclusion

Methods

Introduction

Terminology servers provide functionalities to browse,query, search on, manage and develop controlledvocabularies and their elements, subsets and mappings.These tools also offer other functionalities for SNOMED CTlike the extensions manager one or the support to createpost-coordinated expressions. These functionalities can beprovided in two modes:• Through a (web) user interface.• Consuming (web) services.

This duality allow us create a subset of SNOMED CT usingthe user interface and to list or search on the elements ofthis subset in a end-user application, like a CWS, invokinga Web Service (WS). Terminology Servers helps usmanaging controlled vocabularies and using them toencode clinical information.

How to use terminology servers from Clinical WorkStations

Abstract Terminology servers are tools designed specially to allow us work with controlled vocabularies. We can use thesetools directly to manage and develop semantic resources but we can also use their services to obtain controlledvocabularies in other applications, like Clinical WorkStations (CWS) of healthcare professionals. Thanks this approach wecan support physicians in encoding of recorded information without working with codes.


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Authors: Rius A, Graupera A, Pratdepàdua C, Ayza J, Janer LTecnocampus Mataró-Maresme, Barcelona (Spain)

[email protected]

Methods & Materials

To support the clinical information encoding when it isbeing recorded we use a WS from a terminology serverthat returns all descriptions matching with the word(s)that the professional is looking for in a search field:1. Physician starts writing the word(s) in a field of his or

her CWS.2. WS is called on each key-press, returning the most

similar results as proposals.3. When physician chooses a description, it is a term of a

controlled vocabulary associated to a code.4. The encoded information is stored in the centre’s

information system.

To control the input information we limit the results of theWS to a concrete vocabulary (or subset) and in case ofmulti-hierarchy terminologies like SNOMED CT we filter byaxis too.

Results

We have developed a simulated CWS environmentwith different fields that are filled in invoking WS.Three of these fields allow us to encode vaccinesadministered to patients that have caused adversereactions and their route of administration:• First field is a search area where user can entervaccines’ name and the invoked WS returns moresimilar descriptions of the immunizations’ subset ofSNOMED CT, created through the web user interface.

• Second field is a drop-down list whose elements aredescriptions of the subset of routes of administration.

• Third one is another search area filtered by the subsetof adverse reactions.

When the user selects terms in these fields the informationis stored encoded.

Conclusions

Having the support of terminology servers, physicians canrecord encoded information without being necessary forthem to work directly with codes and applying controlsrelated to the domain of the system’s input information.With these tools healthcare organizations can managetheir semantic ecosystems, maximizing the availablestructured information, improving the quality of therecorded data and promoting research and innovationprojects.

Figure 1. Subset of immunizations in ITServer Terminology Server.

Figure 2. Result of invoking the searchTermsInSubet WS, looking for “hepa”.

Figure 3. Simulated Clinical Work station with fields filled invoking WS.

Introduction

Title

The “binding” between an informationmodel and a coding system is currentlyan important problem in electronichealthcare records (EHRs).Furthermore, the information stored inEHRs can be represented using a greatnumber of different terminologies andcoding systems, some of themstandard and some of them specific tothe information system. Thetranslation from a local coding systemto a standard one is usuallyimplemented by one-to-one mappingtables between the local codes and theones in the standard coding system.This approach is therefore tedious toimplement and very difficult to keepupdated.

Linking clinical data with multiple terminologies

Abstract. The “binding” between an information model and a coding system is currently an important problem in electronic healthcare records (EHRs). Our proposal is based on the use of ontologies as a binding mechanism between an information model and different coding systems that can be used to store or communicate information.


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Authors: Lozano-Rubí R*#†, Pastor-Duran X*#, Conesa A**: Medical Informatics. Hospital Clínic; #: Public Health Dep. Univ. of Barcelona;

†: Computer Science Dep. Autonomous Univ. of Barcelona

Title

Methods & Materials

Figure 3 shows the structure of ICD 9CM. The metaclass ICD_Conceptintroduces the properties icd_code,description and active. Four subclassesof ICD_Concept are used to representthe different classifications: Diseasesand injuries, procedures, externalcauses of injury and poisoning, andfactors influencing health status andcontact with health services.

Acknowledgements

Results

Our proposal is based on the use ofontologies as a binding mechanismbetween an information model anddifferent coding systems that can beused to store or communicateinformation. Firstly, we use ontologiesto conceptualize the domain (seefigure 1). This step is dependent onthe concrete application.

Conclusions

This work made possible by fundingfrom the Instituto de Salud Carlos IIIof Spain (exp. PI12/01399), and co-funding from European RegionalDevelopment Fund (ERDF), EuropeanUnion.

It is feasible to use ontologies as abinding mechanism between aninformation model and one or severalcoding systems.

This approach allows seeing a specificconcept from a twofold perspective:either from the conceptual point ofview in a domain application; or as acode, with its properties, of a specificcoding system.

Ontologies provide great flexibility andare easy to reuse. Ontologies have anincreasing importance in the medicaldomain and a lot of related tools areavailable.

Figure 2: A model of SNOMED CT RF2.

Figure 1: An example of application.

Figure 3: A model of ICD9 CM.

As a central piece of our EHR system,we are currently implementing aknowledge server following thisapproach. We have modeled SNOMEDCT Release Format 2 (RF2) and ICD 9CM as the initial coding systems to beincluded in the server.

The modeling of coding systems isdone once for each one, the modelsproduced are reused in differentapplications by an import mechanism.In fact, available ontologies can beused.

An advantage of this approach is itsflexibility. A concept can be bound to acode system, to several code systemssimultaneously, or to none.

Finally, we integrate both kinds ofontologies. “To code” a concept, theclass is made an instance of themetaclass representing thecorresponding terminology system.

Figure 4a shows the “Liver cellcarcinoma” as an ICD 9 CM code, andfigure 4b as a SNOMED CT concept.

Secondly, we use ontologies toconceptualize the structure andcontent of each coding systems to beused. The concepts to be coded aremodeled as classes in the ontology.Therefore, the properties of theconcepts have to be defined inmetaclasses. Each coding system ismodeled as a metamodel.

Figure 2 shows the main structure ofSNOMED CT following the ReleaseFormat 2.0 specification. SCT_Conceptis a metaclass that introduces theproperties SctId, effectiveTime, active,moduleId and definitionStatusId, and alink to the corresponding descriptions.

Figure 4a: Liver cell carcinoma as an ICD9 CM code.

Figure 4b: Liver cell carcinoma as a SNOMED CT code.

Introduction

Title

The Sixty-sixth World Health Assembly’s resolution WHA58.28 on eHealth Standardization and Interoperability adopted on May 27, 2013 recognized “that, through standardized electronic data: health workers can gain access to fuller and more accurate information in electronic form on patients at the point of care; pharmacies can receive prescriptions electronically; laboratories can transmit test results electronically; imaging and diagnostic centres have access to high-quality digital images; researchers can carry out clinical trials and analyse data with greater speed and accuracy; public health authorities have access to electronic reports on vital events in a timely manner, and can implement public health measures based on the analysis of health data; and individuals can gain access to their personal medical information, which supports patient empowerment.”

Electronic sharing of health information requires the adoption of interoperable health information technology (HIT) solutions such as Electronic Health Records Systems (EHRS), Laboratory Information Management Systems (LIMS) and other HIT products. Information systems interoperability is becoming the key technology feature to enable secure information sharing between clinicians, patients, researchers, educators, public health professionals and other stakeholders.

To support interoperability* (Health Level Seven (HL7). Coming to Terms: Interoperability. White Paper. 2007), standards development organizations have been developing numerous HIT standards for (a) representation of clinical and population health content in IT products and decision support (semantic interoperability), (b) IT infrastructure for information exchanges/sharing (technical interoperability), and (c) information governance (functional interoperability).

Operation of the interoperable HIT products requires a skilled workforce proficient in newly emerging areas of interaction among HIM, IT, health informatics and law. Academic and continuing education programs in medicine, public health, IT, HIM and law need to be extended to train the new workforce required to support standard-based interoperable HIT products. These efforts are being pursued under an emerging alliance between AHIMAand the Public Health Data Standards Consortium (http://www.phdsc.org) with other stakeholders.

Strengthening Informatics Education for Health Information Management Professionals in the Era of Interoperable Standards-

based Health Information Exchanges

Abstract There is an urgent need to strengthen the current curricula for training informaticians and health information management (HIM) professionals to support their work in the new era of standardized interoperable electronic data exchanges. This need includesdeveloping competencies and training courses and programs focused on (a) standardization of health information technology (HIT), (b) health information systems interoperability, and (c) information governance. Based on over 5-years experience from offering the online course on HIT Standards and Systems Interoperability for clinicians and public health professionals at Johns Hopkins University as well as using the benchmarking AHIMA White Paper that assessed today’s information governance practices and related challenges, authors discuss the ways of expanding the current informatics and HIM curricula for professionals in healthcare, public health and law.


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Marjorie Greenberg, Deborah Green, Anna OrlovaAmerican Health Information Management Association (AHIMA), Chicago, Illinois, USA

Methods & Materials

The emerging roles of HIM and public health professionals in a new interoperable electronic data sharing environment include:� Standard setters � Educators � Consumer advocates � Experts in data structure � Brokers of information � Advocates of quality data � Informaticians supporting clinical and business decisions � Data analysts.

(Paul Van Dolan. Reframing Roles. AHIMA Leadership Symposium, July 11-12, 2014 Chicago, IL, USA).

From the business needs of the healthcare and public healthorganizations and, in turn, from training perspectives, two new areas of HIM may emerge (Figure 1) as follows:1 – Content Managers - a bridge between traditional HIM and IT2 – Information Governance Specialists - a bridge between IT and

Law.

The 1st specialty – Content Managers - will include training of the HIM specialists to operate standards-based tools for semantic interoperability (e.g., vocabulary and terminology services tools for data structure, ontologies, computer-based coding tools), which will require a skilled workforce with competencies in HIM, coding, informatics, HIT standards, data analysis and computer science. This specialty will support vocabulary and terminology services as well as data analytics services to address the needs of semantic interoperability between information systems in healthcare, public health, social services and e-government initiatives at large.

The 2nd specialty - Information Governance Specialists - will require a workforce with competencies in HIM, hospital administration, HIT standards, computer sciences and law. This specialty will support business processes and information governance practices when using EHRS, LIMS, pharmacy systems, public health surveillance systems, personal health records, etc. This specialized training should be offered to HIM as well as legal professionals working in the area of protecting data integrity, privacy, security, transparency and accountability.

Based on over 5-years experience from offering the online course on HIT Standards and Systems Interoperability for clinicians and public health professionals at Johns Hopkins University (Johns Hopkins Opencourseware URL: http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/InfStandards/coursePage/index/); as well as using the benchmarking AHIMA White Paper – A Call to Adopt Information Governance Practices (URL: www.ahima.org/IGwhitepaper), we propose expanding the current informatics and HIM curricula to include competencies and training for newly emerging roles of HIM and public health professionals in the following two interdisciplinary areas (Figure 1):

1- between IT and HIM (to support semantic interoperability)and 2- between IT and Law (to support functional interoperability).

Results and Discussion

Conclusions

We invite leaders in HIM, IT, informatics, public health and legal training to join AHIMA in developing educational resources for the emerging HIM and public health workforce roles and skills in the electronic environment.

Figure 1. New HIM Workforce Specialties for Electronic Data Exchanges in the Era of Systems Interopera-bility

Introduction

Title

Variations in medical practice (VPM),since the seminal study of Dr. JohnWennberg in 1973, is a persistentissue, not only regarding healthcareservices, but also about the scientificbasis of medicine. VPM are defined assystematic variations, not due tochance, of adjusted rates of clinicalprocedures for a given level ofaggregation of the population. To knowutilization rates of different clinicalconditions and surgical proceduresfrom a population perspective shouldoffer a richer perspective for theassessment of health services in acomplex public healthcareenvironment. The aim of this project isto explore and describe variations inmedical practice following theexperience of the Dartmouth Atlas ofHealth Care and the Atlas of VPM inSpain.

Atlas of Variations in Medical Practice of Catalonia

Abstract Atlas of variations in medical practice of Catalonia, is a health services research project concerning the analysisof unwarranted variations in medical practice and healthcare outcomes in Catalonia. The aim is to compare healthcareindicators by area with a view to giving powerful feedback to policy decision-makers and managers.


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Authors: Tebé C, Espallargues M, Vela E, Pons JMVAgència de Qualitat i Avaluació Sanitàries de Catalunya; Servei Català de la Salut

Title

Methods & Materials

Three variations atlas have beenpublished until now: in knee and hiparthroplasties and about thrombolysisin acute ischemic stroke (chart 1).Primary knee replacement is aprocedure of moderate variability,although there is considerablevariability in the age group between 20and 60 years (chart 2). Primary totalhip replacement is a practice ofmoderate variability, although in theage group 80 years or more a largevariability was observed due topatient's frailty (chart 3). Thrombolytictherapy has spread practicallythroughout all the country in the pastseven years; however variability is stillhigh (chart 4). Nowadays we areworking in three new atlas: homerespiratory care, renal insufficiencysubstitution therapy, and rachissurgery. Atlas reports can bedownloaded fromhttp://aquas.gencat.cat/

Acknowledgements

Results

The main information source is thehospital discharge data set from allhospital admissions in Catalonia andfinanced by the public insurer. Thebasic strategy of analysis is to makecomparisons among the rates ofactivity (numerator: hospitaladmissions) of the inhabitants of aterritory (denominator: basic healtharea). Results are presented in tablesof standardized rates and ratios ofactivity using small areas analysis.Most results are presented in maps forbetter visualization. Moreover weconfigure an expert group to discussand present a list of proposals atdifferent decisions levels to reducethese variations.

Conclusions

The authors acknowledge thecontributions of Sònia Abilleira, MiquelGallofré, Gaietà Permanyer, AlexAllepuz, Francesc Pallisó, Lluis Puig,Josep Riba, Miquel Pons, Moisès Coll,Montse Bustins and Teresa Salas. Inaddition, the authors would also like tothank members of the "project AtlasVPM", Atlas of Variations in MedicalPractice in the National Health System(www.atlasvpm.org).

Variations analysis can be a goodmonitor tool for any health system.Published atlases have receivedattention both in clinical andhealthcare managers audiences.Expert committees proposals suggestnew fields for research regarding newforms of organization in order toprovide an assessment of theadequacy. There is a need for deeperanalysis of the causes of thesevariations rather than descriptivestudies on them.

Chart 2: Standardized activity ratios ofprimary knee arthroplasties by area in menand women between 20 and 59 years(2005-2012).

Chart 4: Standardized rates for ischemicstroke hospitalizations with intravenousthrombolytic therapy (rt-PA) in men andwomen in 2005 and 2011/12.

Chart 2: Variation statistics in primary total hip arthroplasty in men and women (2005-2012).

n:

RV:

CSV:

EB:

30831 6706 7449 11607 5069

2.24 3.14 3.14 2.73 5.86

0.05 0.08 0.08 0.06 0.14

0.05 0.07 0.05 0.06 0.13

-3

-2

-1

0

1

2

3

Taxa e

sca

la log

arí

tmic

a m

itja

na 0

20+ anys 20-59 anys 60-69 anys 70-79 anys 80+ anys

Chart 1: Atlas of variations in medicalpractice published .

Title

At international level and in population-based artroplasty registers, prosthesis survival is considered the most robust and main outcome measure of total hip (THA) and knee (TKA) arthroplasties. In Sweden or England and Wales, several outcomes are followed to obtain a broad report on the quality of healthcare and benchmark centres undergoing this kind of surgeries. The aim of this study was to develop a set of indicators and assess their feasibility and validity for the benchmarking performance and outcomes of centres undergoing THA and TKA procedures in Catalonia and other regions in Spain.


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DEFINITION & PILOT TESTING OF INDICATORS FOR THE BENCHMARKING OF OUTCOMES IN HIP AND KNEE ARTHROPLASTIES IN THE CATALAN HEALTH SYSTEM

Serra-Sutton Vicky1,2,, Martínez Olga1, Marcella Marinelli1,2 Tebé Cristian1,3,Prieto-Alhambra Daniel4,5, Pons Joan MV1,2, Espallargues Mireia 1,2

1 Agència de Qualitat i Avaluació en Salut de Catalunya (AQuAS), 2 CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona,3 Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), 4 Jordi Gol SIDIAP, Barcelona, 5 OxfordUniverstity, Oxford. This project is carried out with a grand from the Fondo Investigación Sanitaria (FIS PI1100166).

Methods & Materials

Phase 1. An exhaustive literature review was carried out to identify indicators and adjustment factors and were classified according to a defined conceptual model. From approximately 200 concepts/ indicators a list of 33 were sent to experts in a Delphi study using the Health Consensus platform. Participants voted each indicator twice according to three criteria. Consensus was defined if 75% or more experts in the different profiles scored 7-9 in at least importance and perceived feasibility.

Conclusions

Conclusions

Figure 1. Conceptual model & number of indicators for electronicconsensus (Health Consensus platform)

Phase 2. Charts with a formula, definition, interpretation, level of consensus were proposed. Indicators were tested in a pilot study using data from the Arthroplasty Registry of Catalonia (RACat), Minimum Basic Data Set at Hospital Discharge (MBDSHD) and the Information system-based primary care electronic medical records (SIDIAP). An additional Patient Reported Outcome (PROMS) cohort was used for pilot.

A group of 44 and 237 experts participated in2 waves of Health Consensus (55% and 41% response rate, respectively). Most participants were men, worked in an acute hospital and described themselves as clinicians. Twelve indicators reached the level of consensus and were feasible and valid (figure 2).

Most were outcome measures and could be calculated in the RACAt and MBDSHD; proposed risk adjustment factors could be collected in the MSDSHD or SIDIAP. Certain level of variability was described when implementing the set of indicators to compare the centres. For example, hospital mortality raw rates (up to 90 days-considered adverse effects) was 2.39% (range: 0%-7.05%) in THA and 0.089% (range: 0%-0,82%) in TKA.

Figure 2a and figure 2b. Proposed indicators for benchmarking of primary hip and knee artroplasties

Title of indicator Level of consensus

Testing database

Domain/ attribute measured

I1. Hospital mortality rate (until discharge, and up to 30 and 90 days)

I, F, & PR: >75% MBDSHD Patient safety

I2. Mortality rate (90 days after)

I, F & PR: >75% Register of Health

Insurance

Health status

I3. Prosthesis survival I, F & PR: >75% RACat Clinical effectiveness I4. Early failure (up to a year)

I, F & PR: >75% RACat Clinical effectiveness

I5. Re-operation I, F & PR: > 75% MBDSHD Clinical effectiveness I6. Pain relief a year after surgery I, F & PR: >75% PROMs

cohorts Clinical

effectiveness/ patient centered

care I7. Complications during surgery I, F & PR: >75% Surgical form

database Patient safety

I8a. General complications rate (until discharge and up to 30 days)

I, F & PR: >75% MBDSHD Patient safety

I18b. Complication from pulmonary embolism and venous thrombosis (until discharge and up to 30 days)

Included as part of I18a.

MBDSHD Patient safety

Title of indicator Level of consensus

Testing database

Domain/ attribute measured

I9. Average hospital stay

I, F: >75% MBDSHD Efficiency

I10. Readmission rate

I, F & PR: >75% MBDSHD Clinical effectiveness

I11. Time in waiting list I, F & PR: >75% Waiting list register

Patient centered care

I12. Time until intervention (in hip fractures)

I, F & PR: >75% Hip fracture register

Patient centered care

I13. Improvement of physical function a year after surgery

I & PR:>75%

PROMs cohort Clinical effectiveness/ patient centered

care I14. Improvement of health related quality of life a year after surgery

I & PR:>75%

PROMs cohort Clinical effectiveness/ patient centered

care

A robust set of indicators have been defined and tested that allow to measure the whole health care process, taking into account a multidisplinary perspective of this kind of procedures. Most proposed indicators them measure clinical effectiveness and patient safety. The next steps of the project include risk adjustment models of indicators taking into account patient and centres characteristics (such as reason for surgery, sociodemographics , comorbidity, hospital complexity level) and further analysis in datasets from other health regions.

Conclusions

Introduction

Results

I: important; F: perceived as feasible; PR: measured relevant aspects for patients

Introduction

Title

Research on innovative practices andstructured generation of scientificevidence regarding chronic care andhealth services sustainability is apriority for health systems in order toassess their value (health/socialbenefits and costs) and their capacityto be scaled up throughout the HealthSystem.

Quality of chronic healthcare in Catalonia: a web-based tool for performance analysis and benchmarking of chronic care models

Abstract It is unclear the impact of new forms of service delivery and organization of care seeking greater coordination, continuity and ultimately greater healthcare integration in an increasingly aging population with even more health and social needs. In Catalonia (Spain), although most organizational models show some health benefits in specific targeted patients (pilot studies) they do not seem to have an overall impact on the system (at the population level) when analyzing different healthcare quality indicators.


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M. Espallargues(1,2), C. Tebé(1,3), N. Robles(1,3), V. Serra-Sutton(1,2), C. Colls(1), J. Escarrabill(3,4)

1. Agència de Qualitat i Avaluació Sanitàries de Catalunya; 2. CIBER Epidemiología y Salud Pública, Spain; 3. Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Spain; 4. PDMAR y Hospital Clínic i Provincial de Barcelona

Title

Methods & Materials

Healthcare quality indicators werederived from a process of identificationand consensus with experts usingqualitative techniques (metaplan andDelphi) focusing mainly on outcomesof health care (Figure 1).

Conclusions

Results

Spatial-temporal evaluative studyon small areas using primary careteams (362) as the unit of analysis andobserved measures (indicators) duringseveral years (from 2011 onwards) asa dependent variable (performance).

Quality indicators were comparedbetween areas with and withoutintegrated chronic care models(benchmarking).

Sources of information: MinimumData Sets (hospital admissions,primary care), central register of publichealth insured people and electronicprescription.

Statistics: Standardized rates,variability statistics and ratios of theobserved and expected (O/E) cases fora set of 10 indicators (intermediateand final outcomes) have beenmapped for each area for the availableyears of information and implementedon a web-based interactiveplatform that allows a dynamiccomparison of results (benchmarking)and performance analysis of chroniccare models.

Web-based platform

• No relevant pattern is observedwhen comparing areas with andwithout integrated chronic caremodels, nevertheless there areareas performing better or worsethan others.

• Although most organizationalmodels show some health benefitsin specific targeted patients (pilotstudies) they do not seem to havean overall impact on the system (atthe population level).

Figure 5: Benchmarking: O/E values are representedin funnel plots in order to show those areas with thehighest and lowest number of O/E values for thewhole territory. 95% (yellow line) and 98% (red line)confidence intervals were calculated for definingareas of exclusion.

Objective

To assess new organizational modelsof chronic healthcare in Catalonia(Spain) through the development ofindicators for benchmarking andassessment of performance, as well asto implement them in a web-basedcomputing platform.

Figure 1: Quality indicators for assessing chronic care models in Catalonia, Spain

Preliminary analyses have identifiedareas with values significantly differentfrom expected in indicators as urgenthospital admissions (Figure 2), hospitalreadmissions or potentially avoidablehospitalizations. These areas do notcorrespond exclusively to the areasthat have integrated chronic caremodels. The full analysis of theindicators will confirm or refute thehypothesis that best results over timeare expected in areas with greaterintegration of chronic healthcare.

Figure 2: Urgent hospital admissions (public hospitals network, Catalonia, 2012): map of observed/expected ratios in primary care areas

Contact: [email protected]

Patients contacted 48 hours after hospital discharge

Accumulated hospital days per year for same reason

Patients visited at ED by source of demand

Inpatient readmissions

Patients with polypharmacy (10-15 or more drugs)

Patients with efficacious drugs

Institutionalized population (social & geriatric care)

Population attended with chronic health disorders

Time between decompensations requiring admission

Pharmaceutical expenditure

Circumstance at discharge of patients

Patients visited at ED

Access to shared medical records by health professionals

Mean hospital stay

Hospital mortality

Population attended in chronic care programmes/models

Population attended with different levels of risk stratification

Potentially avoidable hospitalizationsFigure 4: Performance: the O/E values are shown in aselected region of the map for a specific indicator. Thetable shows the O/E values for all the indicatorscalculated for one primary care area (marked in blueon the map): the blue diamond shows the O/Evalue and the red line shows the median value forCatalonia.

Figure 3: Mapping of the O/E values in primary careareas for Mortality indicator. Palest/darkest coloursrepresent areas where observed values are significantlower/higher than expected ones respectively.

Observats < Esperats

Observats = Esperats

Observats > Esperats

Ciutat de Barcelona

Hospitalitzacions urgents de HA (per 100 habitants):Global

Introduction

The Agency for Health Quality andAssessment of Catalonia (AQuAS) isa public entity depending on the HealthMinistry of the Government ofCatalonia its main objective is togenerate value and relevant knowledgeto contribute to the improvement andsustainability of the Catalan healthsystem through the analysis ofinformation, the innovation and theassessment.

Today, technology and informationsystems are a key component to thehealthcare system as they are used toprovide health care services and toshare clinical data between providers,patients and healthcare organizations.Although the data managed withinthese information systems is mainlygenerated for healthcare purposes, itcan be transformed to valuableknowledge that can be used toincrease research, development andinnovation capabilities.

With this objective in mind, AQuAS haslaunched a project called VISC+aimed to impulse research,development and innovation in thehealth and life sciences industriesthrough the access to clinical data.

More Value to the Health Information of Catalonia - VISC+ project

Abstract VISC+ (More Value for the Health Information of Catalonia) project consists in relating and analysing theinformation that is constantly being generated at an individual level across all the Catalan healthcare system, in ananonymous and secure way, and to give analysis and data access services to researchers and life sciences industries sothat they can improve and impulse their activity.


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Authors: Argimon Pallàs, J. M., Garcia Lopez, C., Roman Viñas, R. Garcia Altés, A. Maspons Bosch, R. & Pons Ràfols, J. M. V.

Agency for Health Quality and Assessment of Catalonia, Barcelona.

Methods & Materials

After the competitive dialog hasfinished, a final public contract willbe awarded to one company (or to ajoint-venture between the companiesthat have been involved in the dialog)that will be AQuAS partner for 8 years.

The choice of a public-privatepartnership (PPP) responds to thewillingness to maximize the abilitiesof both parts to make the projectmore competitive:� To enhance the ability to analysedata and to ensure the promotionand commercialization of theproject and its services.

� To share risks and benefitsbetween both parts.

� To obtain investments needed tobuild and operate the model.

Through this PPP VISC+ will relate andanalyse the information that isconstantly being generated at anindividual level across all the Catalanhealthcare system in an anonymousand secure way.

The services of VISC+ will providevalue directly and indirectly on fourdifferent levels.� To the research centres,healthcare industries anduniversities, by increasing theirability to carry out their researchactivities.

� To economic and industrialsectors, by increasing the ability toattract talent and investment onhealth research sectors and othersectors related to life sciences.

� To the Catalan healthcaresystem, increasing the capacity toplan and allocate resources, findefficiencies, proactivity on patienthealth and experience improving,system control and performanceassessment and improvement.

� To the Catalan society in general,by promoting open data,accountability and transparency byaccess to the information.

To do so, the PPP VISC+ contractor willhave to implement a Health AnalyticsCompetence Centre, located inCatalonia from where all the VISC+services will be created and providedby highly qualified staff specialized inlife sciences and data analytics.

Results

VISC+ will be the result of a public-private partnership tenderedthrough a competitive dialogue. Thecompetitive dialogue has the objectiveof co-designing the public–privatepartnership model involving thecandidates to be the future partnerfrom the very beginning of the project.

During the competitive dialogue, a setof relevant issues have been discussedwith the participants, divided in threerounds: governance model, businessplan, service catalogue, data qualitydue diligence assessment, legal andsecurity model, organization.

Conclusions

Through this project, the time durationand the costs of the research projectswill be decreased, supplyinginformation to researchers that willhelp them answer clinical questionsmore efficiently. For example, inbiomedical research, based on VISC+services, we can determine whethercertain treatments are more effectivethan others; we can find more effectiveways of preventing, treating andmanaging illnesses or understand whois most at risk for particular diseasesand conditions.

Thus, VISC+ will contribute toovercome the main barriers toresearch and innovation: poor accessto evidence, data and metrics.

Moreover, as VISC+ will integratedatabases from all the healthinformation systems, it will be able toprovide valuable information forclinical trials with natural population(representative sample) as part of thereal-world-evidence services that areplanned to be provided.

The project has a holistic approachto all the data from the publichealthcare system in order to analyseinformation and extract insights toimprove the research projects and togive value to the life sciences industry.

The success of this model is based onhigh quality data, with a historicaldepth, longitudinal and representativeof the population.

This is a feasible challenge thanks tohaving a universal healthcare cardwith a personal identification code thathas been operating since 2002 in theCatalan healthcare system. This cardhas to be used in all health contactsallowing to easily link all datasets.

Finally, the Catalan Data ProtectionAuthority has validated the datasecurity and anonymization model thatwill be implemented in VISC+.

Electronic prescription and dispensation (140 M prescriptions / year)

Risk factors, mortality and lab tests

Electronic radiological and non-radiological image (500 TB digital images)

Primary care, social health and mental health

Hospital activity (760kdischarges / year, with 4 diagnoses & 10 procedures)

Specific registers: Alzheimer disease, cancer, heart attack, stroke, etc.

Chart 1: Initial VISC+ available datasets.

Chart 2: VISC+ logo will be visible in all the promotion and commercialization acts as well as in the offices of the new Health Analytics Competence Centre.

Introduction

Title

In the past years, sentinel networks have been more useful for the surveillance of some diseases than universal reporting of cases systems. However, these sentinel systems also have limitations, which derive from the voluntary participation of physicians, the lack of representativeness, and the low use of case definition.Since 2006, 80% of primary care physicians in Catalonia (Spain) routinely register their activity in the electronic medical records system (EMRS). Data produced is a key source of information that could also be used for surveillance of certain diseases.

DIAGNOSTICAT: A DISEASE SURVEILLANCE SYSTEM DERIVED FROM THE ELECTRONIC MEDICAL RECORDS

Abstract Diagnosticat is an open website which contains reports of many diseases occurring in Catalonia. The information is obtained weekly from the electronic medical records system (EMRS). The website is timely updated a few minutes after every finished epidemiological week (EW). We compared the data provided by Diagnosticat with that of sentinel networks (r: 0.887). We concluded that reporting of cases from the EMRS is a valid method to determine the trend of certain diseases.


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Authors: Ermengol Coma, Leonardo Méndez, Joan Camús, Manuel MedinaInformation system for primary care services. Information System Department. Institut

Català de la Salut, Catalonia

Title

Methods & Materials

We published weekly information about all flu cases recorded in the EMRS. This information was timely updated the day after every finalized epidemiological week.

The comparison of our data with that provided by sentinel networks shows that both epidemic curves are highly correlated (r: 0.887; 95%CI: 0.838-0.922) and have the same pattern over several years (chart 2 and 3).

In addition, our data is published in a more timely fashion, one week prior to those reported by sentinel network.


Results

We developed a process of extracting health conditions information from the electronic medical records. The database contains reports of many diseases occurring in Catalonia, such as influenza, papilloma or chickenpox (table 1).Initially we focused on influenza diagnosis and the process included all diagnoses codes (ICD-10 code) recorded in the EMRS during the flu season (table 2).Nowadays, we provide information about some diseases, available on the internet website Diagnosticat (http://4.sisap.cat/diagnosticat) (chart 1). In order to validate the system we compared the epidemic curve obtained by this method with those obtained by the sentinel network using Pearson correlation coefficient (r).

Conclusions

Reporting of cases from the electronic medical records system can be a rapid and valid method to determine the trend of certain diseases that could help surveillance of some health conditions

Chart 2: Comparison with data provided by sentinel network. Epidemic curves have the same pattern over several years

Chart 1: Diagnosticat website

Diseases

Chlamydia

Condyloma acuminata

Enteritis and diarrhea

Scarlet fever

Influenza

Genital Herpes

Papilloma

Trichomonas

Chickenpox

Chart 3: Comparison with data provided by sentinel network. Epidemic curves are highly correlated

Table 1: Diseases included in the Diagnosticat website

Table 2: Influenza ICD-10 codes.

Diagnosticat would not be possible without the work of all healthcare profesionals of Catalan Institute of Health. We also thank all the people involved somehow in the process of the creation of Diagnosticat.

Introduction

Title

As recognized by the WHO during the Health Data Standardization and Interoperability in Geneva, December 2012 and in Action 77by the EC’s Digital Agenda, in a fragmented eHealth sector where exclusive set of standard as are being applied, interoperability is a major issue.It is important that SDO’s , Academic and research Institutions, and subject matter experts work together for the implementation of eHealth standardization and interoperability.DECIPHER is a project funded by the European Commission 7th Framework Programme (FP7). DECIPHER is a pre-commercial procurement procedure coordinated by AQuAS, where 3 procuring authorities (TICSALUT, Catalonia, ESTAV Centro, Tuscany and TRUSTECH, Manchester) is challenging the eHealth service industry in developing mobile solutions enabling secure cross-border access to existing personal health record (PHR). This stakeholder dialogue is a mean of fostering the adoption of international standards in the fragmented mHealth market. One of the main objectives of the project is to create a cross-border reference implementation with selected technical standards for mobile solutions accessing PHRs and produce the pillars of a common framework for producing interoperable, mobile, secure and cross-border European PHR service.

Pre-commercial Procurement: a tool to promote the adoption of international

standards in fragmented sectors

Abstract With the Pre-commercial procurement, DECIPHER consortium is able to promote the adoption of the international standards at the early stages of eHealth solutions development. Technologies defined to cover needs from Catalonia, Tuscany and Manchester and adopting widely international recognised interoperability standards, have the potential to be seamlessly deployed across Europe.


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Authors: Rossana Alessandrello1,Jean Patrick Mathieu2, Jaakko Lähteemäki31, 2AQuAS, Spain - 3VTT Technical Research Centre, Finland

Title

Methods & Materials

Three procuring authorities, from three European Regions have pooled their resources to find a common set of needs still uncovered by current state-of-the-art and attractive enough to the market to invest in the relevant R&D.In order to achieve this, the procuring authorities have previously identified common needs. Those needs were verified with patients and healthcare professionals from the three procuring authorities regions and with market across Europe. Fruit of this process the procuring authorities were able to come up with the translation of those needs in functional requirements, used afterwards as the technical specifications for the PCP. By sharing the risks and benefits of the R&D process with the Technological industry, DECIPHER’s procuring authorities set-up the conditions for a dialogue between stakeholders and foster the adoption of interoperability standards. The PCP procurement opened in June 2014, bidders had two months to submit their proposals and DECIPHER consortium is currently evaluating them, to select the ones joining the PCP procedure.


Results

DECIPHER procuring authorities will co-create technologies and services (DECIPHER service) though a pre-commercial procurement (PCP): a tender process divided into different Phases,

Conclusions

Acknowledgement : the DECIPHER project is the joint production of an European consortium that includes: AQuAS, TRUSTECH, ESTAV Centro, TICSALUT, ANCI Innovazione, BDIGITAL and VTT Technical Research Centre.

(see: www.decipherpcp.eu)

Current deployment of eHealth technology across Europe is highly fragmented. Unfortunately regional deployed PHR systems do not always adopt relevant industry standards.Ideally DECIPHER Service will be valid for all regional EU PHR initiatives and 3rd party off-the-shelf solutions making use of the most common EU recognized interoperability standards.Usage of clinical code systems is important in order to enable semantic interoperability and automatic language translation of coded terms. This is another feature of DECIPHER Service which is expected to exceed the state-of-the-art of current apps. The usage of clinical codes seems not to be common in current mobile applications based on the available information. DECIPHER project is strongly advocating for the use of clinical code systems to fulfil its requirements in interoperability issues. These code systems, widely in use at the procuring countries, will be implemented in DECIPHER service. To overcome the fragmentation due to local variants, DECIPHER will promote the use of the original version of the code systems maintained by WHO (ICD-10, ICPC-2 and ATC) and Regenstrief Institute (LOINC). PCP is considered the right instrument to be used by Public procurers to lead standardization in a fragmented sector.

Figure 2: DECIPHER Innnovation Management Framework

Figure 1: A pre-commercial process

in such a way that the number of Bidders shall decrease from one Phase to the next one to ensure selecting those that best address the technical challenge on which DECIPHER PCP is based.The adoption of this procurement procedure is in line with what Edquist and Zabala (2013) defined as catalytic procurement, in which the procurer is not the targeted end-user of the procured technology and such development would not have happened otherwise.

Figure 3: DECIPHER Innovation Funnel

Figure 1: Countries covered to date in the GHMC (July 2014)

Introduction

Title

� Administrative health data generated by episodes of care (deaths, hospital stays, physician visits) can be used to study population health, health services, and quality of care

� International health comparisons are performed using administrative health data resources

� A disparity in the availability and validity of data limit comparative research

� An essential pre-requisite is a detailed characterization of existing international health data holdings

� Recognizing this, we are compiling detailed data about health data –i.e., a “Metadata catalogue” – for international administrative health data holdings

Objectives:

� To create a ‘Global Health Metadata Catalogue’ (GHMC), an online, open access compendium of existing codified health data resources for all officially listed countries

� Promote this tool for researchers and organizations interested in accessing international administrative health data

� Foster international collaboration to help create, improve and maintain the GHMC

� Leverage the skills in this user community towards the efforts in knowledge translation and health system improvement globally

The Global Health Metadata Catalogue

Abstract. We have created an online, open access research tool that catalogues detailed information about international administrative health data holdings, or a ‘Global Health Metadata Catalogue’. This tool represents a fundamental first step required in order to perform accurate international comparative health research


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Gabriel Fabreau, Evan Minty, Liana Rosenkrantz Woskie, Nandini Sarma, James Yang, Ashish Jha, William Ghali

University of Calgary – Calgary, CanadaHarvard School of Public Health – Boston, USA

Figure 2: A screen shot of the GHMC and available data for a high-income country

�An open access Metadata Catalogue has been created and needs an active user community for further improvement (imecchi.org)

�Current scope of the GHMC extends mostly across information rich countries

�Work continues to detail holdings in less developed countries

�Large variability exists across countries in the scope of administrative data available, and also in the extent to which validity and data definitions are documented

�Data collected highlights an information paradox where countries with the highest burden of disease paradoxically often lack high quality health data

Results

Conclusions

�The GHMC is a fundamental first step in international comparative health research�The GHMC has the potential to help harmonize international approaches to health data management�This tool requires an active user community to continue to develop and assist in knowledge translation efforts�Future innovative approaches include dissemination through a HarvardXmassive online open source course (MOOC) in September 2014 (highq.hsph.harvard.edu)

� Using Internet, telephone interviews, e-mail, written correspondence, and document analysis, metadata is gathered in three distinct relational layers for each individual country

� Layer 1 consists of contact information and location of national-level agencies or individuals who hold coded health data

� Layer 2 provides a nominal description for each individual dataset held by any given agency

� Layer 3 consists of any supporting documents or validity elements that further describe the databases identified

� Live web-links are provided at each layer

where possible throughout the GHMC

Methods and Materials

Methods and Materials

� The GHMC is a collaborative project between the International Methodology Consortium for Coded Health Information (IMECCHI –imecchi.org) and the Harvard Initiative on Global Health Quality (HIGHQ - highq.hsph.harvard.edu)

� Data are complied from a diverse sources including: health insurance registries, inpatient care, day surgery, vital statistics and others

� Databases of interest are national-level, describing individual care encounters recorded using international coding systems (i.e. ICD 9-CM, ICD 10, SNOMED)

Introduction

Methods & Materials

Results

Conclusions

A systematic review of Twitter’s hashtags in public health: an example of a

globally adopted standard

Authors: de San Pedro M, Canela-Soler J, Pla M, Martínez J, Griñán M.C, Garcia-Cuyàs F.Affiliation: TicSalut Foundation Location: Vic (Barcelona)

Abstract The objective is to find evidence and make recommendations on the use of Twitter in public health, particularly throughthe study of hashtags (#). This systematic review shows the use of Twitter in different areas of public health:epidemiological surveillance, health promotion, health protection and disease prevention. Articles on this subject published

in indexed journals with impact factor show the importance of conversations to engage the attention of Twitter users by using citations (@user) and retweets (RT); however, not much importance seems to be given to the use of hashtags (#), which are often assimilated to theconcept of keywords. Although tracking recurring hashtags should be less expensive than computing Twitter content, the potential ofhashtagged data has not been properly exploited or recognized over the past years, probably due to the lack of efficient tools.

Acknowledgements:

Analyzing conversations in social media canmeasure different population characteristics,including public health information; forexample, some work has correlated Twittermessages with influenza rates in the UnitedStates. On Twitter, directed conversationsusually involve “@user” syntax to refer toothers and address messages to them. Asecond convention, known as retweeting(RT) is also a common approach to attractfollowers and spread worthy ideas.However, a subset of participants usehashtags (#) to highlight tweets so thatothers can identify useful conversationscentering on a particular topic.

Objectives

An overarching aim is to find evidence onthe use of hashtags in public health and tomake recommendations to boost theusefulness of Twitter’s hashtags fordisseminating information in public health.

Abstract


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Methods

•PRISMA systematic review guidelines. •Search terms include: “Twitter” and “Public Health”.•This study was reviewed by two reviewers. Disagreements were resolved by the consensus of both examiners.

Materials

�Thomson Reuters. Web of Knowledge(from 2009 to 2013)

�Joanna Briggs Institute reviewers’ Manual 2014

�R Statistical Software�Google Scholar

This work is conducted within the framework of the doctoral program in Health, Wellbeing and Quality of Life at the University of Vic –UCC

Acknowledgements: Virtual Nurse, Official College of Nursing in Barcelona (www.infermeravirtual.com); Virtual Doctor, DKV MedicalInsurance (www.dkvseguros.es) and UniversalDoctor (www.universaldoctor.com)

Statistics: Pearson's Chi-squared test: Table (2 x 5 years) over 62 articles. X-squared=5,894; p-value=0,2072. Althoughthe number of indexed journals with impact factor showing the use of Twitter’s hashtags in public health has increased over the years, there has been no significant progress in statistical terms.

The quantity of studies in indexed journals with Impact Factor showing the relevance of Twitter’s hashtags in public health is still poor (n=14). The key question is about the reasons.

The proportion of Confirmatory studies are almost double than Exploratory ones.

Twitter's hashtags in public health are globally adopted to identify and categorize related content, more advanced uses like asking for advice, resolving doubts or following events are less frequent.

The most common use of Twitter’s hashtags in public health papers is in the field of epidemiological surveillance.

The use of hashtags is one of the most efficient ways of organizing conversations on Twitter. However, there is still a lack of web tools for efficiently tracking or disseminating hashtagged information; it could be helpful to engage in conversations about #ICD11.

Inclusion criteria: English research papers and reports explaining the use of Twitter’s hashtags in public health, published in journals with impact factor (2009-2013).

%= (# of similar uses of Twitter’s hashtags mentioned in 14 papers) x 100 / (Total number of uses of hashtags mentioned)

Introduction

Title

Effect of Physician Alternative Payment Plans on the Validity of Administrative Health Data


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Cunningham CT, Jette N, Dhanoa R, Hemmelgarn B., Noseworthy T., Beck CA, Dixon E, Samuel S, Ghali WA., Decoster C, Quan H.

University of Calgary, Canada

Title

Methods & Materials

Of the 182 physicians whose data were

linked, 51 were APP physicians, 94 were

FFS physicians and 37 were on a blended

model.

FFS Physicians

Of the FFS physicians, 77.9% were male;

57.4% were age 40-59 and 44.1% practiced

> 15 years.

APP Physicians

Of the APP physicians, 61.4% were male;

40.9% had practiced for 5-14 years and

67.1% specialized in internal medicine.

Completeness of Claims Submissions The overall submission claims rate was

90.0% for APP physicians, 95.6% for

blended and 91.8% for FFS physicians. For

FFS physicians, psychiatry (97.0%) had the

highest submission rate followed by

neurology/neurosurgery (95.1%), paediatrics

(95.1%), internal medicine (94.1%), and

surgery (92.4%). For APP physicians, the

submission rate varied by speciality from a

high of 91.3% for internal medicine and a

low of 88.6% for surgery.

For APP physicians, the proportion of

submitted claims was significantly higher

when an incentive was provided (93.6% vs.

89.4%).

We analysed the differences in submissions

among physicians whose payment program

was changed from FFS to APP during the

study period. The proportion of submitted

claims decreased significantly from 95.6%

for pre-APP to 90.1% for post-APP (see

Table 3).

Chart Review

Of the 1115 charts

requested for review,

849 were included,

447 (52.6%)

for FFS physicians

and 402 (47.3%) for APP physicians.

FFS physicians had a slightly higher positive

predictive value (87.0%) compared to APP

physicians (85.8%).

For FFS records, psychiatry had the highest

positive predictive vlaue (100%), followed by

surgery (91.0%), paediatrics (82.4%) and

internal medicine (76.5%).

For APP records, neurology had the highest

positive predictive value (93.3%), followed

by surgery (92.0%), paediatrics (91.0%) and

internal medicine (81.0%).


Results

A survey of physician specialists was

conducted to determine APP and FFS status

and obtain consent to use physicians’ claims

data from four acute care hospitals in

Calgary, Canada. The following physician

specialties were targeted: intensive care unit

(ICU), internal medicine, neurology and

neurosurgery, pediatrics, psychiatry and

general surgery.

Inpatient and emergency department (ED)

services were identified from provincial

hospital discharge abstract and ambulatory

care classification system administrative

databases. Services were linked to Alberta

physician claims from 2002 to 2009 using

unique patient and physician identifiers.

After identifying proportion of claims

submitted, inpatient chart review determined

completeness of submissions defined by

positive predictive value. Two chart

reviewers underwent training in the data

extraction process. Finally, the reviewers

extracted data independently for evidence of

the diagnoses submitted in physician claims

through an examination of the entire chart up

to the date of the claim (i.e. medical service

date).

Conclusions

The authors would like to acknowledge the

Canadian Institutes for Health Research

(CIHR) and all those who collaborated on

this project.

We analysed physician claims submitted by

Alberta specialists for inpatient and

emergency department services and found

that Alberta APP physicians, similar to FFS

physicians, submit a high proportion of

medical service claims, and that the

accuracy of diagnostic coding of these

claims is also high.

There is a slight decrease in the overall rate

of submission after APP implementation but

this was lower than 10% non-submissions

for APP physicians, and a much smaller

proportion than expected. The potential for

data loss with the implementation of APPs

seems to be minimal and does not appear to

have affected the overall completeness and

accuracy of claims being submitted in

Alberta.

Alberta is one of several Canadian provinces

that require APP physicians to submit

shadow bills to account for the services they

provide. In addition, many provincial APP

programs based at teaching hospitals utilize

incentive-based programs to motivate

physicians to submit billings. Our results

suggest that such incentives may be

effective. For example in some divisions or

departments APP physicians who do not

submit the recommended quota of shadow

billings based on their expected patient

workload annually face a potential

withholding (e.g. 15%) of their yearly

earnings. Shadow billing monitoring has the

potential to improve the quality and

completeness of claims submitted by

physicians.

The findings from this study offer valuable

insight into one of the largest and richest

sources of Canadian administrative health

data. These findings suggest that contrary to

popular beliefs, physician payment programs

may not have as much of an impact on the

quantity or quality of claims data. Incentive

programs should be considered nationally in

order to preserve the overall quality of

physician claims data and there should be

continuing vigilance with respect to

completeness and accuracy of physician

data, regardless of the payment system.

Canada, because of universal healthcare

and the collection of the physician claims

database, has one of the richest coded

health care data sources in the world. In the

traditional fee-for-service (FFS) payment

model, physicians must submit claims for

every medical service they provide to receive

remuneration. The physician billing claims

database contains unique patient identifiers,

unique physician identifiers, and clinical

information, such as a patient’s diagnosis at

the time of a visit. With this widespread use

of physician claims data, the quality,

accuracy and completeness of these data

are of the utmost importance.

As of 2009, over 20% of Canada’s 55,000

physicians receive some payments for

clinical care from an APP. Unfortunately,

APPs do not typically provide financial

incentives for physicians to submit claims for

all their services (i.e. they are not

compensated for their time spent submitting

claims, referred to as “shadow-billing”)

raising concern about potential data erosion

due to non-submission of shadow billings.

The impact of incomplete and inaccurate

billing submissions decreases the ability to

effectively track health service volume and

utilization, for instance, the burden of chronic

diseases.

Verdana 36 Bold

Conclusions

Fortalecimiento de los Sistemas de Información en Salud. Paraguay

E El Ministerio de Salud Pública y Bienestar Social a través de la Dirección General de Información Estratégicaen Salud (DIGIES), acompañado por la Dirección de Estadísticas en Salud, sigue liderando el proceso del fortalecimientode los Sub-sistemas del SINAIS. Subsistema de Información de Estadísticas Vitales (nacidos vivos y defunciones), laimplementación progresiva del Subsistema de los Servicios de Salud (ambulatoria e internación) y los sistemas expertosque la conforman, en las 18°Regiones Sanitarias y de los Servicios de Salud dependiente s del Ministerio de SaludPublica y Bienestar Social.

VI REUNION RELACSIS – Barcelona OCTUBRE 2014

Olmedo L., Fernández R., Salinas Z., Tullo E., Cuevas E., Almada R., Ministerio de Salud Pública y Bienestar Social

Title

Title

El Ministerio de Salud Pública y BienestarSocial, por Ley Nº 836/80, tiene a sucargo la recolección, procesamiento,análisis y publicación anual de lasEstadísticas Vitales y Sanitarias delsector. Todas las instituciones públicas yprivadas de salud, están obligadas arecolectar y suministrar periódicamente,al Ministerio, los datos que éste necesitapara hacer el análisis y la evaluaciónestadística en salud.Antecedentes• Rediseño e incorporación de la variableEtnia en los certificados de Nacidos Vivosy Defunciones, formalmente adoptadospor las instituciones del sector saludpúblicos y privados desde el 2010 a nivelpaís.•El Diseño y uso a partir del 2011 de losinstrumentos de recolección de datos delos Servicios de Salud (ambulatoria einternación) y su implementaciónprogresiva en establecimientosdependientes del Ministerio de Salud.• El 100% de las Unidades de Salud de laFamilia utilizando los nuevos formulariosde Área Ambulatoria y de los Sub-Sistemas de Información Integradas.•Codificación y carga del 100% deegresos hospitalarios de las institucionesdependientes del MSP y BS en lasRegiones Sanitarias desde el año 2014.Fortalecimiento del Subsistema de Información de las Estadísticas Vitales• La adopción de los instrumentosrediseñados por todas las institucionesdel sector salud desde año 2004• La desconcentración del procesamientode hechos vitales hacia las RegionesSanitarias (2006) y hacia los HospitalesRegionales (2009)• Formación de 180 codificadores deinformación médica entre 2000 y 2008• Diagnóstico situacional del SIS entre2005-2006• Ingreso del Paraguay a la Red Métricade Salud en el año 2007•Elaboración de un plan estratégico2007-2011 para el desarrollo del SIS• La inclusión de la variable “Etnia” enlos instrumentos de recolección dehechos vitales, desde el año 2010• Desde el año 2010, se realiza larecodificación muestral del 10% de lasdefunciones.• Desde el 2011 se realiza la búsquedaactiva de defunciones maternasrecodificando el 100% de lasdefunciones de las madres en edadfértil.

En el marco de la implementación del PlanRegional para el Fortalecimiento de lasEstadísticas Vitales y de Salud (PEVS) de laOPS en alianza con MEASURE – Evaluationliderada por la Red Latinoamericana yCaribeña para el Fortalecimiento de los SIS(RELACSIS) se ha desarrollado lassiguientes actividades.

2) Implementación de un sistema electrónico asistido para codificación de la mortalidad.Visita al país del Lic. Francisco Javier SolísGuerrero del INEGI-MEXICO con el fin debrindar asistencia técnica y seguimiento ala implementación del Sistema deCodificación automatizada.Posterior a la visita Paraguay ha elaboradoun plan de trabajo e iniciado el proceso deconsistencia de la base de datos deEstadísticas Vitales del año 2013 con el finde proceder a la utilización del sistema decodificación y su análisis correspondiente.

•Para más información:

Lic. Luis Olmedo [email protected]. Zunilda Salinas

[email protected]. Estefana Cuevas

[email protected]

RESUMEN

1) Fortalecer la codificación con la CIE-10 a través de cursos virtualesParticiparon 9 funcionarios Codificadores delas dependencias del Ministerio de SaludPública y Bienestar Social del CursoVirtual de Codificación de InformaciónMédica con la Clasificación EstadísticaInternacional de Enfermedades yProblemas Relacionados con la Salud.Decima Revisión (CIE-10). Todosaprobaron el curso de forma satisfactoria yrecibieron sus respectivos certificados departicipación. Para la selección se tuvo encuenta el mayor volumen de certificados deDefunción generados en las Institucionesde Salud.Se contó con la asistencia técnica deTutores especializados del Centro Mexicanode Clasificación de Enfermedades y CentroColaborador para la Familia deClasificaciones Internacionales de laOrganización Mundial de la Salud enMéxico (CEMECE) y del Centro Argentino deClasificación de Enfermedades(CACE) deArgentina.

3) Curso en línea para lasensibilización de médicos en elregistro adecuado de la causa demuerte.Se ha desarrollado el curso sobre elregistro adecuado de la información de lacausa de muerte en el certificado dedefunción. El curso tuvo una duración dedos sesiones de dos horas cada una.Participaron alrededor de 20 médicos de losestablecimientos de salud seleccionados.

4) Curso de capacitación en Formación de codificadoresSe llevó a cabo un Curso para la Formaciónde Codificadores de Información Médica enbase a la CIE-10 – para Morbilidad; conapoyo de GT ITAIPU/SALUD PY.Participaron del curso 24 funcionarios yfuncionarias de las oficinas de estadísticasde los establecimientos de salud de laDécima Región Sanitaria de Alto Paraná. Elcurso tuvo una duración de 40 horas y fuedesarrollado por dos Instructoras de CIE-10formadas en el curso de Formación deInstructores llevado a cabo en Quito-Ecuador en 2011.

• Elaboración anual de la publicacióndenominada Indicadores Básicos de Saluddisponibles en la página web del PortalSINAIS e impreso con apoyo de la OPS/OMS• Base de datos e indicadores disponibles adiferentes usuarios externos e internos,generados por los diferentes Subsistemasen Salud•Análisis cuantitativo y cualitativo de losdatos ingresados desde todas los serviciosde salud publica, privada, policiales,militares e IPS, en los diferentessubsistemas.

Funcionarios de X Región Sanitaria capacitados en CIE-10

Ministro de Salud de Paraguay, representante de OPS local, Director General de DIGIES y Consultores de RELACSIS

Ing. Javier Solís (México),

con el equipo de codificación

automatizada de mortalidad.

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