recent advances in the field of family medicine classifications icpc into who-fic j k soler wonca...
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Recent advances in the Recent advances in the field of Family Medicine field of Family Medicine
classifications classifications ICPC into WHO-FICICPC into WHO-FIC
J K SolerJ K Soler
Wonca International Classification Wonca International Classification CommitteeCommittee
International Classification of Primary CareInternational Classification of Primary Care
Why do we need ICPC?Why do we need ICPC?
A classification is A classification is the ordering the ordering
principle of a defined principle of a defined domaindomain
The International Classification of The International Classification of Primary Care is the ordering Primary Care is the ordering
principle of the domain of primary principle of the domain of primary care and family medicinecare and family medicine
Rubrics code mutually exclusive conceptsRubrics code mutually exclusive concepts Inclusion and exclusion criteria: definitionsInclusion and exclusion criteria: definitions Covers the breadth of the domainCovers the breadth of the domain ““Granularity” appropriate for the domainGranularity” appropriate for the domain Classification based on empirical dataClassification based on empirical data
200
600
400
10.000
SYMPTOMS DIAGNOSES
ICPC: > 1 PER 1000
PPY
ICD:<1 PER 1000
PPY
ICPC and ICD structureICPC and ICD structure
ICPC (WONCA)ICPC (WONCA) Conceptual Conceptual
constructconstruct LocalisationLocalisation About health About health
problems and problems and patient complaintspatient complaints
Patient centredPatient centred
ICD (WHO)ICD (WHO) Historical Historical
constructconstruct EtiologicEtiologic About diseasesAbout diseases
Provider centredProvider centred
All included in UMLS
All linked to Snomed-Ct
ICD9
ICD10
ICPC and ICD relationships
ICPC
UMLSUMLS
National Library of Medicine - Unified National Library of Medicine - Unified Medical Language SystemMedical Language System
Develops and distributes electronic Develops and distributes electronic knowledge sources and lexical programsknowledge sources and lexical programs
Facilitate development of software that Facilitate development of software that understands medical terminologyunderstands medical terminology
Metathesaurus, SPECIALIST lexicon and Metathesaurus, SPECIALIST lexicon and Semantic NetworkSemantic Network
WHY DO WE NEED AN ICPC2-ICD10WHY DO WE NEED AN ICPC2-ICD10
THESAURUS?THESAURUS?
BecauseBecause
ICPC does order the domain ofICPC does order the domain of
family medicine..family medicine..
....but has insufficient granularity tobut has insufficient granularity to
document all individual patients’ diagnosesdocument all individual patients’ diagnoses
.... thus a thesaurus would allow easy, .... thus a thesaurus would allow easy, semi-automatic double coding, using:semi-automatic double coding, using:
ICPC-2 as an ordering principle based ICPC-2 as an ordering principle based on the high prevalence of common on the high prevalence of common diagnoses in family practicediagnoses in family practice
and ICD-10 as a nomenclature based and ICD-10 as a nomenclature based on the wide range of known diagnoseson the wide range of known diagnoses
Example:Example:In the Search text box, you type ‘pneumonia’,In the Search text box, you type ‘pneumonia’,
there are many types of pneumonia in ICD-10,there are many types of pneumonia in ICD-10,
..and the various types by aetiology show. ..and the various types by aetiology show. (Note: the cursor jumps to J18.9; the list starts with J12.0)(Note: the cursor jumps to J18.9; the list starts with J12.0)
Say we want to select ‘pneumonia; Haemophilus Say we want to select ‘pneumonia; Haemophilus influenzae’ (typing ‘pneum;h’ will do)..influenzae’ (typing ‘pneum;h’ will do)..
..double click, and the export box shows. ..double click, and the export box shows. Suppose you want to add a new type (e.g., ‘Amsterdam’). Suppose you want to add a new type (e.g., ‘Amsterdam’).
You can add that term, and also you may add this new type You can add that term, and also you may add this new type to your Thesaurus.. just click ‘Export and add’…to your Thesaurus.. just click ‘Export and add’…
..and now the label is added to your personal Thesaurus...and now the label is added to your personal Thesaurus.
Relationships to other Relationships to other classificationsclassifications
CONVERSIONS WITH ICPC-2CONVERSIONS WITH ICPC-2
ICD-10ICD-9-CM
ICIDH-2/ICF
Snomed-CTRead
MESH
ICPC-2
UMLS browser examplesUMLS browser examples
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
WHO FICWHO FIC
Reference classificationsReference classifications International Classification of Diseases (ICD)International Classification of Diseases (ICD) International Classification of Health International Classification of Health
Interventions (ICHI)Interventions (ICHI) International Classification of Function, International Classification of Function,
Disability and Health (ICF)Disability and Health (ICF) Anatomical Therapeutic Chemical (ATC)Anatomical Therapeutic Chemical (ATC)
Related classificationsRelated classifications ICPC, ICD-O-3, ICECIICPC, ICD-O-3, ICECI
ICHI
ICF ICD
ATCDDD
Thesaurus
UMLS
ICPC
ICPC within WHO-FICICPC within WHO-FICICPC is the ordering principle of the domain of primary care and acts as the link between other classifications in the FIC
WHO-FIC
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
Research into diagnosticsResearch into diagnostics
Collecting data on all elements of the Collecting data on all elements of the encounterencounter
Structuring data within episodes of careStructuring data within episodes of care Using a classification with the correct Using a classification with the correct
granularitygranularity Using Bayesian statistical methods to Using Bayesian statistical methods to
study non-linear relationshipsstudy non-linear relationships The Transition ProjectThe Transition Project
REASONS FOR ENCOUNTER AT START REASONS FOR ENCOUNTER AT START
OF EPISODE BY ICPC-CHAPTER (%)OF EPISODE BY ICPC-CHAPTER (%)
0
10
20
30
40
A B D F H K L N P R S T U W X Y Z
NETH J APAN POLAND MALTASERBIA
NEW EPISODES OF CARE NEW EPISODES OF CARE BY ICPC-CHAPTER (%)BY ICPC-CHAPTER (%)
0
10
20
30
40
A B D F H K L N P R S T U W X Y Z
NETHJ APAN POLAND MALTASERBIA
Crosstab of new episode with start-RFE
Row % Row %Episode R96 Other epi Total
with RFE R02 66 26.5 183 73.5 249with other RFE 272 1.1 23403 98.9 23675Total 338 1.4 23586 98.6 23924Sens: 0.20 LR+: 25.17 LR-: 0.81 PV+: 0.27 Odds: 31.03 Pretest 0.01Spec: 0.99 int.: 19.40-32.64 int: 0.77-0.85 PV-: 0.99 int.: 22.86-42.13 Posttest: 0.36
Episode R02 Other epi Totalwith RFE R96 0 0 8 100 8with other RFE 16 0.1 23900 99.9 23916Total 16 0.1 23908 99.9 23924
SOB as a predictor of diagnosis of asthma
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
Recent advancesRecent advances
Entry into WHO-FICEntry into WHO-FIC Research into diagnosticsResearch into diagnostics ICPC-3ICPC-3
ICPC-3ICPC-3
Work has started recentlyWork has started recently ICPC structure will probably be maintained due ICPC structure will probably be maintained due
to relationships with ICD within WHO-FICto relationships with ICD within WHO-FIC New types of data one can record?New types of data one can record?
Classification of objective findings and investigations Classification of objective findings and investigations
Data elements for classification and for EPRData elements for classification and for EPR Linkages to other classifications yet to comeLinkages to other classifications yet to come