icpc-3 · 2012. 1. 2. · transition project dr. c. van boven icpc-3 prevention: the actions taken...
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Transition project Dr. C. van Boven
ICPC-3
Decisions to make
ICPC has to fit on a 2 pager?
ICPC must aIso fit for “community care”?
Changes as little as possible?
Ready in 2 years?
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Transition project Dr. C. van Boven
ICPC-3
The core of ICPC
Episode of Care in the context of time and co-morbidity
Prevalence and Clinical importance
(Rubrics)
Reason for Encounter
Taxonomic rules
Bi-axial, chapters and components
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Transition project Dr. C. van Boven
ICPC-3
Criteria for changing rubrics (1)
Clinical relevance
Prevalence
Consensus
Data
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Transition project Dr. C. van Boven
ICPC-3 Criteria/considerations for changing rubrics (2)
For major changes as deletion or addition of new rubrics,
movement to another rubric.
Is it/are there/do we have
A broader view (community care, more prevention)
New disease? (SARS)
Change in clinical knowledge?
Change in clinical terminology?
Need for greater or less specificity?(Other infect. Diseases)
Changes in clinical management?(RF management)
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Transition project Dr. C. van Boven
ICPC-3 Proposals
Change of code structure from Julie, Helena and Graeme
Change of code structure from Erik and Marianne
From Jean Karl (process)
Merging the X and Y chapter
My proposal: new prevention rubrics in component 1 or 7
Risk factors in the process rubrics
Clinical findings/significant events opened via process
rubrics (ICT solution)
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Transition project Dr. C. van Boven
ICPC-3
In daily work a GP integrates the information
he/she knows about the patient (demographics
social structure, preferences and the functional
status, risk factors significant events) in the
episode of care. There is a need to register that
information to get a better view in the way we act
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Transition project Dr. C. van Boven
ICPC-3
Prevention: the actions taken to avoid occurrence or
development of a health problem and/or its complications.
Can be divided into four categories etc:
But
The concept primum non nocere must dominate the
assessment of currently advocated preventive procedures
and the considerations of new procedures
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Transition project Dr. C. van Boven
ICPC-3
Definition Risk Factor
WONCA DICTIONARY of GENERAL/FAMILY
PRACTICE
an item of personal behavior or lifestyle, exposure,
or individual characteristic which is known to be
associated with ill health or considered important
in prevention of health problems
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Transition project Dr. C. van Boven
ICPC-3
Types of RFs
Behavioral risk factors
Environmental risk factors
Biological risk factors
Genetic risk factors
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Transition project Dr. C. van Boven
ICPC-3 Difficulties with RF in the ICPC structure
(Nijmegen, Sebastian)
Most are life lasting
Its natural level is the patient rather than
encounter
Complex to apply the Episode of Care?
Limited when using RFE mode?
Not a one to one relationship (RF/HP)
A RF can be also a health problem
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Transition project Personal,environmental, genetic history: a RF?
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Henk Lamberts
Signicifant event: RF?
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Transition project Dr. C. van Boven Family history RF
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Transition project Dr. C. van Boven Transition project core quality
Embrace the diversity
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Transition project core quality Dr. C. van Boven
The importance of epidemiology
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Dr. C. van Boven Transition project core quality
Expressing Humanism
Part of the
patient
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Dr. C. van Boven Transition project core quality
Expressing Humanism
Treatment: whole patient
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Table 3.- ICPC 2
Symptoms/complaints
Process components
Diagnoses/diseases
-INFECTIONS
-NEOPLASMS
-INJURIES
-CONGENITAL ANOMALIES
-OTHER DIAGNOSES
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DATA ENTRY
RFE:
Symptom/
Complaintor
Diagnosis
RFE:
Request for
intervention
Clinical
Findings
Diagnosis
+ Certainty
and
Episode
Status
Process
Intermediate
Intervention(s)
Process
Resulting
Inter-vention(s)
Almost every box could contain
RF or an examination for RF
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ICPC 2, process/intervention
components
Diagnostic and prev.procedures
Medication, treatment, therapeutic procedures
Results
Administrative
Referrals and other reasons for encounter
-
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ICPC 2, process/intervention
components
33 opens to a list of sensitivity tests
34 opens to a list of blood test
50 opens to a drug list (ATC coded)
53 opens to a list of instrumentation etc.
66 opens to a list of referrals to primary
67 opens to a list of specialist
? opens to a list of Risk factors or important information-
? opens to a list/classification of functional status
All data you stored, medication, test results, episodes pop up if needed in the episode of care
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Person:
demographics
social structure
goals, preferences
functional status (?)
Problem(s):
RFE as starting point
current/active
severity
Clinical Modifiers:
prevention
risk factors
significant events
Actions (“Process”):
Decisions
Interventions
Plans
Time:
Episode structure
Data import/export:
Exchange protocols
A Primary Care Data Model: simple building blocks to capture complex reality.
STRUCTURE
Klinkman, Phillips, Green, Pace: 2008
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Person:
demographics
social structure
goals, preferences
functional status (?)
Problem(s):
RFE as starting point
current/active
severity
Clinical Modifiers:
prevention
risk factors
significant events
Actions (“Process”):
Decisions
Interventions
Plans
Time:
Episode structure
Data import/export:
Exchange protocols
ICPC provides structure and some (basic) content.
STRUCTURE
ICPC
ICPC (minimally)
ICPC (process)
ICPC
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Transition project Dr. C. van Boven
Presentation History
General Introduction
Content in more detail. Coding the RFE, Diagnosis etc.
Data/information from the Dutch Transition Project
Conclusions