icpc-3 · 2012. 1. 2. · transition project dr. c. van boven icpc-3 prevention: the actions taken...

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?

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

Transition project Dr. C. van Boven

ICPC-3

Criteria for changing rubrics (1)

Clinical relevance

Prevalence

Consensus

Data

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)

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)

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

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

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

Transition project Dr. C. van Boven

ICPC-3

Types of RFs

Behavioral risk factors

Environmental risk factors

Biological risk factors

Genetic risk factors

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

Transition project Personal,environmental, genetic history: a RF?

Henk Lamberts

Signicifant event: RF?

Transition project Dr. C. van Boven Family history RF

Transition project Dr. C. van Boven Transition project core quality

Embrace the diversity

Transition project core quality Dr. C. van Boven

The importance of epidemiology

Dr. C. van Boven Transition project core quality

Expressing Humanism

Part of the

patient

Dr. C. van Boven Transition project core quality

Expressing Humanism

Treatment: whole patient

Table 3.- ICPC 2

Symptoms/complaints

Process components

Diagnoses/diseases

-INFECTIONS

-NEOPLASMS

-INJURIES

-CONGENITAL ANOMALIES

-OTHER DIAGNOSES

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

ICPC 2, process/intervention

components

Diagnostic and prev.procedures

Medication, treatment, therapeutic procedures

Results

Administrative

Referrals and other reasons for encounter

-

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

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

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

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