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					    The Dutch Family of
International Classifications:
  ICPC-2, ICD-10, and ICF

              Dr KEES VAN BOVEN
      Dutch College of General Practitioners
Roles of the Dutch family
members

In general practice electronic patient records
 diagnostic ordering principle for the GP: ICPC-2
 diagnostic specificity: ICD-10
     (combined in one tool: ICPC2-ICD10 thesaurus)
 additional data on functioning and disability: ICF
INTERNATIONAL
CLASSIFICATION
OF PRIMARY CARE
      ICPC-1: 1987
      ICPC-2:1998
     ICPC-2-E: 2000
A classification is the
ordering principle of a
defined domain
ICPC:

    THE DOMAIN OF
   FAMILY PRACTICE…

        quantitatively…..
SYMPTOMS DIAGNOSES
   200        400     ICPC: > 1 PER 1000 PPY


    600




                     ICD: <1 PER 1000 PY
            10.000
and qualitatively…..
DESCRIBES THE CONTENT OF
PATIENT-FP ENCOUNTERS
 localization before etiology
 symptoms AND diagnoses
 -28 impairment category
 -27 fear of .. category
 -64 category (FP’s initiative)
 social problems
 patient and FP oriented
What is the unit of observation
in family medicine?
 Patients?
 Doctors?
 Encounters?
 Diagnoses?

 Episodes: the patient with his/her
 problem over time
episode of care

  health problem from the first
  encounter for it with a health care
  provider till the last one
      EPISODE OF CARE

Perceived        Perceived        RFE,       Diagnosis   Process
health problem   need for care    demand
                                  for care




                                  RFE,       Diagnosis   Process
                                  demand
                                  for care




                                 RFE,        Diagnosis   Process
                                 demand
                                 for care
ICPC

 bi-axial structure
 17 alpha-coded chapters based on body
 systems/problem areas
 7 identical components, with rubrics
 bearing a two-digit numeric code
ICPC Chapters (Systems)
A   General and unspecified
B   Blood/bloodforming organs, lymphatics (spleen, bone marrow)
D   Digestive
F   Eye (Focal)
H   Ear (Hearing)
K   Circulatory
L   Musculoskeletal (Locomotion)
N   Neurological
P   Psychological
R   Respiratory
S   Skin
T   Endocrine, metabolic and nutritional (Thyroid)
U   Urological
W   Pregnancy, child bearing, family planning (Women)
X   Female genital (X-chromosome)
Y   Male genital (Y-chromosome)
Z   Social problems
 ICPC Components
Components (standard for each chapter)             CODES

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

 Core Elements
     Reasons for encounter
     Health problems/diagnoses = Episode Title
     Process of care/interventions
     (Outcomes)
 Transitions
     One or more encounters, including changes in their
      relations over time
Episodes of care
Reason for encounter (RFE)
The agreed statement of the reason(s)
why a patient enters the health care
system, the demand for care by that
person.
    Symptoms or complaints (headache, tiredness,
     feeling depressed, having fear of cancer)
    Known diseases (diabetes, hay fever)
    Requests: for preventive or diagnostic services
     (a blood pressure check or an ECG), a request
     for treatment (repeat prescription), getting
     information, or test results, or administrative
     procedure (a medical certificate).
It is the PATIENT’S statement, clarified
by the doctor.
Episodes of care
Reason for encounter (RFE)


 This is a true primary care concept

 Primary Care is RFE driven, not diagnosis
 driven
Episodes of care
Health problem: the diagnosis
   Certainty
   Status
Clinical findings
   No coding (yet) for everything in
    primary care
TOOLS
ICPC-2
    1404 terms including all process codes
    Acts as ordering principle
    Common entities have distinct codes
    Surprisingly complete given small size
    Context of episode adds specificity
ICD-10
    14,000 terms
    Adds clinical specificity to ICPC
Episodes of care
Processes of care
   Diagnostic/preventive procedures
   Treatment, procedures and medication
   Tests and results
   Administrative
   Referrals
Outcome
   Functional status, ICF, WONCA/COOP
    indicators
   Severity of illness, DUSOI
Episode example
   23 yr old woman typist, tennis player
   RFE: pain R elbow for 10 days, and can’t
   use R arm at work:
   ICPC code?
     L10 & L28

   Process: Tenderness R lat. Epicondyle:
   ICPC code?
     L31 Partial examination

   Diagnosis: Tennis elbow:
   ICPC code?
     L93

   Process: Steroid injection:
   ICPC code?
     L55
Episode of care
         RFE
1st               Health Problem   Intervention
visit   feeling
                    fatigue           Hb
         tired

2nd      RFE                       Intervention
                  Health Problem
visit    test                       barium
        result      anemia          enema

3rd       RFE
                  Health Problem   Intervention
visit    test
        result      Ca colon        referral
Episodes of care

 Transitions
     An episode may occur over many
      encounters
       Diabetes is a lifelong episode
     Each encounter may have more
      then one episode assessed
     Many to many relationship
      between episodes and encounters
Possibilities for data on functioning & disability

   Classification of Body Functions
     in patients’ Reasons for Encounter, as symptoms and
     complaints,
     in GP’s clinical observations, as extension of ICPC
     process mode
   Classification of Activities and Participation
     involves clinical consequences of a specific episode of
     care, resulting in limitations, as extension of ICPC
     process mode
   Qualifiers for Function and Activities & Participation
     might be quite useful for family practice
                   Health condition
                 (disorder or disease)



Body function         Activities            Participation
and structures




          Environmental               Personal
           Factors                    Factors
                    COPD (ICPC/ICD code)




Breathlessness         Can`t get upstairs         No work
Poor condition




             Living in a flat               Smoking
    Case history Mr De Vries, age 72
• Present complaints       • ICPC code
• Shortness of breath      • R02
• Palpitations             • K04

•   Findings               •   ICPC - ICF code
•   Hypotension            •   K43 - B4201
•   Bradycardia            •   K43 - B410
•   Can’t get upstairs     •   K48 - D460
•   Walking difficulties   •   K48 - D450
                 Relation ICF and ICPC
           ICF                ORDENING            RELATION WITH ICPC
                                 ICF
Body Functions               Physiological In each chapter:
                             Chapters      1st component: -28 code as RFE;
                                           2nd component, the -43 code as
                                           process code
Body Structures              Anatomical    None
                             Chapters
Activities & Participation   9 domains     In each chapter:
                                           2nd component, the -48 code as
                                           process code
Contextual Factors           5 domains     Chapter Z: social problems;
(environmental and                         especially as RFE
personal)
     Activities and Participation
         and ICPC chapters
• Learning/knowledge       •   Chapters K,N,P and Z
• General tasks            •   Chapters F,K,N,P and Z
• Communication            •   Chapters F,H,K,N and P
• Mobility                 •   Chapters F,K,L and N
• Selfcare                 •   ?
• Domestic life            •   ?
• Interpersonal            •   Chapters P and Z
  interactivity            •   Chapters P and Z
• Major life areas         •   Chapters P and Z
• Community, social life   •   ?
    REFERRAL WITH ICPC2-ICD10-DIAGNOSIS AND A
G   SELECTION OF THE ICF CLASSIFICATION: BODY   P
E    FUNCTIONS AND ACTIVITIES/PARTICIPATION     H
                                                Y
N
         INTAKE, SELECTION OF B.F. and A/P,     S
E
             ADDITIONAL INFORMATION             .
R
A                                               T
L                                               H
                  RESULTS ADDED
.
                                                E
P
                                                R
R                 FINAL REPORT
                                                A
A
                                                P
C
         POSSIBLY: REQUEST FOR FURTHER          I
T                   TREATMENT                   S
.
                                                T
                Future
University of Ghent: relation between ICF-
functions and components 1 and 2 of ICPC

University of Amsterdam: relation between
ICF-activities/participation and component 2
of ICPC

WICC: relation between ICF-external factors
and chapter Z of ICPC?
            Data Model
            Basic Unit:
            The episode at an encounter


 RFE:     RFE:                                 Health                  Outcome
                                              Problem                   COOP
 Sympt.    Inter-   Intermediate   Clinical               Subsequent
Complt.   vention   Intervention   Findings      +           Inter-     ICF
Problem                                       Certainty     vention
                                                                       DUSOI
                                    ICF?      & Status



               Repeated for each episode at that
                          encounter
              Repeated at each encounter for that
                       health problem

				
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