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