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1
ICF – Aktuelle Entwicklungen aus der
internationalen Perspektive
ICF Anwendertagung
REHAB Basel, 05. Dezember 2013
Birgit PRODINGER, PhD, MSc Projektleitung, ICF Unit, Schweizer Paraplegiker Forschung (SPF)
Lehrbeauftragte, Seminar Health Sciences and Health Policy, Universität Luzern
2
Herausforderungen, gegenwärtige Entwicklungen und damit verbundene
Risiken und Nebenwirkungen in der Implementierung der ICF als
internationalen Standard zur Beschreibung und Messung von Gesundheit und
Behinderung
http://www.who.int/classifications/icf/en/
05.12.2013, Birgit Prodinger
3
Ausgangssituation: Internationaler Kontext
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Information als Entscheidungsgrundlage
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Information als ein Baustein von
Gesundheitssystemen
http://www.biomedcentral.com/1472-698X/11/13/figure/F1
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6
Beispiel: Schweizer Gesundheitssystem
http://www.public-health.ch/logicio/pmws/publichealth__home__de.html
http://www.samw.ch/de/Publikationen/Bulletins/Archiv.html
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GesundheitsINFORMATIONsysteme
http://www.samw.ch/de/Publikationen/Bulletins/Archiv.html
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Interoperabilität Nahtlose Zusammenarbeit unterschiedlicher Systeme
Technisch
Syntaktisch Systeme
Semantisch Konzepte
Organisatorisch Normen, Standards, Richtlinien, Gesetze
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WHO’s Familie der Klassifikationen
http://www.who.int/classifications/en/FamilyDocument2007.pdf
http://www.who.int/classifications/icf/en/
Semantic interoperability
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10
Chancen von Standardisierung
- Fragmentierte Datenerhebung
- Mangelnde Kommunikation und Koordination
- Mangelnde Verfügbarkeit von Informationen über den Kontext der
Datenerhebung hinaus
- Redundante Datenerhebung
http://www.wdpo.org/world-data-protection-harmonization-standardization/
05.12.2013, Birgit Prodinger
11
Kostensenkung
Effizienz
Einheitliche Terminologie
Vergleichbarkeit
Planung und Kontrolle
Innovation
Rasche Umsetzung
Differenzierung (abhängig von z.B. Kontext und Zweck)
Standardisierung – Chancen und Risiken
Harmonisierung ist nicht ausreichend für Interoperabilität
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Konzeptualisierung und Klassifizierung
Was beschreiben? Messung
Wie messen? Berichterstattung
Wie berichten?
http://www.dwaynebaraka.com/blog/2013/06/17/gris-g4-materiality-transparency-comparability-fight/
Klassifikation: Einteilung von Objekten anhand bestimmter Merkmale http://touque.ca/EC/students/GuptaR/html/Assig
nments/what_if_my_name_was.html
http://www.kpn.de/smart-reporting
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13
Vergleichbarkeit von Inhalten
«Was beschreiben?»
ICF Core Sets
Comprehensive ICF Core Sets
Brief ICF Core Sets
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14
Verfügbare ICF Core Sets
Further ICF Core Sets are in development • E.g. after lower
limb amputation
ACUTE EARLY-POST ACUTE LONG-TERM
Neurological conditions Neurological conditions Multiple sclerosis
Stroke (also as a cardiopulmonary condition)
Traumatic brain injury
Spinal Cord Injury Spinal Cord Injury
Cardiopulmonary
conditions
Cardiopulmonary
conditions
Chronic ischemic heart disease
Diabetes mellitus
Obesity
Obstructive pulmonary diseases
Musculoskeletal
conditions
Musculoskeletal
conditions
Ankylosing spondylitis
Chronic widespread pain
Low back pain
Osteoarthritis
Osteoporosis
Rheumatoid arthritis
Acute inflammatory
arthritis
For geriatric patients
Bipolar disorders
Depression
Breast cancer
Head and neck cancer
Hand conditions
Hearing loss
Inflammatory bowel diseases
Sleep
Vertigo
Vocational Rehabilitation
http://www.icf-research-branch.org/
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15 05.12.2013
Generic Set
Extended Generic Set
Generic Set
Disability Set (Extended Generic Set)
ICF Core Set for specific health condition, e.g. Spinal cord injury
b110 Consciousness functions
b126 Temperament and personality functions
b130 Energy and drive functions b130 Energy and drive functions b130 Energy and drive functions
b134 Sleep functions b134 Sleep functions
b140 Attention functions
b152 Emotional functions b152 Emotional functions b152 Emotional functions
… …
b280 Sensation of pain b280 Sensation of pain b280 Sensation of pain
… …
b455 Exercise tolerance functions b455 Exercise tolerance functions
… …
b640 Sexual functions b640 Sexual functions
b670
Sensations associated with genital and
reproductive functions
b710 Mobility of joint functions b710 Mobility of joint functions
b715 Stability of joint functions
b730 Muscle power functions b730 Muscle power functions
… …
s120 Spinal cord and related structures
s430 Structure of respiratory system
… …
d230 Carrying out daily routine d230 Carrying out daily routine d230 Carrying out daily routine
d240 Handling stress and other psychological
demands d240 Handling stress and other psychological
demands
d360 Using communication devices and techniques
… …
d450 Walking d450 Walking d450 Walking
d455 Moving around d455 Moving around d455 Moving around
d460 Moving around in different locations
d465 Moving around using equipment
d470 Using transportation d470 Using transportation
… … … …
d850 Remunerative employment d850 Remunerative employment d850 Remunerative employment d870 Economic self-sufficiency
d910 Community life
d920 Recreation and leisure d920 Recreation and leisure
d930 Religion and sprituality
+ Environmental factors + Environmental factors
16
Beispiel Querschnittlähmung
«Was beschreiben?»
Langzeit-versorgung
Querschnitt-lähmung
(Biering-Sorensen et al. 2006; Cieza et al. 2010;
Kirchberger et al. 2010)
Validierungsstudien, zB ICF Core Sets für Rückenmarksverletzungen (Langzeitversorgung) - ErgotherapeutInnen (Hermann et al., 2011)
- PhysiotherapeutInnen (Hermann et al., 2011)
PatientInnenperspektive (Lüthi et al. 2011)
Akutver-sorgung
Neurologische Erkrankungen
Post-akute Versorgung oder
Frührehabilitation
Querschnitt-lähmung
Statistisches Set: Querschnitt-
lähmung (Ballert et al. 2012)
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Vergleichbarkeit und Anwendbarkeit von
Instrumenten in einem bestimmten Kontext
«Was messen?»
Inhaltlich angemessen
Verlässlich
Zweckmässig und praktikabel
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…
b1 b130 b134 b152 b180 b1801 • • • s299 s710 s720 s730 s73001 s73011 • • • d170 d230 d360 d410 d415 d430 • • •
e110 e115 e120 e125 e135 e150 • •
RAQoL
Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep
HAQ Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep
SF-36 INSTRUCTIONS: This survey asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every question by marking the answer as indicated. If you ar unsure about how to answer a question, please give the best answer you can.
EQ-5D
Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep
MFI Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep
CES-D INSTRUCTIONS: This survey asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every question by marking the answer as indicated. If you ar unsure about how to answer a question, please give the best answer you can. ICF Linking rules
(Cieza et al. 2002; 2005)
Vergleichbarkeit von Inhalten
Instruments, assessments and clinical tests Regardless of mode of administration - Paper-pased - Computer-based - Interviewer-administered - Self-reported - Proxy-reported - Expert-conducted
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Vergleichbarkeit der Inhalte
MFI-20 (Multidimensional Fatigue Inventory)
I feel fit.
I feel very active.
I feel tired.
I am rested.
Physically, I feel only able to do a little.
Physically, I can take on a lot.
I tire easily.
Physically, I feel I am in excellent condition.
CES-D (Center for Epidemiologic Studies Depression Scale)
I felt that everything I did was an effort.
I could not get “going”.
SF-36 (Short form Health Survey)
Did you have a lot of energy?
Did you feel worn out?
Did you feel tired?
RAQOL (Rheumatoid Arthritis Quality of Life)
It’s too much effort to go out and see people.
I have to keep stopping what I am doing, to rest.
I feel tired whatever I do.
b130 Energy and drive functions
Cieza et al. (2009) 05.12.2013, Birgit Prodinger
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Vergleichbarkeit der Metrik
http://www.cosmin.nl/images/upload/File/checklist%20final%20feb%202010.pdf
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Vergleichbarkeit der Metrik
Magasi & Post (2010)
IMPACT-S: ICF Measure of Activity and Particiaption – Screener; IPA: Impact on Autonomy and Participation; KAP: Keele Assessment of Participation; LIFE-H: Assessment of Life Habits; PAR-PRO: Participation Profile; PARTS/M: Participation Survey/Mobility; PM-PAC: Participation Measure for Post Acute Care; P-Scale: Participation Scale
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Vergleichbarkeit der Metrik
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 10
0
SF_4i Did you feel tired?
M FI_20 I could not get “going”
QoLRA I feel tired whatever I do.
QoL10 I have to keep stopping what I am doing to rest
M FI_12 I am rested
M FI_16 I tire easily
M FI_1 I feel fit
M FI_8 Physically I can take on a lot
M FI_5 I feel tired
M FI_3 I feel very active
SF_4e Did you have a lot of energy?
M FI_2 I did not feel like eating; my appetite was poor
SF_4g Did you feel worn out?
DE_07 I felt that everything I did was an effort
CES_20 I could not get “going”
QoLRA_25 It’s too much effort to go out and see people
0
MFI 2: Physically, I feel only able
to do a little
SF-36 9e: Did you have a lot of
energy?
MFI 3: I feel very active
MFI 5: I feel tired
RAQoL 25: It’s too much effort
to go out and see people
CES-D 20: I could not get „going“
CES_D 07: I felt that everything I
did was an effort
SF-36 9g: Did you feel worn out?
MFI 8: Physicaly, I can take a lot
MFI 1: I feel fit
MFI 16: I tire easy
MFI 12: I am rested
RAQoL 10: I have to keep
stopping what I am doing, to rest
RAQoL 21: I feel tired whatever I
do
MFI 20:Physically, I feel I am in a
excellent condition
SF-36 9i: Did you feel tired? 43.3
45.5
46.4
47.9
48.1
48.1
50.8
52.0
52.6
52.6
54.8
56.1
60.6
62.1
62.9
67.7
4% 24% 49% 95%
Raw Score (16 Items)
Logit scale ICF category interval scale
(0 to 100)
ICF Qualifier
0 -6.36 0 0
1 -4.72 14
2 -3.81 21 1
3 -3.29 26
4 -2.94 29
5 -2.66 31
6 -2.43 33
7 -2.23 35
8 -2.05 36
9 -1.9 37
10 -1.75 39
11 -1.62 40
12 -1.49 41 2
13 -1.37 42
14 -1.26 43
15 -1.15 44
16 -1.04 45
17 -0.94 45
18 -0.84 46
19 -0.74 47
20 -0.64 48
21 -0.54 49
22 -0.45 49
23 -0.35 50
24 -0.25 51
25 -0.15 52
26 -0.05 53
27 0.05 54
28 0.15 54
29 0.26 55
30 0.36 56
31 0.47 57
32 0.59 58
33 0.7 59
34 0.82 60
35 0.95 61
36 1.08 62 3
37 1.22 63
38 1.36 65
39 1.51 66
40 1.67 67
41 1.84 69
42 2.03 70
43 2.23 72
44 2.45 74
45 2.7 76
46 2.97 78
47 3.28 81
48 3.65 84
49 4.1 88
50 4.72 93
51 5.59 100 4
Conversion table: Mapping on to ICF
qualfifier
Cieza et al. (2009)
Psychometrische Analyse zur Erstellung einer gemeinsamen Metrik
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Vergleichbarkeit der Metrik
UBS: Unified Balance Scale BBS: Berg Balance Scale; POMA: Performance Oriented Mobility Assessment; TUG: Time Up and Go Test; TB: Tinetti balance; TW: Tinetti Walking; FAB: Fullerton Advanced Balance Scale.
La Porta et al. (2011) 05.12.2013, Birgit Prodinger
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Standardisierte Berichterstattung
«Wie berichten?»
Standardisierte Berichterstattung erfordert
Vergleichbarkeit der Inhalte und Metrik.
ICF
Instrumente, Assessments, Tests zur Datenerhebung in der
Praxis
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ICF Qualifier als Messskala
Standardisierte Berichterstattung
«Wie berichten?» Spinal Cord Independence Measure (SCIM)
10 meter walk test (10MWT)
Walking Index for Spinal Cord Injury (WISCI II)
Graded and Refined Assessment of Strength, Sensibility, and Prehension (GRASSP)
usw.
Hospital Anxiety and Depression Scale (HADS)
Hospital Anxiety and Depression Scale (HADS)
Positive and Negative Affect Scale (PANAS)
ICF-basierte Berichterstattung
ICF Core Sets
Item Bank
Co-Kalibrierung der Items
Item Pool
Vergleich von Inhalten und Metrik
ICF Qualifier als Referenzskala
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(Cieza et al. 2009)
La Porta et al. (2011)
(Fellinghauer et al. 2010) (Van Buuren et al. 2005) (Spreyermann et al. 2011)
Berichterstattung
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Psychometrische Architektur der
Funktionsfähigkeit braucht «Cross-walk»
05.12.2013, Birgit Prodinger
Existierende
Instrumente
ICF qualifiers
als
Messinstrument
- Lokale, nationale, und internationale Vergleichbarkeit von Testwerten in Praxis und Forschung (zB Meta-Analysen)
- Universelle anwendbar, d.h. unabhängig von lokalen Ressourcen
29
Entwicklung einer Architektur zur ICF-basierten
Berichterstattung und Datenerhebung
Prof. Dr. Gerold Stucki Prof. Dr. Jerome Bickenbach
Dr. Birgit Prodinger Prof. Dr. Alan Tennant Prof. Dr. Alarcos Cieza
Carolina Ballert Maren Hopfe Mirjam Brach
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GesundheitsINFORMATIONsysteme
31
Elektronische Kranken-
geschichten
Klinische Terminologie
Klassifikation
- Supportsystem für klinische Entscheidungen
- Semantisch interoperabler Informationsaustausch
- Krankheits-, Gesundheits- und Behinderungsstatistiken
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WHO’s Familie der Klassifikationen – Joint use
http://www.who.int/classifications/en/FamilyDocument2007.pdf Functioning Topic Advisory Group (fTAG)
Revisions of ICD-10
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«Risiken und Nebenwirkungen»
• Operationalisierung
• Klinische Terminologie <-> Klassifikation
• Implementierung von ICF-basierter Berichterstattung auf allen Systemebenen
• Anwendung ICF-basierter Information als Entscheidungsgrundlage
05.12.2013, Birgit Prodinger