Improving the Population’s Health
Through Standards: The Case for ICF
ICDR State-of-the-Art Conference
New Federal Applica...
Presentation Agenda
• Appreciation
• The Case for Data Standards and ICF
• International Classification of Functioning,
Di...
Underlying Assumption
Information on functional status is becoming
increasingly essential for fostering healthy people
and...
What are Data Standards?
• Essential Building Blocks of Information
Systems
– Classification Systems and Terminologies (e....
The Case for Data Standards
• Data Standards are the common language
that allows:
– sharing information
– communication ac...
WHO Family of
International Classifications
• A suite of classifications for international
use as meaningful information t...
WHO Family of Classifications
REFERENCE
Classifications
II nternationalnternational
CC lassification oflassification of
DD...
WHO Collaborating Centres for
International Classifications
• ICD and ICF are maintained and promoted by an
international ...
WHO Collaborating Centres for
International Classifications
• Centres are established by language and
geography
• North Am...
International Classification of
Impairments, Disabilities and
Handicaps (ICIDH)
• WHO developed preliminary scheme
concern...
New paradigm vs. Old paradigmNew paradigm vs. Old paradigm
Everyone may haveEveryone may have
disabilitydisability
Continu...
World Health AssemblyWorld Health Assembly
May 2001May 2001
Endorse and publish ICFEndorse and publish ICF
use the ICF in ...
ICF as an International StandardICF as an International Standard
• to provideto provide aa scientific basisscientific basi...
Availability of ICF
• Developed and published simultaneously in
the six WHO official languages:
– English Spanish French
–...
Multilingual CD-ROM BrowserMultilingual CD-ROM Browser
& Internet Edition& Internet Edition
• classification in its treecl...
The ICF Online Browser!
http://www3.who.int/icf/onlinebrowser/icf.cfm
Foundations of ICFFoundations of ICF
Human FunctioningHuman Functioning -- notnot merely disabilitymerely disability
Unive...
Health ConditionHealth Condition
((disorder/diseasedisorder/disease))
Interaction of ConceptsInteraction of Concepts
ICF 2...
Tear of articular cartilage of knee
S 83.3
4th
floor without lift
Crutches
Physical therapy
Pain medications
(60 yr old,
m...
ICF ComponentsICF Components
Body FunctionsBody Functions
&&
StructuresStructures
ActivitiesActivities
&&
ParticipationPar...
Body Functions and StructuresBody Functions and Structures
Skin and related structuresSkin and related structuresFunctions...
Activities and ParticipationActivities and Participation
DomainsDomains
11 LearningLearning &Applying Knowledge&Applying K...
Activities and ParticipationActivities and Participation
Domains: Four OptionsDomains: Four Options
• Activity is the exec...
Environmental FactorsEnvironmental Factors
1.1. Products and technologyProducts and technology
2. Natural environment and ...
Every ICF Code requires a
Qualifier
• Depending on the ICF domain, the base ICF code
can be modified to impart information...
Every ICF Code requires a
Qualifier
• Body Structures codes can include up to 3 post-
decimal Qualifier digits, representi...
ICF StructureICF Structure
ClassificatioClassificationn
PartsParts
ComponentsComponents
Constructs/Constructs/
qualifiersq...
How many codes adequately
describe a case?
• In ICF, a person’s health state may be assigned an
array of codes across the ...
ICF Checklist and Core Sets
• WHO has developed an ICF Checklist with a short
list of body function and body structure cod...
ICF is not……
• An assessment or
measurement tool.
• It is a framework
and set of
classifications on
which assessment
and m...
ICF and Terminology
• A terminology is a formal system of linguistic
symbols that support meaning conveyance in a
conceptu...
ICF Adaptations
• No country adaptations
• No discipline-specific adaptations
• However, nature and form of functioning in...
NCVHS 2001 Report
Findings
• Health care and health policy must go
beyond a narrow disease-based focus
• ICF is a promisin...
NCVHS 2001Report
Recommendations
• Functional status information should be reported
at appropriate intervals in standardiz...
Consolidated Health
Informatics Initiative (CHI)
• Phase II report of CHI Disability Workgroup
completed in 2006
• Recomme...
Institute of Medicine
Future of Disability in America
• Disability in the form of limited activities and
restricted partic...
WHO-FIC Network
Priorities for ICF
• Raising Awareness and Education
• Applications in four areas
– Health and Disability ...
WHO-FIC Functioning and
Disability Reference Group
• Established in 2006 with eight projects and active
North American par...
North American CC
Dissemination and Education
• Periodic newsletter from North American
Collaborating Center (NACC)
http:/...
Annual NACC Conferences
• Pre-conference Tutorial in 2004 (10th
Conference)
“Understanding ICF in the Terminology Spectrum...
Dissemination and Education:
ICF workshops in 2006-2007
• American Congress of Rehabilitation Medicine
and American Societ...
North American CC
Dissemination and Education
• Developed ICF tabletop exhibit and
brochure for use at meetings
• Publishe...
Dissemination and Education
Code ICF
• An interactive web-based training tool, developed
by NCHS in collaboration with WHO...
Dissemination and Education
Host ICDR Subcommittees
• From 2004 – 2006 the Interagency
Subcommittee on New Freedom Initiat...
Dissemination and Education
Seminars and Workshops
• Seminar on ICF and International
Collaborative Research (CIRRIE 2003)...
Health and Disability Statistics:
Use of ICF in Surveys
• Collect data on all levels of functioning or
targeted areas
• Co...
CDC Surveys
• National Health Interview Survey (NHIS) and
Behavioral Risk Factor Surveillance Survey have
included questio...
CDC- supported survey research
• Washington University developed a
community health environment checklist
based on ICF and...
International Applications:
Health and Disability Statistics
• WHO World Health Survey (WHS)
– Designed to compile baselin...
International Applications
Health and Disability Statistics
• United Nations Disability Statistics Data Base
(surveys and ...
Research and Development
• NIDRR Long Range Plan for FY 2005 – 2009 invokes ICF
as conceptual guideline for extramural res...
Research and Development
• American Psychological Association is
working with other professional
associations to develop P...
North American
Research Agenda on ICF
• Identified 45 research priorities
• Participants assigned highest priorities:
– Cr...
North American
Research Agenda on ICF
• NCHS funded WHO to crosswalk ICF with
major assessment tools (results presented at...
Policy Applications
• ICF used as conceptual framework for disability-
related objectives in Healthy People 2010
• Use ICF...
Policy applications
• Several NIDRR-funded projects, including
the RRTC at Cornell University, feature
investigators inter...
ICF Implementation
• Promote ICF and ICF-CY use in WHO-FIC
priority areas
• Implement ICF as conceptual model and
classifi...
ICF Implementation
• Conduct research recommended by NCVHS,
NACC Research Agenda and CHI
• Promote collection of functiona...
ICF Implementation
• Contribute to guidelines development and
updating process for ICF through FDRG
• Improve ICF as a cla...
Challenges
• Who should report functional status –
patient, provider or both?
• How often should it be collected?
• Should...
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  1. 1. Improving the Population’s Health Through Standards: The Case for ICF ICDR State-of-the-Art Conference New Federal Applications of ICF Arlington, Virginia July 10-11, 2007 Marjorie S. Greenberg, M.A. (msg1@cdc.gov) National Center for Health Statistics, CDC Head, NACC
  2. 2. Presentation Agenda • Appreciation • The Case for Data Standards and ICF • International Classification of Functioning, Disability and Health (ICF) – WHO, What, Why, When, Where and How • Implementation of ICF in North America and internationally • Foreshadow selected Conference presentations
  3. 3. Underlying Assumption Information on functional status is becoming increasingly essential for fostering healthy people and a healthy population. Achieving optimal health and well-being for Americans requires an understanding across the life span of the effects of people’s health conditions on their ability to do basic activities and participate in life situations – in other words, their functional status. ----NCVHS June 2001 (http://www.ncvhs.hhs.gov/010617rp.pdf )
  4. 4. What are Data Standards? • Essential Building Blocks of Information Systems – Classification Systems and Terminologies (e.g., ICD, ICF, SNOMED) – Core Data Sets (vital statistics, hospital discharge data) – Identifiers (provider, plan, individual) – Message formats (e.g., HL-7 and X12) – Implementation Guides – Privacy and Security
  5. 5. The Case for Data Standards • Data Standards are the common language that allows: – sharing information – communication across disciplines – integration of disparate data systems – comparisons among data sets – linkage of data in a secure environment
  6. 6. WHO Family of International Classifications • A suite of classifications for international use as meaningful information tools to capture the core health dimensions, such as deaths, disease, disability and health as well as related health system parameters such as health interventions
  7. 7. WHO Family of Classifications REFERENCE Classifications II nternationalnternational CC lassification oflassification of DD iseasesiseases II nternationalnternational CC lassification oflassification of FF unctioning,unctioning, Disability & HealthDisability & Health II nternationalnternational CC lassification oflassification of HH ealthealth II nterventionsnterventions (under development)(under development) RELATED Classifications International Classification of Primary Care (ICPC) International Classification of External Causes of Injury (ICECI) The Anatomical, Therapeutic, Chemical (ATC) classification system with Defined Daily Doses (DDD) ISO 9999 Technical aids for persons with disabilities – Classification and Terminology DERIVED Classifications International Classification of Diseases for Oncology, Third Edition (ICD-O-3) The ICD-10 Classification of Mental and Behavioural Disorders Application of the International Classification of Diseases to Dentistry and Stomatology, Third Edition (ICD-DA) Application of the International Classification of Diseases to Neurology (ICD-10-NA) ICF, Children & Youth Version (ICF -CY)
  8. 8. WHO Collaborating Centres for International Classifications • ICD and ICF are maintained and promoted by an international network of WHO Collaborating Centres for the Family of International Classifications • Network includes Collaborating Centres, WHO HQ, WHO country and regional offices, other members of WHO member States, and non- governmental organizations http://www.who.int/classifications/en/
  9. 9. WHO Collaborating Centres for International Classifications • Centres are established by language and geography • North American Collaborating Center (NACC) was established at NCHS in 1976 • NCHS partners with Statistics Canada and Canadian Institute for Health Information • Designation is in partnership with Pan American Health Organization • http://www.cdc.gov/nchs/about/otheract/icd9/nacc .htm
  10. 10. International Classification of Impairments, Disabilities and Handicaps (ICIDH) • WHO developed preliminary scheme concerning consequences of disease in 1972 • First edition of ICIDH was published in 1980; reprinted with additional foreword in 1993. • Revision process for ICIDH initiated 1993 • Evaluation, conferences and field trials • Resulted in development of ICF
  11. 11. New paradigm vs. Old paradigmNew paradigm vs. Old paradigm Everyone may haveEveryone may have disabilitydisability ContinuumContinuum Multi-dimensionalMulti-dimensional Neutral languageNeutral language Specific impairmentSpecific impairment groupsgroups CategoricalCategorical Uni-dimensionalUni-dimensional Pathology languagePathology language
  12. 12. World Health AssemblyWorld Health Assembly May 2001May 2001 Endorse and publish ICFEndorse and publish ICF use the ICF in Member States in:use the ICF in Member States in: researchresearch surveillancesurveillance reportingreporting Joint use with ICDJoint use with ICD Operational subsets:Operational subsets: surveyssurveys clinical encountersclinical encounters Periodic revisionPeriodic revision
  13. 13. ICF as an International StandardICF as an International Standard • to provideto provide aa scientific basisscientific basis for consequences offor consequences of health conditionshealth conditions • to establish ato establish a common languagecommon language to improveto improve communicationscommunications • to permitto permit comparison of datacomparison of data across:across: – countriescountries – health care disciplineshealth care disciplines – servicesservices – timetime • to provide ato provide a systematic coding schemesystematic coding scheme for healthfor health information systemsinformation systems
  14. 14. Availability of ICF • Developed and published simultaneously in the six WHO official languages: – English Spanish French – Chinese Arabic Russian • Full version and short version • Public access on the internet • Electronic versions available
  15. 15. Multilingual CD-ROM BrowserMultilingual CD-ROM Browser & Internet Edition& Internet Edition • classification in its treeclassification in its tree structurestructure • Two languages at theTwo languages at the same timesame time • Advanced searchAdvanced search functionfunction • Cross references viaCross references via hyperlinkshyperlinks • Selects and work onSelects and work on subsetssubsets • Internet basedInternet based upgrading facilitiesupgrading facilities
  16. 16. The ICF Online Browser! http://www3.who.int/icf/onlinebrowser/icf.cfm
  17. 17. Foundations of ICFFoundations of ICF Human FunctioningHuman Functioning -- notnot merely disabilitymerely disability Universal ModelUniversal Model -- notnot a minority modela minority model Integrative ModelIntegrative Model -- notnot merely medical or socialmerely medical or social Interactive ModelInteractive Model -- notnot linear progressivelinear progressive ParityParity -- notnot etiological causalityetiological causality Context - inclusiveContext - inclusive -- notnot person aloneperson alone Cultural applicabilityCultural applicability -- notnot western conceptswestern concepts OperationalOperational -- notnot theory driven alonetheory driven alone Life span coverageLife span coverage -- notnot adult drivenadult driven
  18. 18. Health ConditionHealth Condition ((disorder/diseasedisorder/disease)) Interaction of ConceptsInteraction of Concepts ICF 2001ICF 2001 EnvironmentalEnvironmental FactorsFactors PersonalPersonal FactorsFactors BodyBody function&structurefunction&structure (Impairment)(Impairment) ActivitiesActivities (Limitation)(Limitation) ParticipationParticipation (Restriction)(Restriction)
  19. 19. Tear of articular cartilage of knee S 83.3 4th floor without lift Crutches Physical therapy Pain medications (60 yr old, motivated) Contextual factors The Biopsychosocial Model of Functioning and Disability Carrying objects, kneeling, walking, climbing Body function and body structure Take care of her grandchild Doing housework Assisting her husband with his business Pain, stability of joints, muscle power Articular cartilage of knee
  20. 20. ICF ComponentsICF Components Body FunctionsBody Functions && StructuresStructures ActivitiesActivities && ParticipationParticipation EnvironmentalEnvironmental FactorsFactors BarriersBarriers FacilitatorsFacilitators FunctionsFunctions StructuresStructures CapacityCapacity PerformancePerformance
  21. 21. Body Functions and StructuresBody Functions and Structures Skin and related structuresSkin and related structuresFunctions of the skin and relatedFunctions of the skin and related structuresstructures Structures related to movementStructures related to movementNeuromusculoskeletal and movement-Neuromusculoskeletal and movement- related functionsrelated functions Structures related to the genitourinaryStructures related to the genitourinary and reproductive systemsand reproductive systems Genitourinary and reproductiveGenitourinary and reproductive functionsfunctions Structures related to the digestive,Structures related to the digestive, metabolic and endocrine systemsmetabolic and endocrine systems Functions of the digestive, metabolicFunctions of the digestive, metabolic and endocrine systemsand endocrine systems Structures of the cardiovascular,Structures of the cardiovascular, immunological and respiratoryimmunological and respiratory systemssystems Functions of the cardiovascular,Functions of the cardiovascular, haematological, immunological andhaematological, immunological and respiratory systemsrespiratory systems Structures involved in voice andStructures involved in voice and speechspeech Voice and speech functionsVoice and speech functions The eye, ear and related structuresThe eye, ear and related structuresSensory functions and painSensory functions and pain Structures of the nervous systemStructures of the nervous systemMental functionsMental functions
  22. 22. Activities and ParticipationActivities and Participation DomainsDomains 11 LearningLearning &Applying Knowledge&Applying Knowledge 22 General Tasks and DemandsGeneral Tasks and Demands 33 CommunicationCommunication 44 MovementMovement 55 Self CareSelf Care 66 Domestic Life AreasDomestic Life Areas 77 Interpersonal InteractionsInterpersonal Interactions 88 Major Life AreasMajor Life Areas 99 Community, Social & Civic LifeCommunity, Social & Civic Life
  23. 23. Activities and ParticipationActivities and Participation Domains: Four OptionsDomains: Four Options • Activity is the execution of a task or action by an individual • Participation is involvement in a life situation • No overlap between domains • Partial overlap between domains • Detailed categories as activities and broad categories as participation with or without overlaps • Total overlap of domains
  24. 24. Environmental FactorsEnvironmental Factors 1.1. Products and technologyProducts and technology 2. Natural environment and human-made2. Natural environment and human-made changes to the environmentchanges to the environment 3. Support and relationships3. Support and relationships 4. Attitudes4. Attitudes 5. Services, systems and policies5. Services, systems and policies Environmental Factors are to be codedEnvironmental Factors are to be coded from the perspective of the personfrom the perspective of the person whose situation is being described andwhose situation is being described and can serve as Facilitators or Barrierscan serve as Facilitators or Barriers
  25. 25. Every ICF Code requires a Qualifier • Depending on the ICF domain, the base ICF code can be modified to impart information about – extent of impairment, – nature and location of impairment, – performance and capacity, and – degree of facilitation, depending on the ICF domain • General categories: None, Mild, Moderate, Severe, and Complete
  26. 26. Every ICF Code requires a Qualifier • Body Structures codes can include up to 3 post- decimal Qualifier digits, representing extent, nature, and location of structural impairment • Body Functions codes can include 1 Qualifier, representing extent of functional impairment • A&P codes can include a Performance Qualifier and a Capacity Qualifier with/without assistance • EF codes can include a PLUS or MINUS sign to indicate a Facilitator or Barrier, and a Qualifier digit indicating the degree of facilitation
  27. 27. ICF StructureICF Structure ClassificatioClassificationn PartsParts ComponentsComponents Constructs/Constructs/ qualifiersqualifiers Domains andDomains and categoriescategories at different levelsat different levels ICFICF Part 1:Part 1: Functioning andFunctioning and DisabilityDisability Part 2:Part 2: ContextualContextual FactorsFactors BodyBody FunctionsFunctions and Structuresand Structures Activities andActivities and ParticipationParticipation EnvironmentalEnvironmental FactorsFactors PersonalPersonal FactorsFactors Change inChange in BodyBody StructuresStructures CapacityCapacity PerformancePerformance Facilitator/Facilitator/ BarrierBarrier ItemItem levels:levels: 11stst 22ndnd 33rdrd 44thth ItemItem levels:levels: 11stst 22ndnd 33rdrd 44thth ItemItem levels:levels: 11stst 22ndnd 33rdrd 44thth Change inChange in BodyBody FunctionsFunctions ItemItem levels:levels: 11stst 22ndnd 33rdrd 44thth ItemItem levels:levels: 11stst 22ndnd 33rdrd 44thth
  28. 28. How many codes adequately describe a case? • In ICF, a person’s health state may be assigned an array of codes across the domains of the components of the classification • In real-life applications of ICF, a set of 3 to 18 codes may be adequate to describe a case with two-level (three-digit) precision • Generally, the more detailed four-level version is intended for specialist services, whereas the two- level classification can be used for surveys and health outcome evaluation Source: ICF Annex 2, “Coding Guidelines for ICF”, pg. 220
  29. 29. ICF Checklist and Core Sets • WHO has developed an ICF Checklist with a short list of body function and body structure codes, Activity and Participation codes and Environmental factor codes • The German Collaborating Centre has developed “Core Sets” for specific health conditions (see Dr. Gerold Stucki et al) • NIDRR is sponsoring a core sets project for spinal core injury treatment and rehabilitation
  30. 30. ICF is not…… • An assessment or measurement tool. • It is a framework and set of classifications on which assessment and measurement tools may be based, and to which they can be mapped. • This distinction is often misunderstood
  31. 31. ICF and Terminology • A terminology is a formal system of linguistic symbols that support meaning conveyance in a conceptual domain. • ICF is considered by many as a major milestone in elaboration and formalization of a human disability and functioning (HDF) ontology (i.e., a representation of things or a way of knowing the essence of things) • The ICF introduction is an attempt at formalization of HDF ontology • However, currently ICF, as a classification, lacks formalism and has ambiguity
  32. 32. ICF Adaptations • No country adaptations • No discipline-specific adaptations • However, nature and form of functioning in children is different from that of adults • Main volume of ICF needs detail for children • Indicators of functional risk factors crucial for prevention and early intervention • ICF for Children and Youth (ICF-CY) will be published this year!
  33. 33. NCVHS 2001 Report Findings • Health care and health policy must go beyond a narrow disease-based focus • ICF is a promising approach to coding functional status and deserves careful study • A coding system that specifies the elements of functioning is a reasonable place to start dealing with measurement and interpretation of functional status
  34. 34. NCVHS 2001Report Recommendations • Functional status information should be reported at appropriate intervals in standardized data sets • ICF is only viable candidate for a code set to classify functional status • The concepts and conceptual framework of ICF have promise as a code set for reporting functional status in administrative records and computerized patient records
  35. 35. Consolidated Health Informatics Initiative (CHI) • Phase II report of CHI Disability Workgroup completed in 2006 • Recommended that ICF be recognized as a CHI- endorsed vocabulary for exchange of health information in the functioning and disability domains in the federal enterprise • Also recommended inclusion of ICF in NLM’s Unified Medical Language System (UMLS) • NCVHS concurred with recommendations and submitted them to the Secretary, DHHS
  36. 36. Institute of Medicine Future of Disability in America • Disability in the form of limited activities and restricted participation in social life is not an unavoidable result of injury and chronic disease • Federal agencies are encouraged to adopt ICF as their conceptual framework for disability monitoring • Use of ICF would help standardize how agencies describe and measure different aspects of disability
  37. 37. WHO-FIC Network Priorities for ICF • Raising Awareness and Education • Applications in four areas – Health and Disability Statistics – Outcome measurement for clinical purposes – Administrative and clinical records – Social policy (e.g., disability certification)
  38. 38. WHO-FIC Functioning and Disability Reference Group • Established in 2006 with eight projects and active North American participation – Principles of use, coding rules and guidelines – ICF Updates – ICF implications for ICD – Measurement and statistical use of ICF – Educational materials (joint project with Education Committee) – Ethics and ICF – Environmental factors – Terminologies and ICF
  39. 39. North American CC Dissemination and Education • Periodic newsletter from North American Collaborating Center (NACC) http://www.cdc.gov/nchs/about/otheract/icd9/icfho – Currently over 900 subscribers • Host annual NACC Conferences on ICF – 2008 (14th Annual) Conference will be last week of August in Quebec, Canada • Present papers at annual WHO-FIC Network meeting and other venues
  40. 40. Annual NACC Conferences • Pre-conference Tutorial in 2004 (10th Conference) “Understanding ICF in the Terminology Spectrum for Human Function and Disability” (Halifax, NS) • 11th Annual Meeting and tutorial at Mayo Clinic, June 21-24, 2005, “Mapping the Clinical World to ICF” (Rochester, MN) • 12th Conference on “Living in our Environment: The Promise of ICF” (Vancouver, BC) • 13th Conference on “Sharing Knowledge through the ICF” (Niagara Falls, NY)
  41. 41. Dissemination and Education: ICF workshops in 2006-2007 • American Congress of Rehabilitation Medicine and American Society of Neurorehabilitation Joint Conference • Health care professionals in South Africa • Seventh Annual National Rehabilitation Educators’ Conference • National Oral Health Conference • Congress of World Confederation for Physical Therapy • 19th Annual World Conference on Health Promotion and Education
  42. 42. North American CC Dissemination and Education • Developed ICF tabletop exhibit and brochure for use at meetings • Published special issue of Health Care Financing Review on classifying functional status, which includes six ICF articles – http://www.cms.hhs.gov/review/03spring/default.asp • Publication of ICF articles in Disability and Research, Rehabilitation Education, Journal of Visual Impairment and Blindness and other journals
  43. 43. Dissemination and Education Code ICF • An interactive web-based training tool, developed by NCHS in collaboration with WHO and Western University • Provides a general overview of ICF and its multiple applications • Includes Frequently Asked Questions and coding vignettes • Will be incorporated into web-based tool for ICD- 10 and ICF under development by WHO
  44. 44. Dissemination and Education Host ICDR Subcommittees • From 2004 – 2006 the Interagency Subcommittee on New Freedom Initiative hosted monthly meetings at DHHS to raise awareness of potential ICF applications • The Interagency Subcommittee on Disability Statistics features ICF topics at each of its monthly meetings
  45. 45. Dissemination and Education Seminars and Workshops • Seminar on ICF and International Collaborative Research (CIRRIE 2003) • Workshop on ICF and Development of Clinical Measurement Tools ( ICDR 2004) • Seminar on Best Practices for Surveying People with Disabilities (ICDR 2004) • Improving Disability Data (ICDR 2006)
  46. 46. Health and Disability Statistics: Use of ICF in Surveys • Collect data on all levels of functioning or targeted areas • Combine data on functioning with data on health conditions • Capture functional status with or without assistive devices and personal assistance • Ask capacity or performance questions • Examine gap between experience of disabled people compared to non-disabled • Select questions to fit purpose
  47. 47. CDC Surveys • National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance Survey have included questions on environmental factors and functioning using ICF framework • NCHS Questionnaire Design Research Lab tested eight sets of disability questions, including WHO survey questions • SLAITS/Children with Special Health Care Needs (2005-2006) incorporates ICF concepts • Canadian Participation and Activity Limitation Survey (PALS) uses ICF framework
  48. 48. CDC- supported survey research • Washington University developed a community health environment checklist based on ICF and surveyed people with mobility limitations about perspectives • Craig Hospital measured community environmental barriers in Colorado using ICF
  49. 49. International Applications: Health and Disability Statistics • WHO World Health Survey (WHS) – Designed to compile baseline information on the health of populations (74 countries) – Intended to build the evidence base to monitor health systems and whether they are achieving desired goals – Conceptually linked to ICF • Conceptual framework for defining health (WHS defines as person’s capacity with aids) • Comprehensive set of domains • Representative item pool for survey questionnaire to measure health states
  50. 50. International Applications Health and Disability Statistics • United Nations Disability Statistics Data Base (surveys and censuses) – Uses ICF (previously ICIDH) for definitions and common framework • United Nations International Seminar on Measurement of Disability – June 2001 led to establishment of Washington City Group – Agreed that ICF should be used as framework for measurement of disability – Includes participation by developed and developing countries; pre-testing questions for census and surveys – http://www.cdc.gov/nchs/citygroup.htm
  51. 51. Research and Development • NIDRR Long Range Plan for FY 2005 – 2009 invokes ICF as conceptual guideline for extramural research funding activities. • Several significant research awards with ICF components have been made – U.S. National Institutes of Health – U.S. Department of Education • Rehabilitation Research Training Center (RRTC) on Demographics and Statistics – Cornell University • Center for International Rehabilitation Research Information and Exchange (CIRRIE-2) – U.S. Centers for Disease Control and Prevention
  52. 52. Research and Development • American Psychological Association is working with other professional associations to develop Procedural Manual and Guide for Standardized Application: A Manual for Health Professionals • 10th Annual NACC Meeting on ICF produced a draft North American research agenda for ICF (http://www.nordclass.uu.se/WHOFIC/papers/rey kjavik37.pdf)
  53. 53. North American Research Agenda on ICF • Identified 45 research priorities • Participants assigned highest priorities: – Crosswalks of assessment tools and terminologies to ICF – Development of ICF-based assessment tools – Delineation of Activities and Participation – National and international comparisons – Empirical applications in clinical practice – Research on environmental factors
  54. 54. North American Research Agenda on ICF • NCHS funded WHO to crosswalk ICF with major assessment tools (results presented at 13th NACC Conference) • Negotiations are being finalized to incorporate ICF into UMLS to facilitate future mappings with SNOMED CT and other terminologies
  55. 55. Policy Applications • ICF used as conceptual framework for disability- related objectives in Healthy People 2010 • Use ICF for measuring progress of disability- related objectives in Healthy People 2020 • Potential use of ICF framework in strategic review of rehabilitation services and in disability income replacement programs (Canada)
  56. 56. Policy applications • Several NIDRR-funded projects, including the RRTC at Cornell University, feature investigators interested in federal policy applications of the ICF • Universities and professional associations are incorporating ICF into teaching of students and rehabilitation professions – e.g., ICF is component of Preferred Practice Patterns for Speech-Language Pathology
  57. 57. ICF Implementation • Promote ICF and ICF-CY use in WHO-FIC priority areas • Implement ICF as conceptual model and classification system for – Disability monitoring systems – Electronic Health Records – Personal Health Records – Health Information Exchanges – Quality Indicators – Pay for Performance – Eliminating health disparities
  58. 58. ICF Implementation • Conduct research recommended by NCVHS, NACC Research Agenda and CHI • Promote collection of functional status in health records • Code functional status information consistently • Map SNOMED-CT to ICF; identify gaps • Crosswalk assessment tools to ICF – Identify gaps – Standardize assessment tools in relation to ICF codes for clinical specialties • Develop new assessment tools based on ICF
  59. 59. ICF Implementation • Contribute to guidelines development and updating process for ICF through FDRG • Improve ICF as a classification – Clarify operational definitions of A&P* – Develop Personal Factors classification* – Continue development of Environmental Factors* – Enhance content coverage – Clarify and standardize qualifiers * (see Box 2.5 of IOM report)
  60. 60. Challenges • Who should report functional status – patient, provider or both? • How often should it be collected? • Should it be measured with or without assistive devices/environmental factors? • How should consumers be involved? • Demonstrate value in relation to costs of collection (e.g., time, coding) • Consider incentives for recording information

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