# Presentation: 123010

## ICF UPDATE:  2004 NCHS Data Users Conference  July 14, 2004

- Paul J. Placek, Ph.D. Senior Statistician, CPHDSS Office of the Center Director, National Center for      Health Statistics, CDC 3311 Toledo Road - Metro IV - Suite 2414 Hyattsville, MD 20782 tel 301-458-4437 fax 301-458-4022 PJP2@CDC.GOV

## ICF

**ICF**

- World Health Organization Classification Assessment Surveys & Terminology Group

- as a **Member in the **
**WHO Family of **
**International Classifications**
*on a par with and to be used with ICD-10 *

**www.who.int/classification/icf**

**Notes:**
Greetings , 
I am happy to greet you on behalf of the World Health Organization and it is my pleasure to provide you with this introduction on the WHO Family of  International Classifications  (WHO- FIC)

We are now in an upgrading process and moving towards the a unified concept of integrated classification systems for health information. 
In this presentation, I would like to address the following points:
 What is the WHO Family of International Classifications ?
Why is there a need for the WHO FIC ?
What are the key concepts of WHO FIC  And the underlying principles of family ?
How can we use the WHO FIC to improve people’s health? 

For your information, a copy of the slides used in this presentation is available from WHO or over the INTERNET.  The contact addresses are found at the end of this presentation.

## ICF  

**Notes:**
[Keywords] random###[Narration] ###

## Comprehensive Framework

**Comprehensive Framework**

## Body Functions and Structures

**Skin and related structures**

**Functions of the skin and related structures**

**Structures related to movement**

**Neuromusculoskeletal and movement-related functions**

**Structures related to the genitourinary and reproductive systems**

**Genitourinary and reproductive functions**

**Structures related to the digestive, metabolic and endocrine systems**

**Functions of the digestive, metabolic and endocrine systems**

**Structures of the cardiovascular, immunological and respiratory systems**

**Functions of the cardiovascular, haematological, immunological and respiratory systems**

**Structures involved in voice and speech**

**Voice and speech functions**

**The eye, ear and related structures**

**Sensory functions and pain**

**Structures of the nervous system**

**Mental functions**

## Activities and Participation

- 1	**Learning &Applying Knowledge****	**
- 2	**General Tasks and Demands****	**
- 3	**Communication****	**
- 4	**Movement****	**
- 5	**Self Care****	**
- 6	**Domestic Life Areas****	**
- 7	**Interpersonal Interactions****	**
- 8	**Major Life Areas****	**
- 9	**Community, Social & Civic Life****	**

## Environmental Factors

- 1. Products and technology
- 2. Natural environment and human-made   changes to the environment
- 3. Support and relationships
- 4. Attitudes
- 5. Services, systems and policies

## ICF CODES

- About 1,400 codes at 4–digit level
- s = structure in body codes
- f = function in body codes                                     ***Using the fourth option in Activities & Participation...***
- d = “disability” in A & P list
***Qualifiers indicate extent or magnitude of impairment;  or extent of difficulty in executing A & P activities***
- xxx.0 = no difficulty
- xxx.1 = mild difficulty
- xxx.2=moderate difficulty (med., fair,25-49%)
- xxx.3=severe   xxx.4= complete (total, 96-100%)
- e = environmental facilitator (+1 if mild, +2, +3, +4 if complete) or barrier (.1 if mild barrier, etc.)

## ICF for Children and Youth (ICF-CY) just available

- In development since 2001
- On the WHO website July ‘04  _[www.who.int/classification/icf](http://www.who.int/classification/icf)_
- Uses same code structure as ICF (but expanded)
- Six month comment period just began
- ICF-CY has same survey and clinical applications as ICF

## SURVEY QUESTIONS CAN BE BACK CODED TO ICF

- Are you able to have a conversation with one other person (hearing aid if necessary? (N)
- Does anyone in your household have difficulty in understanding what is said if someone is talking on the other side of the room? (SA)
- Does anyone in the family have any trouble hearing what is said in normal conversation (even when wearing a hearing aid)? (US)
- Do you have any difficulty hearing what is said in a conversation with one other person? (C)

***Sample of Survey Items**
**Body Function**
- B230 Hearing function
- 	B2300 Sound detection
**Activities and Participation**
- D310 Communication with receiving – spoken messages
- D315 Communication with – receiving – non-verbal messages
- 	D3150 Communicating with- receiving-body gestures

## FEDERAL CLINICAL DATA COULD BE CODED TO ICF – POSSIBLE APPLIATIONS

**Social Security Disability Programs**
**SSA could require submission of assessment of functional criteria of its Physical and Mental Listings using ICF**
**Would standardize ‘medical evidence’ for use by SSA evaluators**
**DHHS Medicare claims**
**Clinician’s familiarity with ICF would provide a more standard assessment on MDS’s existing checklist**
**Department of Education**
**ICF could be used to standardize eligibility reviews**

## EXAMPLE:  Mrs. Stevens has severe degenerative arthritis (SSA Listing of Impairments 1.03)

**ICF b530.3 extremely obese**
**ICF b28016.3 arthritis pain acute**
**ICF d6200.4 can no longer grocery shop**
**ICF d465.4 not mobile even with walker**
**ICF d4702.4 boarding bus with high steps is just too difficult**
**ICF d7600.2; e310.2 daughter lives nearby but relationship is strained, no help from her **
**ICF 7100.3 arthritis in right hip**

## Mrs. Stevens had a hip replacement

- ICF e5800+3 successful rehab services
- ICF d465.1 with walker, she had only mild difficulty in navigating
- ICF e5800+1 slightly helpful physical therapist visits at home
- ICF e580.4 but Medicare discontinued her home care coverage
- ICF b28016.0 now she is no longer in pain
- ICF d4702.1 and can board the bus with only mild difficulty

## Mrs. Stevens ...a happy ending

**ICF d465.0 she no longer needs her walker to get around**
**ICF d9103.0 she joined a neighborhood crafts club and attends regularly**
**ICF e1650+4 she won the state lottery grand prize**
**ICF d7702.0 and at the crafts club she met a gentleman and had a torrid affair**

## ADVANTAGES OF ICF

***Degree*** of impairment or activity limitation
***Longitudinal*** applications:  Same code can be applied at two points in time, with different qualifiers, to show progress or decline
- Captures ***variety and depth*** in functional status
- Captures social relationships and ***social support***
- Works with ***clinical terminologies*** used in ***many professions***
- Useable for ***rehab assessment*** & outcome evaluation
- Can be used with ***ICD and other*** codes

## CONSOLIDATED HEALTH INFORMATICS INITIATIVE HAS RECOMMENDED FOR DISABILITY DOMAIN...

- Complete content analysis of ICF, SNOMED-CT and other sources within UMLS
- Full mapping between ICF and SNOMED_CT
- www.whitehouse.gov/omb/egov/downloads/disability_full_public.doc

## ICF RELEVANCE FOR PWD IN “NEW FREEDOM INITIATIVE” June 2001 Executive Order 13217

- Integrate into workforce
- Promote community-based services
- Promote safe housing, home ownership
- Access to assistive technology
- Expand educational opportunity
- Expand transportation options
- Full access to community life
- Health of PWD

## New Freedom Initiative (& ICF Codes)

- Integrate into workforce(d845 on p. 155)
- Community based services/supports(d825 on p. 154)
- Housing/ownership(d610 on p. 145)
- Workforce/caregivers(d660 on p. 148)
- Transportation(d470 on p. 140)
- Access to community life (d710 on p. 150, d910on p. 158)
- Health (d510 on p. 142)

## OFFICE ON DISABILITY (DHHS) ESTAB. ICF SUBCOMMITTEE UNDER NFI WORKGROUP

- Chaired by Margaret Giannini, M.D., F.A.A.P., Director, OD
- Reps from every HHS agency
- Meets monthly to review possible ICF applications within their respective Federal agencies
- ICF can benchmark NFI objectives

## THE NACC HAS HAD 10 ANNUAL MEETINGS ON ICF (& PREDECESSOR ICIDH)

- 10th - June 2-4, 2004 in Halifax
- Record # of 54 abstracts
- Record # of 103 registrants
- Record # of 12 countries attend
- Poster sessions
- Concurrent sessions
- Top papers in Disability and Health book Spring 2005
- June 1 all-day ICF Tutorial

## HALIFAX GOALS

- Bring together ICF researchers and users from Canada, U.S. and abroad
- Report accomplishments in past year
- Learn about applications of ICF and ICF research
- Develop a draft North American Research Agenda for ICF
- Set priorities for ICF research and implementation
- Develop science base for ICF implementation
- Sell needed research to agencies and funders

## OVER 45 PAPERS EACH HAD UP TO 6 RESEARCH RECOMMENDATONS

- Nearly 200 research implications stated
- Attendees voted on top 5 priorities
- Preliminary draft is available from Paul Placek

## ICF RESEARCH PRIORITIES FOR 44 PERSONS IN HALIFAX (each person had 5 votes—the total voting for each is in parentheses)

- Clinical applications(N=4)
- Empirical applications of ICF use in clinical practice(N=11)
- Crosswalks to ICF of assessment tools and terminologies(23)
- Development of ICF-based assessment tools(16)
- Protocols for ICF codebooks and procedures manuals(10)
- Measurement of quality of care using ICF(0)
- Scientific appraisals of ICF in assessing functional status(4)
- Comparisons of self, proxy and clinical assignments of ICF codes(1)
- Applications of ICF in health programs(5)

- Administrative applications(2)
- Assessments of ICF uses in administrative records(5)
- Research on use of ICF in payment and reimbursement systems(1)
- Program assessments using ICF (e.g., ADA, Olmstead)(2)
- Empirical studies of ICF implementation in public and private sector venues (1)
- Operationalizing ICF(4)
- Examinations of approaches for operationalizing ICF terms and concepts (5)
- Reliability and validity studies(10)
- Empirical research on the qualifiers(7)
- Use of capacity versus performance(10)
- Delineation of activities and participation(14)

- Survey applications(2)
- Harmonization of survey questions with ICF terms, including data dictionaries(5)
- Pre and post harmonization strategies(4)
- Educational applications and training(3)
- Development and utility of training tools(7)
- Scholarly studies of ICF in various types of academic    curricula(2)
- ICF Early in school system(0)
- National and international comparisons of ICF implementation(12)
- Appraisals of ICF by the disability community(6)
- Updating ICF, ICF-2(2)
- Convergence with other terminologies(2)
- Cohesion among conceptual frameworks(3)
- Policy Applications , eg, Income support, housing(8)

- The world of consumers e.g.,  Participant Action Research(6)
- Developing methods for crosswalking(3)
- Research on environmental factors (e.g. assistive devices) impact participation(11)
- Universal design(3)
- International comparisons(5)
- Application of technology to uses of ICF(2)
- Use for institutionalized , esp. E factors(2)
- Diffusion to other sectors(1)
- Accessibility of ICF in different formats (e.g., Braille) (Sec 508) (W3C WAI)(1)
- How can ICF influence clinical practice?(1)
- Use for special populations-children, aged, prisoners(1)

## HIGHEST PRIORITY RESEARCH (N=10+ votes)

- Crosswalks of assessment tools & terminologies to ICF(23)
- Development of ICF-based assessment tools(16)
- Delineation of activities & participation(14)
- National & international comparisons of ICF implementation(12)
- Empirical applications of ICF use in clinical practice(11)
- Environmental factors (& assistive devices) impact on participation (11)
- Protocols for ICF codebooks & procedures manuals (10)
- Reliability & validity studies (10)
- Use of capacity vs. performance (10)

## JOIN US IN 2005

- 11TH NACC Meeting on ICF June 13-17, 2005 in Rochester, Minnesota at Mayo Clinic
- CEU Credits
- ICF Tutorial

## TRAINING TOOLS AND TUTORIAL

- CODE ICF - web-based courseware (in development)
- ICF Video – 25 ICF experts
- ICF Curricula (Mulhorn, Yoder)
- Brochure, table top exhibit
- TUTORIAL – June 1 in Halifax, covered terminologies, applications, evolution, ICF in surveys and clinical practice

## TO LEARN MORE

- Since Fall 2002, read the Monthly “NACC Clearinghouse on ICF” Messages at _[http://](http://www.cdc.gov/nchs/about/otheract/icd9/icfhome.htm)__[www.cdc.gov/nchs/about](http://www.cdc.gov/nchs/about/otheract/icd9/icfhome.htm)__[/ otheract/icd9/icfhome.htm](http://www.cdc.gov/nchs/about/otheract/icd9/icfhome.htm)_
- Free, monthly, email news on ICF in North American
- Covers awards, publications, meetings, training, “Spotlight on...”

## SEND EMAIL TO PJP2@CDC.GOV FOR

- To join the NACC Clearinghouse on ICF
- For free reprints of 6 articles on ICF and functional status in Vol. 24 No. 3, 2003 Health Care Financing Review  _[www.cms.hhs.gov/review/03spring/](http://interdev2.nchs.cdc.gov/nchs/)_ default.asp
- For free reprints of 15 ICF articles in Vol .25 No. 11-12, 2003  Disability and Rehabilitation

## Slide 32

## THANK YOU VERY MUCH...and today is my son’s 9th birthday, so HAPPY BIRTHDAY VINCENT!