《中国康复理论与实践》

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (11): 1241-1255.doi: 10.3969/j.issn.1006-9771.2020.11.001

• 专稿 • 上一篇    下一篇

世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图

姜静远1,2,邱卓英2,3,4,5(),王国祥1,2,3(),邱服冰2,6,杨剑3,7,李安巧2,3,马洪卓2,3,朱婷2,8,王梅9,孙宏伟2,3,陈迪3,4,5,黄秋晨10,11,郑洁皎12,张鸣生13,石秀娥14,唐涛15,许涛16,张爱民4,5,吴弦光4,5,刘巧云17,肖晓飞18,井淇2,3   

  1. 1.苏州大学体育学院/运动康复研究中心,江苏苏州市 215021
    2.中国ICF研究院,山东潍坊市 261000
    3.世界卫生组织国际分类家族中国合作中心,北京市 100068
    4.中国康复研究中心康复信息研究所,北京市 100068
    5.中国康复科学所康复信息研究所,北京市 100068
    6.深圳大学体育部,广东深圳市 518060
    7.华东师范大学体育与健康学院,青少年健康评价与运动干预教育部重点实验室,上海市 200241
    8.深圳市龙岗区特殊教育学校,广东深圳市 518100
    9.武汉体育学院健康科学学院,湖北武汉市 430079
    10.中国康复研究中心北京博爱医院物理疗法科,北京市 100068
    11.首都医科大学康复医学院,北京市 100068
    12.复旦大学附属华东医院,上海市 200040
    13.广东省人民医院,广东省医学科学院,广东省老年医学研究所,广东广州市 510080
    14.甘肃省康复中心医院,甘肃兰州市 730000
    15.四川省八一康复中心,四川成都市 611130
    16.华中科技大学同济医学院附属同济医院康复医学科,湖北武汉市 430030
    17.华东师范大学教育学部康复科学系,上海市 200333
    18.滨州医学院康复医学院,山东烟台市 264003
  • 收稿日期:2020-10-08 修回日期:2020-10-14 出版日期:2020-11-25 发布日期:2020-11-24
  • 通讯作者: 邱卓英,王国祥 E-mail:qiutiger@hotmail.com;kwang63@163.com
  • 作者简介:姜静远(1997-),男,汉族,江苏泰州市人,硕士研究生,主要研究方向：WHO-FICs、ICF、运动康复、康复体育。通讯作者：|邱卓英(1962-),男,汉族,湖北武汉市人,博士,研究员、教授,博士生导师,主要研究方向：WHO-FICs、ICF、康复心理学、残疾研究、康复科学、康复信息。|王国祥(1963-),男,汉族,辽宁喀左县人,博士,教授,博士生导师,主要研究方向：WHO-FICs、ICF、运动康复、康复体育。
  • 基金资助:
    1.中央级公益性科研院所基本科研业务费专项资金项目(重大科学研究引导基金项目)(2018CZ-4);2.国家社会科学基金项目(19BTY125)

Systematic Implementation of World Health Organization Family International Classifications in Rehabilitation: Protocol and Roadmap

JIANG Jing-yuan1,2,QIU Zhuo-ying2,3,4,5(),WANG Guo-xiang1,2,3(),QIU Fu-bing2,6,YANG Jian3,7,LI An-qiao2,3,MA Hong-zhuo2,3,ZHU Ting2,8,WANG Mei9,SUN Hong-wei2,3,CHEN Di3,4,5,HUANG Qiu-chen10,11,ZHENG Jie-jiao12,ZHANG Ming-sheng13,SHI Xiu-e14,TANG Tao15,XU Tao16,ZHANG Ai-min4,5,WU Xian-guang4,5,LIU Qiao-yun17,XIAO Xiao-fei18,JING Qi2,3   

  1. 1. School of Physical Education and Sport Sciences/Exercise Rehabilitation Research Center, Soochow University, Suzhou, Jiangsu 215021, China
    2. China Academy of ICF, Weifang, Shandong 261000, China
    3. WHO-FIC Collaborating Center in China, Beijing 100068, China
    4. Research Institute of Rehabilitation Information, China Rehabilitation Research Center, Beijing 100068, China
    5. Research Institute of Rehabilitation Information, China Rehabilitation Sciences Institute, Beijing 100068, China
    6. Department of Physical Education, Shenzhen University, Shenzhen, Guangdong 518060, China
    7. Key Laboratory of Health Evaluation and Sport Intervention of Ministry of Education, School of Sport and Health, East China Normal University, Shanghai 200241, China
    8. Longgang School of Special Education, Shenzhen, Guangdong 518100, China
    9. Institute of Health Sciences, Wuhan Sports University, Wuhan, Hubei 430079, China
    10. Department of Physical Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    11. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    12. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
    13. Guangdong Institute of Geriatrics, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, Guangdong 510080, China
    14. Rehabilitation Center Hospital of Gansu, Lanzhou, Gansu 730000, China
    15. Rehabilitation Hospital of Sichuan Province, Chengdu, Sichuan 611130, China
    16. Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
    17. Department of Rehabilitation Sciences, East China Normal University, Shanghai 200333, China
    18. School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
  • Received:2020-10-08 Revised:2020-10-14 Published:2020-11-25 Online:2020-11-24
  • Contact: QIU Zhuo-ying,WANG Guo-xiang E-mail:qiutiger@hotmail.com;kwang63@163.com
  • Supported by:
    National Special Fund Projects of Basic Research of Public Benefits for Institutes at Central Governmental Level (Leading Project of Major Scientific Research)(2018CZ-4);National Social Science Fund of China(19BTY125)

RichHTML

PDF (PC)

摘要：

目的 研究世界卫生组织国际健康分类家族(WHO-FICs)在康复领域宏观层面的政策和理论架构、中观层面的治理与管理机制,以及微观层面的系统应用。方法 基于国际康复政策文件,主要是世界卫生组织《世界残疾报告》、《全球残疾行动计划》和《健康服务体系中的康复》等分析康复发展的政策理论架构;探讨WHO-FICs,包括《国际疾病分类》(ICD-11)、《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHIβ-2)三大参考分类在康复领域的系统应用。结果 基于WHO-FICs构建康复宏观政策和理论架构,明确现代康复服务的内涵和原则。康复服务是现代健康服务的重要组成部分,涉及6大要素,包括领导力与治理能力、筹资、健康人力资源、服务提供、医药技术和健康信息系统。要求在康复服务中依据ICD、ICF和ICHI的架构和知识体系,对康复领域的疾病、功能和干预的分类、命名规则、内涵、外延、术语体系和编码系统进行标准化,并完成康复相关的评估和统计。基于WHO-FICs构建康复治理与管理的中观机制。康复服务基于生物-心理-社会模式,坚持以人为本和功能定向原则;情景要素包括服务地点、服务设施和服务场景三个方面。在康复领域系统应用WHO-FICs推荐采用“评定(ICHI)–功能分类、评定、说明和编码(ICF)–疾病分类、诊断、编码(ICD-11)–康复干预(ICHI)”系统应用模式,遵循“评估(功能和需求)和诊断(疾病和功能)–确定康复目标和康复方案–实施康复干预–康复结局评价(功能评定)”的标准化流程。基于WHO-FICs构建康复的微观应用模式,明确康复涉及的主要疾病有28大类,主要功能障碍有7大类,康复干预有6大类。根据ICD-11和ICF推荐的整体功能评估工具有WHO残疾评定方案(WHODAS 2.0)、WHO示范残疾评估表简明版(MDS-B)和VB40通用功能领域(VB40),同时推荐ICF核心分类组合用于康复功能和康复结局的评估。WHO-FICs在康复病案管理和病案首页报告中的应用,可实现康复病案管理的标准化,基于康复病案首页的疾病、功能和干预编码以及康复绩效报告的标准化为康复付费和支付管理提供了工具。基于WHO-FICs构建标准康复数据集,建立标准化康复大数据,实现功能相关的诊断相关分类和case-mix统计。结论 将WHO-FICs分类系统应用于康复领域,在宏观层面构建康复理论和政策架构,在中观层面明确康复治理与管理的机制,在微观层面建立康复应用模式,可进一步提升康复服务的科学化、规范化、精细化和信息化水平,提升康复服务的治理水平和治理能力,提高康复服务的质量、安全性和覆盖率,提供科学有效的整体解决方案。

关键词: 世界卫生组织国际健康分类家族, 康复服务, 国际疾病分类, 国际功能、残疾和健康分类, 国际健康干预分类

Abstract:

Objective To explore systematic implementation of World Health Organization Family International Classifications (WHO-FICs) in the field of rehabilitation: the theoretical and policy framework at macro level, governance and management mechanism at meso level, and implementation modules at micro levels, respectively.Methods The policy and theoretical framework of rehabilitation development was discussed based on the international rehabilitation policy documents of WHO, mainly as World Report on Disability, Global Action Plan on Disability and Rehabilitation in Health Service System. Protocol and roadmap of systematic implementation of WHO-FICs, including International Classification of Diseases (ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHIβ-2) was proposed.Results With the use of WHO-FICs, the theoretical and policy framework of rehabilitation was constructed, and the contents and principles of modern rehabilitation services were clarified at macro-level. Rehabilitation is an important part of health service, there are six building blocks: i.e. leadership and governance, financing, human resources for health, service providing, medical technology and health information system. It proposed to use knowledge management system of WHO-FICs, including the classification, nomenclature, definitions, descriptions, terminology and coding systems, to standardize rehabilitation evaluation and statistics. The management and governance system of rehabilitation should be implemented using WHO-FICs. Rehabilitation services are based on the bio-psycho-social model and implemented the principles of people-centered and functioning-oriented. The systematic implementation of WHO-FICs in rehabilitation abide by the model of "Evaluation (ICHI)–Evaluation, Description, Classification and Coding of Functioning (ICF)–Disease Classification, Diagnosis and Coding (ICD)–Rehabilitation Intervention (ICHI)", and with the standardized process of "Evaluation (Functioning and unmet needs)–Diagnose (Disease and Functioning)–Planning of Rehabilitation–Intervention–Evaluation of Outcome". The mic-modules of implementation of WHO-FICs in rehabilitation had been constructed. There were 28 categories of diseases, 7 categories of functioning and 6 categories of rehabilitation interventions in rehabilitation proposed by International Society of Physical and Rehabilitation Medicine. According to ICD-11 and ICF, it proposed to use WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), Brief Model Disability Survey (MDS-B) and VB40 Generic Functioning Domains (VB40), and the ICF core-sets in evaluation of functioning and rehabilitation outcome. The implementation of WHO-FICs in management of medical records and reporting realized the standardized management of medical record, encoding of diseases, functioning and intervention, reporting of performance, and provided tools for billing, reimbursement and payment management of rehabilitation. It proposed to develop WHO-FICs based clinical data sets and big data to implement functioning-related Diagnosis Related Groups and case-mix statistics.Conclusion With the systematic implementation of WHO-FICs in rehabilitation, the policy and theoretical framework at macro level had been developed. The mechanism of management and governance at meso level had been explored. The application modules and approaches at micro level had been established. A scientific and effective overall solution had been proposed to enhance the scientific, standardized, refined and informatization level, strengthen the level and governance capacity, and improve the quality, safety and the coverage of rehabilitation services.

Key words: World Health Organization Family International Classifications, rehabilitation services, International Classification of Diseases, International Classification of Functioning, Disability and Health, International Classification of Health Intervention

中图分类号: