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

doi:10.3969/j.issn.1006-9771.2020.11.001

《Chinese Journal of Rehabilitation Theory and Practice》 ›› 2020, Vol. 26 ›› Issue (11): 1241-1255.doi: 10.3969/j.issn.1006-9771.2020.11.001

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

JIANG Jing-yuan^1,²,QIU Zhuo-ying^2,^3,^4,⁵(),WANG Guo-xiang^1,^2,³(),QIU Fu-bing^2,⁶,YANG Jian^3,⁷,LI An-qiao^2,³,MA Hong-zhuo^2,³,ZHU Ting^2,⁸,WANG Mei⁹,SUN Hong-wei^2,³,CHEN Di^3,^4,⁵,HUANG Qiu-chen^10,¹¹,ZHENG Jie-jiao¹²,ZHANG Ming-sheng¹³,SHI Xiu-e¹⁴,TANG Tao¹⁵,XU Tao¹⁶,ZHANG Ai-min^4,⁵,WU Xian-guang^4,⁵,LIU Qiao-yun¹⁷,XIAO Xiao-fei¹⁸,JING Qi^2,³

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)

Abstract

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

CLC Number:

JIANG Jing-yuan,QIU Zhuo-ying,WANG Guo-xiang,QIU Fu-bing,YANG Jian,LI An-qiao,MA Hong-zhuo,ZHU Ting,WANG Mei,SUN Hong-wei,CHEN Di,HUANG Qiu-chen,ZHENG Jie-jiao,ZHANG Ming-sheng,SHI Xiu-e,TANG Tao,XU Tao,ZHANG Ai-min,WU Xian-guang,LIU Qiao-yun,XIAO Xiao-fei,JING Qi. Systematic Implementation of World Health Organization Family International Classifications in Rehabilitation: Protocol and Roadmap[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1241-1255.

Figures/Tables 14

References 40

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分类	分类理论架构和知识体系				分类宏观应用架构
分类	理论模式	知识分类与管理	术语体系	编码系统	政策制定	政策实施	实施效果和影响评价
ICD-11	生物-心理-社会的疾病模式	疾病损伤知识分类系统	国际疾病分类术语	疾病编码	健康促进疾病预防医疗保健	疾病相关健康政策实施方案、计划、资源	疾病相关的健康政策实施效果和影响
ICF	生物-心理-社会的功能残疾模式	功能分类知识系统	国际功能分类术语	功能编码	康复政策	功能相关健康政策实施方案、计划、资源	功能相关的健康政策实施效果和影响
ICHIβ-2	生物-心理-社会的健康干预模式	康复干预分类知识系统	国际干预分类术语	干预编码	干预政策	干预相关健康政策实施方案、计划、资源	干预相关的健康政策实施效果和影响

要素	康复服务组成部分	WHO-FICs系统应用
康复领导力与治理能力	1.针对康复问题的法律、政策、规划和战略 2.针对康复问题的治理结构、监管机制和问责制流程 3.为康复制定规划、协作和协调康复过程	1.制定康复发展战略规划的工具 2.规划执行和实施的工具 3.跨行业、多领域协调工具
康复筹资	1.卫生健康支出中康复的支出 2.包括康复在内的卫生健康筹资、服务收费和支付结构	1.康复服务筹资的架构建设和统筹规划 2.康复收费和支付的方法和标准
康复人力资源	1.可以提供康复干预-包括康复医学、康复治疗和康复护理的卫生健康人力资源	1.人力资源学科专业体系 2.专业人员的知识、技能和职业伦理
康复服务提供	1.提供康复干预的卫生健康服务,包括在三级医院、二级医院和诊所以及在初级卫生保健机构和社区环境中提供专门化的康复干预服务的康复医院、康复中心、病房和机构	1.服务提供的理论架构和服务体系 2.服务提供的标准 3.服务的评价
康复医药技术	1.康复者常用的药品和技术,特别是辅助产品	1.康复技术、设备和辅助产品
康复信息系统	1.在卫生健康信息系统中与康复相关的数据,例如人口功能状态数据、康复有效性和利用数据,以及康复结局的数据 2.与康复政策和项目有关的研究	1.康复信息系统的数据架构和数据标准 2.康复服务相关的统计

架构	ICD-11	ICF	ICHIβ-2
理论基础	生物-心理-社会疾病模式	生物-心理-社会功能残疾模式	生物-心理-社会健康干预模式
分类体系	疾病和损伤分类	功能分类(身体结构和身体功能,活动和参与,环境因素和个人因素)	健康干预分类(目标-行动-方式)
命名方法	疾病和损伤命名	功能描述	干预方法描述
术语体系	疾病和损伤术语(类目、编码、父节点、描述、不包括等)	功能术语(类目、编码、定义、包括、不包括等)	干预术语(类目、编码、定义、索引词、包括、不包括)
编码	疾病编码	功能编码	干预编码
临床应用	疾病诊断	功能描述	干预、服务收费和支付
临床统计	疾病统计(DRGs, case-mix)	功能统计(f-DRGs, case-mix)	干预统计

康复服务情景	说明
服务地点	位置特征：农村地区、城市地区、社区
服务地点	服务场所面积：人口、地理区域、行政区域
服务设施	建筑和其他方面的设施。如实验室、诊断和治疗室、床等
服务场景	保健水平：初级、二级和三级专业化
	服务提供的方式：住院患者、门诊患者,日间医院/日间服务,家庭和社区,远程康复,或任何其他提供服务的场所
	保健阶段：康复、前期康复、急性康复护理、亚急性康复护理、亚急性期康复保健和长期/慢病期康复保健

康复服务涉及的主要疾病	ICD-11分类	ICD-11编码
某些传染病和寄生虫病的后遗症	某些感染性疾病或寄生虫病	1A00-1H0Z
癌症的功能结局	肿瘤	2A00-2F9Z
心血管疾病、血液系统疾病	血液或造血器官疾病	3A00-3C0Z
淋巴系统疾病	免疫系统疾病	4A00-4B4Z
内分泌、营养和代谢性疾病	内分泌、营养或代谢疾病	5A00-5D46
与康复有关的精神和行为障碍	精神、行为或神经发育障碍	6A00-6E8Z
	睡眠-觉醒障碍	7A00-7B2Z
与年龄有关的疾病：神经系统的非创伤性疾病	神经系统疾病	8A00-8E7Z
与年龄有关的疾病：	视觉系统疾病	9A00-9E1Z
与康复有关的前庭功能障碍	耳或乳突疾病	AA00-AC0Z
心血管疾病	循环系统疾病	BA00-BE2Z
呼吸系统疾病	呼吸系统疾病	CA00-CB7Z
消化系统疾病	消化系统疾病	DA00-DE2Z
皮肤和皮下组织疾病、与年龄有关的疾病	皮肤疾病	EA00-EM0Z
肌肉骨骼系统的非创伤性疾病	肌肉骨骼系统或结缔组织疾病	FA00-FC0Z
生殖泌尿和胃肠系统疾病	泌尿生殖系统疾病	GA00-GC8Z
	性健康相关情况	HA00-HA8Z
	妊娠、分娩或产褥期	JA00-JB6Z
	起源于围生期的某些情况	KA00-KD5Z
儿童疾病	发育异常	LA00-LD9Z
与年龄有关的疾病：多种原因引发的复杂状况	症状、体征或临床所见,不可归类	MA00-MH2Y
创伤性疾病	损伤、中毒或外因的某些其他后果	NA00-NF2Z
	疾病或死亡的外因	PA00-PL2Z
儿童疾病	影响健康状态或与保健机构接触因素	QA00-QF4Z
	用于特殊目的的编码	RA00-RA26
	传统医学病证-模块1	SA00-SJ3Z
	功能评定补充部分	VA00-VC50
疼痛	扩展码	XS8H-XX2QG9

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

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功能障碍	说明	ICF编码
功能障碍	说明	身体功能	身体结构	活动和参与
神经系统功能障碍	脑卒中、脑损伤、脊髓损伤等	b1	s1	d1~d9
骨骼肌肉障碍	颈障碍、腰障碍、上下肢骨骼肌肉障碍等	b7	s7	d1~d9
神经肌肉障碍	重症肌无力等	b7	s7	d1~d9
心脏障碍、呼吸障碍	心律失常、心力衰竭;支气管炎、肺气肿等	b4	s4	d1~d9
癌症	各种癌症相关的身体结构与功能、活动和参与障碍	b1~b8	s1~s8	d1~d9
儿童健康状况	各种儿童健康状况相关的身体结构与功能、活动和参与障碍	b1~b8	s1~s8	d1~d9
老年健康状况	各种老年健康状况相关的身体结构与功能、活动和参与障碍	b1~b8	s1~s8	d1~d9

策略类别	健康目标	主要指标	主要干预措施
预防类	预防健康状况	死亡率患病率功能障碍率	残疾预防
健康促进类	促进身心健康	活动能力	健康教育、健康管理
治疗类	控制改善疾病	患病率	心理治疗、社会工作、教学训练、康复咨询、职业康复
康复类	功能最大化	活动能力活动表现	心理治疗、社会工作、教学训练、康复咨询、职业康复
支持类	疾病控制心理和社会支持	健康质量	心理支持、家庭支持、社会支持、康复咨询
姑息类	提升生活质量和健康福祉	生活质量生活满意度	姑息康复、临终关怀、心理支持

分类	量表	工具	版本	应用说明
ICD	WHODAS 2.0	6大领域：认知、活动性、自我照护、与人相处、生活活动,以及参与及其对健康问题的影响	中文标准版	1.抽样调查应用 2.康复质控中心应用 3.制定疾病标准 4.制定病案首页
	MDS-B	2大评估项目：身体功能、活动和参与,可计算总的功能分数	中文标准版	1.编写临床手册 2.康复领域应用 3.制定病案首页
	VB40	7大领域：学习和应用知识、交流、主要生活领域、社区、社会和公民生活、精神功能、感觉功能和疼痛	基于ICF核心分类组合通用版	1.适用临床应用 2.制定病案首页
ICF	ICF核心分类组合	3大领域：身体结构与功能、活动和参与、环境因素	通用版、综合版、简明版	1.整体功能评估 2.整体功能结局评估

疾病	疾病诊断	ICD-11编码
脊髓损伤	颈段脊髓损伤功能平面	MB57.0
	胸段脊髓损伤功能平面	MB57.1
	腰段脊髓损伤功能平面	MB57.2
	骶段脊髓损伤功能平面	MB57.3
	其他特指的脊髓损伤功能平面	MB57.Y
	脊髓损伤功能平面,未特指	MB57.Z

身体结构和功能		活动和参与		环境因素
功能诊断	ICF编码	功能诊断	ICF编码	功能诊断	ICF编码
脊髓和有关结构	s120	进行日常事务	d230	个人消费用的用品或物质	e110
呼吸系统的结构	s430	控制应激和其他心理需求	d240	个人日常生活用的用品和技术	e115
泌尿系统的结构	s610	改变身体的基本姿势	d410	个人室内外移动和运输用的用品和技术	e120
各部位皮肤的结构	s810	移动自身	d420	公共建筑物用的设计、建设及建筑产品和技术	e150
能量和驱力功能	b130	手和手臂的使用	d445	私人建筑物用的设计、建设及建筑产品和技术	e155
情绪功能	b152	步行	d450	直系亲属家庭	e310
痛觉	b280	到处移动	d455	个人护理提供者和个人助手	e340
排便功能	b525	利用设备到处移动	d465	卫生专业人员	e355
排尿功能	b620	利用交通工具	d470	卫生的服务、体制和政策	e580
关节活动功能	b710	护理身体各部	d520
肌肉力量功能	b730	如厕	d530
肌张力功能	b735	吃	d550
皮肤的保护功能	b810	有报酬的就业	d850

物理治疗			作业治疗和言语治疗			中医治疗			物理因子治疗			辅具技术服务
干预内容	编码	收费项目	干预内容	编码	收费项目	干预内容	编码	收费项目	干预内容	编码	收费项目	干预内容	编码	收费项目
截瘫/四肢瘫物理治疗	93.39001	物理疗法	综合作业治疗/OT作业平台治疗	93.85001	职业技能康复训练	截瘫/四肢瘫针灸	93.35006	针灸	冲击波治疗	93.39005	冲击波治疗	适配服务	93.23001	矫形装置试装
功率自行车/机器人/四肢联动/智能康复训练				93.81001	娱乐疗法	智能电针治疗	93.35006	针灸	超声脉冲电导治疗/超声波治疗	93.35001	超声热疗法	适配服务	93.52001	颈托固定
等速肌力训练				93.82001	教育疗法	截瘫/四肢瘫推拿	93.39003	按摩手法治疗	湿热敷	93.35004	热疗	评估服务	93.02001	矫正评估
体位排痰引流				93.83001	文体活动疗法				半导体激光治疗	93.35008	激光照射治疗
斜板				93.89002	特殊工娱治疗				盆底肌训练	94.39001	生物反馈治疗
关节活动训练系统	93.25001	肢体强迫性牵伸训练		93.01002	手功能评估				电子生物反馈治疗	94.39001	生物反馈治疗
减重步行治疗/跑台训练	93.22001	行走和步态训练		93.71001	诵读训练				经颅磁刺激治疗	94.29001	重复经颅磁刺激
	93.24001	用拐行走训练	言语综合训练	93.72001	语言障碍训练				紫外线治疗	99.82004	局部紫外线照射
	93.11001	辅助运动训练		93.74001	言语缺欠训练				海特光治疗	99.83004	红光治疗
			呼吸训练	93.18002	呼吸训练				热敷	93.34001	透热疗法

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