International classification of treatment methods in medicine

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The International Classification of treatment methods in medicine (English I nternational C lassification of P rocedures in M edicine is) a procedure classification in medicine.

Goal setting

The classic application of medical classifications seems to be to improve cost and performance transparency. That would be a purely administrative objective.

What is mostly overlooked, however, is that the original objective was to improve the quality of medical service and to control clinical processes (Fetter, Thompson 1967).

Application in Germany

According to current guidelines, medical care measures must be designated according to the given classification. These classifications refer to the diagnosis and therapy- oriented case groups ( DRG ). Results of the accompanying research on the application of the DRG are available on 895 pages for the period 2004–2006. The aim was to improve the quality of inpatient care (p. 5, p. 9). The aim was also the incentive to change the organization, whereby the organizational structure and the process organization were targeted (p. 4, p. 48).

Results of the procedure

The coding is carried out in diagnoses according to ICD and with procedures according to OPS in the currently valid version (p. 79). Between 2 and 3 therapeutic procedures per case are recorded (p. 105) and the number of procedures is conspicuously below the number of diagnoses. Thus, the multitude of introductory diagnostic procedures and the care procedures accompanying the stay are neither recorded in terms of type nor diversity. This was only deviated from for intensive medical complex treatment for performance documentation from 2005/2006 (p. 205, p. 228). An increase in the total administrative expenses of all hospitals is found overall (p. 678).

It can thus be seen that the introduction of the procedure code for the administrative processes has increased costs overall.

Results on quality

Only slight improvements or no worsening of the process and result quality were achieved (p. 17) or their improvement is assumed (p. 18: "... should have had positive effects on quality."). An improvement in the structural quality was not recognized (p. 18). Apart from evaluations of statistical material (p. 17), only surveys were carried out (p. 18). Overall, it is claimed that there is extensive knowledge about quality (p. 19). For the future it is expected that there will be significant improvements in quality (p. 76). Changes in the qualitative satisfaction of hospital staff cannot be demonstrated (p. 140). Aspects of the quality of care were not evaluated (p. 140). Aspects of the qualitative satisfaction of the patients were completely excluded (p. 140). Corresponding considerations on medical quality features can be found in great detail (pp. 369–413).

It can thus be seen that the introduction of the procedure key remained rather insignificant for process quality.

Results for process organization

Incentives to improve economic litigation were achieved through the generalization with a 3-4 times higher value than incentives for an improvement in quality (p. 154ff). The scope of the changes in the process organization due to changes in information technology and changes in controlling are each 12 times higher, and with regard to the change in interdisciplinarity even four times higher than the change in the structure of medical work (p. 155ff). The corresponding investments in information technology were used, for example, due to the required accounting methodology (55.4%) and to improve the quality of services (24.3%) (p. 158). A clear differentiation from other causes was not possible (p. 415, p. 651). There is no clear understanding of an improvement in the process organization (p. 566). For example, it is stated that only 23% of hospitals have implemented at least one clinical pathway (p. 693).

It can thus be seen that the introduction of the procedure keys for the organization of the medical processes remained rather insignificant.

history

The ICPM was first published by the World Health Organization (WHO) in 1978 and forms the basis for many procedure classifications (extended and modified in many countries) and thus represents the framework for national extensions. The Dutch ICPM-DE was ultimately the basis for the German one Modification of the ICPM: Operation and procedure key (OPS) (previously: Operation key according to §301 SGB V, OPS-301). The maintenance of the ICPM was suspended by the WHO in 1989 because results from the project “Galen-in-Use” were expected and insufficient resources were available for the international coordination of a revised version.

Meanwhile, the [WHO] is developing a new classification system, the “ International Classification of Health Interventions ” (ICHI) based on the Australian ICD-10-AM.

There are also national procedural classifications without reference to ICPM, for example the Australian ICD-10-AM, the French CCAM and the US PCS.

See also

(German)

(English)

literature

  1. ↑ Archive link ( Memento of the original from March 16, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. .  @1@ 2Template: Webachiv / IABot / www.g-drg.de
  2. ↑ Thompson JD, Fetter RB, Mross CD .: Case mix and resource use. Inquiry. 1975 Dec; 12 (4): 300-12.
  3. ↑ Archived copy ( Memento of the original from May 22, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.g-drg.de
  4. ^ Meeting of Heads of WHO Collaborating Centers for the Classification of Diseases, Copenhagen, 14-20 Oct 1999: PDF
  5. ↑ International Classification of Health Interventions (ICHI): [1]

Portals

Germany

International

Australia

United States