I congratulate Dijkers and colleagues for their summary of work in progress toward a rehabilitation taxonomy.1 As Thomas Mann said, “Order and classification are the beginning of mastery, whereas the truly dreadful enemy is the unknown.”2 So it follows that ordering and classifying various elements of health and health systems is a way to understand and manage the complexity. The World Health Organization (WHO) under its constitution is required to “establish and revise as necessary international nomenclatures of diseases, of causes of death and of public health practices.”3 In undertaking the remit, WHO has developed a family of international classifications (World Health Organization Family of International Classifications [WHO-FIC]).4 The WHO-FIC is a suite of classification products that, when used together, cover various aspects of health information systems. The International Classification of Diseases (ICD)5 and the International Classification of Functioning, Disability and Health (ICF)6 are established classifications. Missing has been the third reference classification recognized in the family, the International Classification of Health Interventions (ICHI). Since 2007, there have been concerted efforts to develop the ICHI. This commentary will explore the possible links between the internationally endorsed classifications and the proposed rehabilitation treatment taxonomy (RTT).7
Interventions Classification
To date, international and national classifications of health interventions, such as the International Classification of Procedures in Medicine8 and the International Classification of Diseases, Clinical Modification (ICD-9-CM)9 have tended to focus on high-profile, high-cost medical, surgical, and diagnostic interventions accessed by limited sections of the population. Interventions delivered in public health, rehabilitation, and community settings are less well defined and rarely measured and reported to the same extent. The policy implications are that those interventions measured and reported are valued and funded, whereas lower-cost interventions with the potential to benefit broad areas of the population receive less attention. The ICHI will provide a basis for collecting, analyzing, and reporting on the full range of health interventions. Thus, the ICHI has the potential to support evidence building for rehabilitation relevant interventions.
Purposes
The purpose of the RTT is to describe and evaluate the clinical practice of rehabilitation using a discrete and detailed set of treatments. Treatments, as a subset of health interventions, lie within the scope of the broader ICHI. The elements of rehabilitation practice that are purposely excluded from the RTT, such as diagnostic interventions, may also be found in chapters of the ICHI.10
The purposes of the ICHI are to provide a classification of appropriate scope and detail for use by countries without a national classification of health interventions, to provide a base that can be extended to develop more finely grained national or specialty classifications, to establish a framework for comparisons of the use of health interventions in different countries, to provide a building block for international case-mix development, and to avoid duplication of effort at a national level.
Similarities and Differences
Both the proposed RTT and the ICHI are intended for collecting information on health interventions consistently and reliably. Both have a tripartite structure with each intervention described in terms of an entity on which the intervention has an effect, an action, and an operational entity. The axes and their definitions are shown in the Table. Both the RTT and the ICHI use the ICF to inform the classification and are profession and setting neutral. As such, it would be desirable if the ICHI could provide the “backbone” for the more finely grained RTT. Although fine-grained information is appropriate for clinical and clinical research purposes, aggregation to broader categories is required for statistical and administrative purposes. Collecting data once and using it for multiple purposes is desirable and would be feasible if the RTT were to relate to the ICHI.
Tripartite Structures of the International Classification of Health Interventions (ICHI) and the Rehabilitation Treatment Taxonomy (RTT)
The groupings of treatment categories described in the RTT reflect the influence of the ICF. The treatments that alter the structure of tissues relate to the body structure component of the ICF; likewise, the treatments that alter or replace functions relate to the body functions component. Skilled performances relate to the life areas classified in the activities and participation component. In the ICHI, the actions that apply to the life areas are different for skilled performances and for the acquisition and interpretation of knowledge. Analysis of the ICHI interventions according to the RTT groupings could be done. The knowledge arising out of such an exercise has the potential to benefit both projects.
Intervention classifications enable the definition and subsequent monitoring of the range of interventions provided across the continuum of health services, and thus the ability to evaluate the respective contributions toward the health of individuals and populations of preventive, primary, acute, rehabilitation, and palliative and support services. The interventions generally, but not exclusively, used by rehabilitation providers will be able to be defined and reported such that the role and efficacy of individual professions within multiprofessional and interprofessional teams can be identified.
Conclusions
In view of the common aims and similarities between the 2 classification products and the significant resources required to develop and maintain a national classification for a single sphere of practice, I would encourage the developers of the RTT to join the international collaborative team in the development of an ICHI that meets the needs of rehabilitation providers.
Footnotes
The author thanks Richard Madden from the National Centre for Classification in Health, University of Sydney, who has led ICHI development, and all members of the ICHI development team; it is their combined thoughts and efforts that underpin this commentary.
- © 2014 American Physical Therapy Association