Invited Commentary

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.

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.