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(MDSB)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。WHOFICs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。
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 biopsycho-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(MDSB)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.
作者
姜静远
邱卓英
王国祥
邱服冰
杨剑
李安巧
马洪卓
朱婷
王梅
孙宏伟
陈迪
黄秋晨
郑洁皎
张鸣生
石秀娥
唐涛
许涛
张爱民
吴弦光
刘巧云
肖晓飞
井淇
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 Jiejiao;ZHANG Ming-sheng;SHI Xiu-e;TANG Tao;XU Tao;ZHANG Ai-min;WU Xian-guang;LIU Qiao-yun;XIAO Xiao-fei;JING Qi(School of Physical Education and Sport Sciences/Exercise Rehabilitation Research Center,Soochow University,Suzhou,Jiangsu 215021,China;China Academy of ICF,Weifang,Shandong 261000,China;WHO-FIC Collaborating Center in China,Beijing 100068,China;Research Institute of Rehabilitation Information,China Rehabilitation Research Center,Beijing 100068,China;Research Institute of Rehabilitation Information,China Rehabilitation Sciences Institute,Beijing 100068,China;Department of Physical Education,Shenzhen University,Shenzhen,Guangdong 518060,China;Key Laboratory of Health Evaluation and Sport Intervention of Ministry of Education,School of Sport and Health,East China Normal University,Shanghai 200241,China;Longgang School of Special Education,Shenzhen,Guangdong 518100,China;Institute of Health Sciences,Wuhan Sports University,Wuhan,Hubei 430079,China;Department of Physical Therapy,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Guangdong Institute of Geriatrics,Guangdong Academy of Medical Sciences,Guangdong Provincial People's Hospital,Guangzhou,Guangdong 510080,China;Rehabilitation Center Hospital of Gansu,Lanzhou,Gansu 730000,China;Rehabilitation Hospital of Sichuan Province,Chengdu,Sichuan 611130,China;Department of Rehabilitation Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;Department of Rehabilitation Sciences,East China Normal University,Shanghai 200333,China;School of Rehabilitation Medicine,Binzhou Medical University,Yantai,Shandong 264003,China)
出处
《中国康复理论与实践》
CSCD
北大核心
2020年第11期1241-1255,共15页
Chinese Journal of Rehabilitation Theory and Practice
基金
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)(No.2018CZ-4)
国家社会科学基金项目(No.19BTY125)。
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
World Health Organization Family International Classifications
rehabilitation services
International Classification of Diseases
International Classification of Functioning,Disability and Health
International Classification of Health Intervention
