ICF and casemix models for healthcare funding: Use of the WHO family of classifications to improve casemix

摘要

Purpose: Casemix models for funding activity in health care and assessing performance depend on data based on uniformity of resource utilisation. It has long been an ideal to relate the measure of value more to patient outcome than output. A problem frequently expressed by clinicians is that measures of activity such as Functional Independence Measure (FIM) and Barthel Index scores may not sufficiently represent the aspirations of patients in many care programs. Method: Firstly, the key features of the International Classification of Functioning, Disability and Health are outlined. Secondly, the use of ICF dimensions in Australia and other countries is reviewed. Thirdly, a broader set of domains with potential for casemix funding models and performance reporting is considered. Results: In recent years, the ICF has provided a more developed set of domains against which outcome goals can be expressed. Additional dimensions could be used to supplement existing data. Instances of developments in this area are identified and their potential discussed. Conclusions: A well-selected set of data items representing the broader dimensions of outcome goals may provide the ability to more meaningfully and systematically measure the goals of both curative and rehabilitation care against which outcome should be measured. More information about patient goals may be needed. Implications for Rehabilitation Casemix models for funding and outcome analysis of healthcare rely on accurate and complete data to classify the complexity and costliness of the care required. The International Classification of Functioning, Disability and Health-ICF has been developed to provide better developed domains of function that include activity and participation. Goals of the patient are an important aspect of the participation domains. Inclusion of activity and participation domains in casemix analysis is likely to improve the performance of casemix tools and better categorise care needs and resource requirements of particular rehabilitation case types.