The International Classification of Impairments, Disability, and Handicap

1
The International Classification of Impairments,
Disability, and Handicap

• Body functions and structure
• Defined as the physiological functions of body
  systems and anatomical parts of the body
• Impairments are problems or limitations in body
  functions and structures
• Examples range of motion, balance, strength,
  sensory abilities, etc.
• In the OPPM model, impairments are classified as
  client factors...

2
ICIDH-2 (continued)

• Activity is defined as the performance of a task
  or action taken by an individual
• Activity limitations are difficulties encountered
  in the performance of activities
• Examples walking, ADL, leisure activities
• In the OPPM, activities are a combination of
  occupations, performance skills, and activity
  demands

3
ICIDH-2 (continued)

• Participation refers to an individuals
  involvement in life situations
• Participation restrictions are problems with the
  manner or extent of involvement in life
  situations
• Participation in the OPPM is referred to as
  engagement in meaningful occupations in context
  or contexts

4
In both the ICIDH-2 and OPPM...

• The important outcome is participation
• Performance skills and activity limitations may
  or may not impact on participation
• The focus of occupational therapists needs to
  move beyond body function and body structure
  concerns to participation in meaningful
  occupations

5
For example, clinicians often focus on changes in
range of motion and strength without concern how
these changes may or may not affect occupational
performance and ultimately, participation in real
world settings
6
Considerations of Outcomes or Economic
Evaluation
7
The earlier question - Does what you do produce
results?

• The current question - Do the results that you
  produce make a difference?

8
Economic Evaluation

• Do the services we provide reduce or
• compensate for disability?
• Do these services result in a higher quality
• of life?
• Which services produce the best results in
• the least amount of time with the least
• resource consumption?
• Do the outcomes attained through these
• services hold down the overall costs of health
  care?

9
Four Considerations

• Effectiveness
• Efficiency
• Quality
• Value

10
Effectiveness1) procedures which most
accurately and consistently define impairments
and disabilities2) procedures which produce the
expected increase in functional status most
consistently
11
Efficiency1) treatment that is absolutely
necessary2) takes the least amount of time to
identify, define, andtreat impairments and
disabilities
12
Quality1) Procedures which are most specific
and effective to a diagnostic group2)
procedures which have the highest correlation
with greatest functional gains3) procedures
which require the least frequency, intensity, and
duration of treatment and which have the greatest
durability
13
Value1) greater ability of patientsto
participate after treatment2) highest patient
satisfaction3) holds down costs
14
How are charges for occupational therapy services
arrived at? What is taken into consideration
when deciding upon amounts?
15
Activity

• Break into your groups
• Make a list of factors that affect charges for
  occupational therapy service units in an
  inpatient rehabilitation setting
• Consider these factors, and list them in order of
  most important to least important in their impact
  on OT costs

16
Types of Economic Evaluations

• Cost consequences
• Cost minimization
• Cost effectiveness
• Cost utility
• Cost benefit analysis

17
Cost Consequences Analysis

• An analysis used to describe a health service OR
  to compare 2 or more health interventions
• Requires a profile of costs and outcomes of
  interventions (impact on health and on economic
  status of client) under study

18
Cost Minimization Analysis

• An analysis used to identify the cheapest
  alternative when two or more services produce the
  same outcome
• Requires evidence from the literature must be
  produced indicating both services produce the
  same outcome

19
Cost Effectiveness Analysis

• Used to compare costs and outcomes of two or more
  services
• Services must produce the same kind of outcome
• Used to study the value of each option since both
  have the same targeted outcome

20
Cost Utility Analysis

• Used to compare two or more services that produce
  different kinds of outcomes
• Consider the health status and value of that
  status to the client when evaluating outcomes

21
Cost Benefit Analysis

• Used to compare two or more services that produce
  different kinds of outcomes
• The researcher must measure and compare the
  values of outcomes

22
Remember value??

• 1) greater ability of patients to participate
  after treatment2) highest patient
  satisfaction3) holds down costs

23
So where does all this fit into evidence-based
practice?
24
Consider the articles you have found so far.

• Effectiveness
• Efficiency
• Quality
• Value

25
Which of the articles you have reviewed capture
any of the four elements mentioned? (slide 10)
26
How can you use the evidence you have generated
to date to support any of the 4 issues discussed
and their relationship to economic issues in OT?