Incorporating the International Classification of Functioning, Disability, and Health (ICF) into an electronic health record to create indicators of function: proof of concept using the SF-12.
OBJECTIVE
The purpose of this proof-of-concept study was to assess the feasibility of using a generic health measure to create coded functional status indicators and compare the characterization of a stroke population using coded functional indicators and using health-related quality-of-life summary measures alone.


METHODS
Multiple raters assigned International Classification of Functioning, Disability, and Health (ICF) codes to the items of the 12-Item Short Form Health Survey (SF-12). Data for comparing the information from the SF-12 and from ICF codes were derived from the Montreal Stroke Cohort Study that was set up to examine the long-term impact of stroke. Available for analysis were data from 604 persons with stroke, average age 69 years, and 488 controls, average age 62 years.


METHODS
The SF-12 provides two summary scores, one for physical health and one for mental health. Domains of the ICF are coded to three digits, before the decimal; specific categorizations of impairments, activity limitations, and participation restrictions are coded to four digits before the decimal.


RESULTS
Persons with stroke scored, on average, approximately 10 points lower than controls on physical and mental health. The ICF coding indicated that this was attributed, not surprisingly, to greater difficulty in doing moderate activities including housework, climbing stairs, and working and was not attributed to differences in pain. Differences in mental health were attributed most strongly to greater fatigue (impairment in energy), but all areas of mental health were affected to some degree.


CONCLUSIONS
The ICF coding provided enhanced functional status information in a format compatible with the structure of administrative health databases.
Mayo
Nancy E
NE
Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada. nancy.mayo@mcgill.ca
Poissant
Lise
L
Ahmed
Sara
S
Finch
Lois
L
Higgins
Johanne
J
Salbach
Nancy M
NM
Soicher
Judith
J
Jaglal
Susan
S
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007182:Income; D038801:International Classification of Diseases; D008297:Male; D016347:Medical Records Systems, Computerized / Q000145:classification*; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D012044:Regression Analysis; D012737:Sex Factors; D018434:Sickness Impact Profile; D020521:Stroke / Q000145:classification*; D018875:Vocabulary, Controlled