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Indicator for Intervention
Background to the IFI Project
In 1998, the Commonwealth Department of Health (Casemix Branch) agreed to fund a project to develop a classification of patients of allied health service providers on the basis of their reason for seeking intervention. The National Allied Health Classification Committee (NAHCC), an Australian peak organisation for allied health on classification, terminology, casemix and clinical informatics, undertook preliminary research in this regard in the period July 1998 to August 1999, but was not funded to continue this work past this point. In 2005, interest in this project was reignited within the Department of Health and Ageing when it was considered that a clear allied health item in the data classification structure was needed to effectively record activity in the outpatient setting. This was seen to be a critical component within a larger data set being developed for outpatient departments across Australian health centres. This enabled NAHCC to revisit the original draft of the Indicator for Intervention (IFI) and further develop it.
Why develop the IFI Classification?
In emergency and inpatient care settings, information is collected regarding the reason for the patient's presentation and their current diagnosis. However, once referred to outpatient services, no standard means of classification exists to indicate what allied health services are provided and who receives these services. Collection of this data would help to understand the demand for specific outpatient services and to then understand what is needed to meet service demands. For example, the diagnostic group of dementia does not actually predict how much allied health intervention may be needed. It is more likely to be the current living circumstances of the patient or particular patient characteristics, rather than the specific type of dementia, or even its severity that predicts the type of allied health intervention needed. In contrast, IFIs focus on the characteristics of the patient behaviour and not the disease process.
What is the IFI?
An IFI indicates what the clinician believes is the most relevant issue of the patient/client that has led to the allied health service. Unlike the diagnosis, the IFI does not necessarily refer to one of the medical disorders or complex illnesses (e.g., ICD-10 or DSM-IV diagnoses), but is more likely to be one of the symptoms, behavioural characteristics or circumstances associated with a person for which allied health services are being sought.
For the IFI data set, the NAHCC has adopted a classification system developed by the World Health Organization (WHO, 2001) called the International Classification of Functioning, Disability and Health (ICF). The ICF was adopted as the basis for the IFI because it is an internationally recognised and validated classification system for coding functioning rather than diagnosis. The ICF has four components, which indicate the area of the problem: body functions, body structures, activity and participation, and environment. Within each of these components are sets of domains (called chapters), which relate to physiological functions, anatomical structures, individual tasks and actions as well as participation in different life situations. Qualifiers can be used to indicate the extent or severity of the problem. However, the IFI in its current form only uses the ICF code at a three-digit level and does not utilise the qualifier. The full set of ICF codes can be accessed at http://www3.who.int/icf/onlinebrowser/icf.cfm.
| Case Example 1: Peter - 10-year-old male
Peter's parents separated and divorced nine years ago. He often reports that he misses his older brother who lives with his father. He is defiant with his mother who cares for him. He does not complete schoolwork and, as such, is performing poorly in school. He has enuresis and encopresis and suffers from asthma. Peter's mother has requested support to help manage his defiance. IFI Allocated: b126 - Temperament and Personality Factors |
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Case Example 2: Wendy - 45-year-old female Wendy, recently diagnosed with breast cancer, reports tearfulness and lack of motivation on a daily basis. She is experiencing menopausal symptoms such as night sweats and poor sleep due to chemotherapy. She reports her mood becoming increasingly low and becomes very anxious before attending chemotherapy and has started to fear medical procedures. She has experienced at least one panic attack and is starting to avoid social situations due to embarrassment around her appearance. IFI Allocated: b152 - Emotional functions |
Benefits of IFI
If you work in an outpatient setting adjoined to a hospital, or a Community Health Centre you may be asked to adopt the IFI classification system in the future. The IFI has a number of benefits:
- IFIs will provide a standardised code-set for data collection and facilitate the analysis of resource use within and across allied health care settings.
- IFI's may be a good predictor of the clinician's involvement in care and, in turn, cost. As such, the IFI could become a major element in planning and budgetary considerations.
- By identifying a behaviour or set of symptoms (rather than a diagnosis) an IFI can permit the measurement of change.
- IFIs form part of a method for defining the value and input of allied health into the health system and community benefit as a whole.
- IFIs will also aid in the use of consistent codes and definitions across service sectors, therefore helping to enhance communication between service providers.
Who is responsible for developing the IFI?
The National Allied Health Classification Committee (NAHCC: www.nahcc.org.au) has been responsible for the development of the IFI. Since its conception in the 1990's, NAHCC has accomplished a number of important achievements including the development of a set of standard intervention categories for each allied health profession with whom they are involved, referred to as "a minimum data set". The APS representative on this committee is David Stokes, APS Manager of Professional Issues, who is also the current NAHCC chair.
The IFI Project 2005-2006
IFI project activities completed by December 2006 included:
- Development of a coding manual to help clinicians in identifying and coding IFIs. This manual was also developed to assist in overcoming some of the barriers identified in assigning IFIs.
- Creation of profession specific sets of IFIs.
- The development of a proposal for the education process, and piloting of the IFI data collection process.
Download Indicator for Intervention Coding Manual 
(497kb)
The IFI Project
The IFI project was started by NAHCC in 1998-89, and recommenced in 2005 with the Australian Psychological Society taking on the management of the project. Eleven allied health groups have been involved in the IFI development so far and will continue to be consulted until completion of the pilot project. The consultative allied health profession representatives group includes representatives from audiology, social work, exercise and sports science, psychology, dietetics, physiotherapy, orthoptics, orthotics and prosthetics, occupational therapy, speech pathology and podiatry.
The IFI Project 2005-2006
IFI project activities completed by December 2006 included:
- Development of a coding manual to help clinicians in identifying and coding IFIs. This manual was also developed to assist in overcoming some of the barriers identified in assigning IFIs.
- Creation of profession specific sets of IFIs.
- The development of a proposal for the education process, and piloting of the IFI data collection process.
IFI Project 2007
The next step for the project in 2007 is to promulgate the IFI codes to allied health representatives, to validate the IFI codeset through pilot testing and to finalise the Data Set Specification for Allied Health for submission to the Health Data Standards Committee.
At the end of 2006, a survey was conducted to develop a better understanding of the structure, current data collection processes, staffing and resources of allied health departments across Australia. The Allied Health Survey was sent to a number of hospitals across Australia to determine the data collection processes that occur for allied health professionals in public health settings and to identify the software and computer operating systems currently in use within these settings. This survey was conducted in order to identify the current data collection systems used by allied health professionals across Australia. There was a 52% response rate to this survey.
The majority (68%) of respondents worked within an Allied Health Department (made up of a range of allied health professionals), with most (58.5%) of these departments employing more than 10 allied health professionals;
- With regard to data collection processes, 36.6% collected profession-specific data, while 87.8% collected data at a departmental level and 63.4% at a hospital level;
- The large majority (95%) of respondents used electronic data collection systems;
- All allied health professions had access to computers and the internet.
Pilot Project
Currently, recruitment of allied health services to participate in a pilot study of the IFI coding system is underway, with five hospital services across Australia agreeing to participate so far.
On-line data collection system
An on-line data collection system, allowing fast and simple on-line entry of the IFI codes has been developed and trialled, along with the workshop for training of the allied health professionals who will participate in the IFI-coding pilot project. The workshop and data collection system were trialled with a total of 26 allied health professionals from a range of professions from one Melbourne, and one Adelaide hospital site. These trials proved useful in finalising the details of the software and the training, with positive feedback being received in regard to the IFI project and its utility, the training, and the software.
On-site IFI support person
To assist in the running of the IFI project, an on-site IFI project support person will be recruited from the allied health participants, who will remain in regular contact with the IFI Project team. The support person will be the contact for participating allied health staff at that site, and will provide training in the IFI coding and data entry for new staff. This person will have their clinical position backfilled to 0.4EFT to cover their usual workload.
Further updates of the project's progress will become available on this website on a regular basis.
Future updates and further information
Upcoming updates will include:
- A link to the on-line data collection system
- A list of participating hospitals and health services
- A list of participating allied health professions.
Further details on the IFI can be found using the links below.
Report on the Development of Allied Health Indicators for Intervention (IFI) and Performance Indicators (PI) and Revision of Allied Health-sensitive ICD-10-AM codes for inclusion in ICD-10-AM. (Edition Two)
www.nahcc.org.au
International Classification of functioning, disability and health. (WHO, 2001).
An on-line summary is available, or the full report can be purchased at: http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=2088
National Allied Health Classification Committee (NAHCC) IFI Project:
Background Document (36kb)
Indicator for Intervention Coding Manual
Download manual (497kb)
