Core Content Classification of GP/FM
3C GP/FM
Attempt to classify main descriptors of GP/FM job. Proposal for a new classification
1
Marc Jamoulle, md, mph.
GP & Health data management specialist
Researcher, Dep. of General Practice, UCL
Wonca Europe 2007
Friday 17 Oct. 2007
But only clinical
Family doctor work area and work load need specific descriptors
ICPC is great
2
Global description of activity, skills and knowledge
Classification complementary to ICPC
Descriptors for indexation
Main axes of training for undergraduate and vocational
GP/FM needs
3
Examples
Journal watch indexing
Grey production retrieval
Internet sites indexing
Wonca abstract archives
Teaching program evaluation
GP/FM needs
4
Specific tool design evolution
5
1987 : Q CODES (Lamberts)
2005-6 : Metaclinical WICC Heidelberg De
2007 : 3C GP/FM WICC Dunedin NZ
6
Q-CODES (level 1)
Amsterdam (+/- 1987) Dep of gen practice. Prof Lamberts
Used for manual indexing. Translated in French (mj)
Q0 Care process (patient linked )
Q1 Care process (not patient linked )
Q3 Support task
Q4 Personal functioning
Q5 Patient’scategories
Q6 Research
Q7 Teaching
Metaclinical (MJ 2005)
7
• All those items aim to describe the content of
GP/FM in its non clinical approach.
• They constitute meta-information on the way the
clinics and the patient doctor relationships are
driven.
Patient issues
Provider’s issues
Structure of practice
Patient’s categories
Hazards
Ethics
Training, teaching
R & D tools
2007 8 domains 3C GP/FM Core Content Classification of GP/FM
8
QP Patient
QD Doctor
QS Structure
QC Categories
QH Hazards
QE Ethics
QT Knowledge
QR Research
Patient’s issue
Provider’s issue
Structure of practice
Patient’s categorie
Hazard
Medical ethic
Training, teaching
R & D tool
Other
9
QP Patient
QD Doctor
QS Structure
QC Categories
QH Hazards
QE Ethics
QT Knowledge
QR Research
QO Other
3C GP/FM
10
Domain Knowledge Management QT
Categories Training QT4
Sub categories Trainers & Supervisors
QT43
Age groups QC1 Gender issues QC2 Social high risk QC3 Addiction QC4 Assault QC5
Patient's categories QC
11
battered women QC51
victims of abuses QC52
torture QC53
ritual mutilations QC54
Assault QC5
12
Teaching QT1 Training QT4 Quality assurance QT5 Editing QT6 Reporting QT7
Knowledge management QT
13
Undergraduate QT41
Vocational training QT42
Continuous medical educ. QT43
Supervision & Balint QT44
Trainers and supervisors QT45
Academics QT46
Training QT4
14
Exercise with Medline
15
Methods:
Choice of medline abstracts: one descriptor with several limits
to get a little number of abstracts to analyse
"family practice"[MeSH Terms]
Limits: only items with links to full text, only items with
abstracts, English, published in the last 3 years, Humans,
Core clinical journals Review: 39 items
Each content of abstract is compared to the metaclinical
classification and correspondences are searched.
Aim: pre test, to compare content of Medline abstract related
to GP/FM with the concepts of metaclinical classification
Exercise with Medline
16
Analysis
Thenumberof“healthissuemanagement”
(QD33) is wondering 29/39
This give an insight on the way the indexing
process is done in Medline under the
Descriptors“review”and“family practice”
This Pretest has been edited by MJ April 15, 2007
Available at http://docpatient.net/class/meta.html
Direct acces to reviewer screens
Copy of 998 abstracts in a database
Indexing by
max 3 codes of 3CGP/FM
max 3 codes of ICPC-2
Indexing Wonca Europe 2007 abstracts
17
Special thanks to
Bernard Gay, Hector Falcoff, Michele Lieurade
Anne Marie Magnier and Madeleine Favre
for helping me
And to Tarik Jamoulle for copying the abstracts
18
Ecranwonca2007avec1paged’abstractsàinsererici
19
Ecran wonca 2007 avec 1 abstract à inserer ici
Some abstract titles seems meaningfull adn enough to make the codes easily
Coding process
20
# 1344 The prevalence of asthma in rural areas in Crete
is similar to that of urban areas QR2
Epidemiology
QS11
Setting (incl rural)
• Reading abstract add information
QC12
Children
R96
Asthma
Coding process after reading abstracts
21
# 1373 Yearly influenza vaccination of elderly:
when do the French GP vaccinate?
QR42
Research network
QC14
Ageing R44
Vaccination
Influenza
Referent with definition, incl, excl. VOCATIONAL TRAINING APPRENTICESHIP TRAINEE
Concept VOCATIONAL TRAINING Knowledge interpretation
Representation
QT42
Stands for
{
Back from codes to abstract
23
QD14 : QD : Provider QD1 Communicator QD14 : systemic
QC13 : QC : Patients categories QC1 : age groups QC13 : adolescents
QC34 : QC : Patients categories QC3 : Social high risk QC 34 : in jail
P ; chapter P : psychological
Lack of family support in the responsibility of the mental disorder in jail
adolescents
+
+
+
=
Poster # 639
Examples of concepts added during the abstract indexing
24
•Patient views QP4
•Patient appraisal QP41
•Patient satisfaction QP42
•Patient knowledge QP43
•Patient autonomy/dependency QP44
•Patient cultural background QP45
•Patient expenses QP46
•Patient health habits QP5
•Nutrition QP51
•Sexuality QP52
•Self care & hygiene QP53
Examples of some other concepts added during the Abstract indexing
25
• ritual mutilations QC54
• Confidentiality QE41
• Informed consent QE42
• Pharmacoepidemiology QR21
• Community health QR22
Analyse and presentation of the content of the base
Elaboration of the project of a knowledge base
Results
998 Abstracts ; types distribution
671; 67%
289; 29%
39; 4% Poster
Oral
Workshop
{
ICPC coding on 872 abstracts
1036 coding but some clusters
768 in chapters
168 in Process codes
28
One ragbag:
chronic kydney disease
(CKD) U88/U99
diabetes T89/T90
overweight T82/T83
skin cut and inj S18/S19
airways obstruction R95/R96
anxiety P02/P74
HTA K86/K87
mouth D19/D20
chronic and acute K74/K75/76
chronic ischaemic K74/K75
All medicine late effects
A84/A85/A86/
A87
metabolic
syndrome T99
First results with simple excell db
Process codes ; Mainly drugs. Surprising 48
29
129
5 7 83
8
20
1
70
2 2 1 1
31 33 34 37 39 40 41 44 48 50 51 52 53 59
Process codes
872 abstracts
103
18
28
6 3
130
33
17
183
120
10
179
1824 24
7
42
A B D F H K L N P R S T U W X Y Z
998 abstracts, ICPC chapters distribution
P
Z
T
B
4
16
39
70
infants children ados ageing
QC11 QC12 QC13 QC14
About age categories : on 990 abstracts
4
28
62
16
24
0 20 40 60 80
Nutrition
Obesity
Diabetes
Hyperlipid
Metabolic S.
Opening of T chapters
19
12
18
28
33
4
UNSP.PSY
ANXIETY TR.
ALCOHOL
NICOTINE
DEPRESSION
BURNOUT
Opening of P chapter
197
643
16 3
151 162
405
QC QD QE QH QP QS QT
8 main domains 3CGP on 998 abstracts
Wonca Paris 2007
1
51
184
88
75
3
Genetic issue
Outcome
Health issue
assesm.
Health issue
management
Health risk
management
Care
management
Care manager (QD3 to QD35)
R & D
1
91
20
101
17
56
19
27
Science philosophy
Epidemiology
Functional status
Research methods
Classification
Scales & Questionnaires
Health economy
PHC planification & organisation
0 20 40 60 80 100
Pharmacoepid.
Communityhealth
of which of which
0 10 20 30 40 50 60
Qualitative
studies
Research
netw orks
NETWORK SENTINEL EVENT REPORT
QR42 QT71 QT73
49
13
8
NP I II III IV
QD4 QD41 QD42 QD43 QD44
51
2819
5 6
kkk
About Prevention
Tree communications with erroneous concepts of
secondary prevention
Secondary prevention of ischemic
cardiopathy in primary care 1020
Secondary cardiovascular prevention: Is
there a correlation between patients’
awareness of high cardiovascular risk and
treatment outcomes?
337
Secondary prevention therapies in patients
with coronary heart disease 127
Prevention term following time frame concept only
Secondary used for consecutive to
Such vocabulary issued from Specialist care and
Pharmaceutical Cies
44
14
38
11
8
4
32
9
QA METHODS
EBM
GUIDELINES
CRIT. READING & REVIEW
PEER REVIEW
ACREDITATION
PRACT. ASSESMENT
DEVICE ASSESM.
Quality QT5 to QT57 (160 16%)
8
11
5
1
3
DIST LEARNING
ONLINE EBM
e-PATIENTS
ONLINE HIS
TELEMEDECINE
Opening of QT62 (On line)
42
Wonca abstracts Paris 2007
on 871 indexed abstracts
13
26
17
3
8
3
0
5
10
15
20
25
30
1
QT41 student QT42 VT QT43 CME
QT44 trainers QT45 superv QT46 academ
QT4 domain (Training) distribution
5
12
22 22
5
2 1
DE
MA
ND
AP
PR
AIS
AL
SA
TIS
FA
CT
ION
KN
OW
LE
DG
E
AU
TO
NO
MY
CU
LT
UR
AL
EX
PE
NS
ES
QP40 QP41 QP42 QP43 QP44 QP45 QP46
DISTRIBUTION OF PATIENT’S VIEWS QP4
{
1
11
0
1
0
2
4
6
8
10
12
Ethnicsubgroups
Migrants &refugees
Homeless In jail
SOCIAL HIGH RISK (on 998 abstracts)
First results with simple excell db
example of QC32 : migrants
On 23 occurences
ICPC associated codes
45
Violence Z25
Health care access Z10
Litteracy Z07
Poverty Z01
W78
Pregnancy W78
Diabetes NID T90
Diabetes T89/T90
Nutrition T
Acute stress P74
Alcohool P15
Psycho P
HIV B90
influenza A80
Infect dis others A78
Tuberculosis A70
Risk others A23
4 Z
2 W
3 T
3 P
1 B
5 A
Blood analysis B34
immunization A44
Imaging *41
chapters process
First results with simple excell db
example of QC32 : migrants
On about 800 abstracts :
23 occurrences
48 other Q codes associated
46 1 Scales & Questionnaires QR6
1 Functional status QR3
1 Epidemiology QR2
2 Nutrition QP51
1 Patient knowledge QP43
4 Acceptab. of health care QP33
3 Accessib. of health care QP32
1 Availability of health care QP31
1 Ethics QE2
3 Prevention QD35
5 Health issue assessment QD33
2 Health issue managem. QD32
1 Health risk assessment QD31
2 A & E QD27
1 battered women QC51
1 Women’shealth QC22
But
No Reproductibility
Not all domains
Not all categories
No error control (ex QT2 and QT3 missing in the code list)
One man show
Utility of 3CGP/FM looks evident
47
Little scientific value
Methods Funds and grants?
Bibliography on the subject
Structure of the classification
Domain, cat, sub cat, definitions, excl, incl.
Database appropriation
Online testing using GP productions
Evolutive product
Open minded (open document – free & controlled acces)
48
Proposal to the WICC ;
plan & develop 3CGP/FM
Now, let we see how to use 3CGP/FM and ICPC as indexing tool for Wonca e-archive knowledge base