听力干预措施在国际健康干预分类中的表示与区分

文献信息

中文摘要

背景： 标准化的干预编码有助于服务可见性、报销、资源规划和卫生系统分析。国际健康干预分类（ICHI）为表示健康干预提供了标准化框架，但其捕捉当代听力学实践广度和临床特异性的能力需要评估。
目的： 评估当代听力学干预在ICHI中可被表示和区分的程度，并识别可能影响健康信息管理、服务报告和报销的编码粒度局限性。
方法： 从历史和当前的南非收费表、执业范围文件、大学课程和当代临床实践中提取听力学干预清单。共105项干预措施，涵盖听力和前庭评估、电生理、设备相关操作以及咨询和康复，使用与目标-行动-手段框架一致的结构化编码规则独立映射至ICHI。对预定义子集计算评分者间一致性。
结果： 所有纳入的干预措施均可在ICHI中表示。大多数（92.3%）与ICHI主干代码显示直接一对一对应。其余需要近似（“最佳匹配”）、后协调或使用多个描述符和/或扩展代码的复合编码。临床不同的干预措施经常在相同主干下汇聚，尤其是在康复、咨询、设备管理和远程听力学方面。这种汇聚降低了编码粒度以及对临床意图、服务复杂性和资源利用的区分。
结论： ICHI对当代听力学干预提供了广泛的结构覆盖；然而，有限的粒度限制了其在详细卫生系统报告、报销建模和服务评估中的效用。需要在康复和技术相关类别中增加区分度，以更好地表示当代听力学实践，并在全民健康覆盖框架内支持以人为本的耳和听力保健。对健康信息管理实践的意义：高层级ICHI主干可能掩盖听力学服务中具有临床意义的差异，降低资金、工作量测量、服务评估和国家报告的数据精度。实施指南和标准化复合编码协议可在现有主干不足时提高特异性。已识别的分类差距可为向世界卫生组织国际分类家族网络正式提交提供信息。提高特异性可加强互操作性、二次数据分析、报销建模和循证听力保健规划。

英文摘要

BACKGROUND: Standardised intervention coding supports service visibility, reimbursement, resource planning and health-system analytics. The International Classification of Health Interventions (ICHIs) provides a standardised framework for representing health interventions, but its ability to capture the breadth and clinical specificity of contemporary audiology practice requires evaluation.
OBJECTIVE: To evaluate the extent to which contemporary audiology interventions can be represented and differentiated within ICHI and identify limitations in coding granularity that may affect health information management, service reporting and reimbursement.
METHOD: An inventory of audiology interventions was derived from historical and current South African tariff schedules, scope-of-practice documents, university curricula and contemporary clinical practice. A total of 105 interventions spanning hearing and vestibular assessment, electrophysiology, device-related procedures, and counselling and rehabilitation were independently mapped to ICHI using a structured coding rubric aligned with the Target-Action-Means framework. Interrater agreement was calculated for a predefined subset.
RESULTS: All included interventions could be represented within ICHI. Most (92.3%) demonstrated direct one-to-one alignment with an ICHI stem code. The remainder required approximate ('best-fit'), postcoordination, or composite coding using multiple descriptors and/or extension codes. Clinically distinct interventions frequently converged under identical stems, particularly within rehabilitation, counselling, device management and tele-audiology. This convergence reduced coding granularity and differentiation of clinical intent, service complexity and resource utilisation.
CONCLUSION: ICHI provides broad structural coverage of contemporary audiology interventions; however, limited granularity constrains its utility for detailed health-system reporting, reimbursement modelling and service evaluation. Greater differentiation within rehabilitation- and technology-related categories is warranted to better represent contemporary audiology practice and support person-centred ear and hearing care within universal health coverage frameworks.Implications for health information management practice:High-level ICHI stems may obscure clinically meaningful variation in audiology services, reducing data precision for funding, workload measurement, service evaluation and national reporting. Implementation guidance and standardised composite coding protocols may improve specificity where existing stems are insufficient. Identified classification gaps may inform formal submissions to the World Health Organisation Family of International Classifications Network. Improved specificity could strengthen interoperability, secondary data analytics, reimbursement modelling, and evidence-based hearing-care planning.